Two of our top docs discuss mental health in young athletes and how to emphasize the positive…especially when there’s an injury.
Dr. Sue Griffith and Dr. Michelle Horn are on the front lines, so to speak.
Dr. Griffith is an orthopedic surgeon who specializes in pediatric orthopedics. Dr. Horn specializes in sports medicine and concussion management. Over the years, they’ve treated thousands of sports-related injuries. And they are increasingly concerned by the dual rise in pressure and mental health issues in young athletes.
So, they asked for a forum to share their insights on sports, mental health, and how parents and coaches can help young athletes reap the benefits of sports – physically, mentally, and emotionally – even when there is an injury.
Here are excerpts from our wide-ranging discussion.
(If your child has suffered a sports injury or is struggling with a chronic injury or pain, contact us at 215-348-7000 for a comprehensive evaluation, diagnosis, and treatment plan.)
You are both doctors, athletes, and parents, can you describe your multi-faceted experience with sports?
Dr. Griffith: I played four sports in high school – field hockey, basketball, soccer, and lacrosse. I was also a 4-year starter and record holder in college on the Division I soccer team at La Salle. I’ve been a coach and raised three children who participated in a variety of sports at the youth, high school, and college level.
Dr. Horn: I was also a multi-sport athlete. I did soccer, swimming, field hockey, track, and softball growing up and was on the track and field team at Dickinson College, where I was also the student-athletic trainer.
Why is it important to talk about mental health and youth sports?
Dr. Horn: As doctors, we are treating the whole patient, not just the “athlete.” And we are seeing so many parents and athletes who are so hyper-focused on one sport or are so intense with their sports that they’re losing sight of the value of playing sports in the first place.
What are the positive aspects of sports for kids?
Dr. Horn: Beyond the enjoyment and physical benefits of exercise, studies show lower rates of substance abuse, risky behaviors, anxiety, and depression in young athletes. Also, there are increases in cognitive performance and creativity.
Dr. Griffith: In general, sports can help you build skills that you can carry through the rest of your life, such as structure, discipline, determination, and the understanding that if you work hard, you can improve your skill set. There can also be a feeling of support, belonging, and camaraderie.
The message you want to convey to parents and coaches is Accentuate the Positive. Why?
Dr. Griffith: Because it feels like we are forgetting the goals of sports. In my opinion, the goal is to achieve a healthy lifestyle and a lifelong appreciation for exercise. Sports should be fun. You should be able to build friendships and self-esteem. There should be an element of motivation, integrity, and learning how to improve skills through dedication and hard work.
So, what do you think is going wrong in youth sports today?
Dr. Griffith: I think there are factors that interfere with the positive aspects of sports. So, what are those interfering factors? It’s not injuries. But it’s how parents and coaches react to the injuries, or the athlete needing time off due to physical and mental limitations.
For example, on any given week, I might see a 9-year-old who has a fractured arm. When I tell them they need to be in a cast for 4 weeks with no sports, the parent’s reaction to that can be very detrimental to the child. For instance, a parent will often immediately say, “you know you’re going to miss the tournament in two weeks.” Or they say, “I know you’re upset.” Meanwhile – the child appears perfectly content. The fact is that the child has an injury and they just need some time. But these kinds of reactions are not helpful.
Dr. Horn: I agree, the intensity is at a whole new level. Personally, I see a lot of patients with concussions and there’s no speeding up a concussion. People often want to be back to the sport, “just like that,” and the more anxiety and pressure that’s put on the athlete to return, the longer it takes to get better.
So, how can parents offer positive, helpful support when their child has an injury?
Dr. Griffith: It’s important to separate the kid’s sports goals from other goals in their lives. So, what I’d rather hear the parent of a 9-year-old say is – “Hey, this gives you 4 weeks to work more on your art. This will give you time to develop that skill that you might use in the future.”
When a parent reacts that way, I love it. Because it doesn’t put the onus on the child, who is trying to get better. It helps them focus on other things that are important. We need to help our kids get over these small things, so they will be able to tackle the big things.
Focus on the things that you CAN do, not the things you can’t do. Don’t make a stressful situation worse.
Dr. Horn: In general, we’re taught the harder you work, the more successful you’ll be. But I think there’s more to it than that. I’m really interested in positive psychology and there’s a lot of evidence that says- happiness is the biggest predictor of success. So, an injury is obviously a difficult thing. But I’d love to see a shift in thought…you’re injured, you need to heal, you’re going to heal faster if you have a more positive outlook on things.
You believe that communication skills are very important for young athletes. How do you reinforce this in your office?
Dr. Griffith: Sports and the situations that sports present can help kids build communication skills and learn to be their own advocate. So, anytime I see a child in the office, I immediately speak directly to the child. And I let the child carry through with their explanation of circumstances and symptoms as far as they can go, to help them develop that confidence that they can communicate with me, and I can be part of their team. Then I can ask the parents to fill in any blanks.
It may seem like a small thing, but letting your child lead the communication with coaches and doctors empowers them as they grow.
You believe that kids can use time off to build their sports IQ and become even better athletes. How?
Dr. Griffith: Aside from taking time to pursue other interests, athletes can also use the time off to build cognitive skills in the game and strengthen their sports IQ. For example, I used to coach soccer and basketball. And when I had players who were hurt, I’d have them sit next to me, pay attention to the game, and listen to what I was saying to the assistant coach and to the players. When those kids recovered from their injury, they were often like their own little coaches. They were talking more constructively and playing better.
Burn-out and pressure can lead to anxiety, quitting, and sometimes amplified musculoskeletal pain syndrome (AMPS). What is AMPS and how is it diagnosed and treated?
Dr. Griffith: The diagnosis of Amplified Pain Musculoskeletal Syndrome (AMPS) was discovered about 15 years ago. We were starting to see all these kids who were physically healthy, but experiencing pain. The parents were pushing for MRIs and imaging studies, yet the test results were normal.
Children’s Hospital of Philadelphia (CHOP) started seeing so many of these cases that they eventually established the Center for Amplified Musculoskeletal Pain Syndrome. AMPS can be quite debilitating and brought on by injuries, illnesses, and very often stress. Treatment includes aerobic exercise, desensitization therapy, and individual therapy to learn coping strategies and stress management skills. In these cases, it’s not uncommon to discover that the children are scared to disappoint their parents, they need to adjust something, or try a different sport.
Of course, we never assume anything is amplified pain. But there are things we see that don’t fit the normal bill, when the physical exam is too exquisite, or their pain level is way higher than it should be. Then we need to have come discussions. In this situation, the pain is certainly real. The source is just not exactly physical.
Dr. Horn: In cases like this, it can be helpful to redirect the child. For example, we may see a gymnast who is requesting cast after cast and there’s nothing physically wrong with them. Then we have to say, “listen, what do you think about diving or track and field?”
We actually had a patient who burned out of gymnastics, moved on to diving, ended up diving in college, and became a nurse. But it was her decision to make that switch and importantly, her parents let her do what she wanted to do and supported her through it.
Do you ever recommend counseling or therapy for a patient?
Dr. Griffith: Yes. I have a few mental health specialists who are near and dear to my heart. They’ve helped students get through rough patches in their life and learn healthy coping skills. It helps kids with amplified pain, kids who might be cutting, or starting to have eating disorders. I am a big believer in the power of counseling and therapy for athletes and non-athletes.
How can young athletes avoid overuse injuries or the burn-out?
Dr. Horn: Don’t put all your eggs in one basket. Especially from a sports medicine perspective, we see a lot of overuse injuries in kids. In my opinion, a multi-sport athlete is one who is less injured because they’re developing and balancing their muscles and anatomy a little better. In fact, that’s what is often happening at physical therapy, the effort to develop those muscles that aren’t firing as frequently because of the use pattern of the sport. We want to make sure that kids are diversifying things – and that doesn’t have to mean multiple sports – but could be a good strength and stretching program.
How can adding an individual sport help a young athlete physically and mentally?
Dr. Griffith: Having an option of an individual sport that doesn’t focus only on the team is a great shift. Sometimes in team sports there are elements of cliques and the influence of that on parents who are coaches. All of that is less likely to occur with swimming, track, tennis, golf, and similar sports where achievement is really based on your time or score. I think it’s a great thing to have an individual sport along with their team sport to broaden their experience, the physical load on their body, and to develop new skill sets.
As sports medicine physicians, what’s the overall takeaway you want to communicate to parents of young athletes?
Dr. Griffith: I want us all to understand that someone is not defined by only one thing in their life. I want parents to know that there’s more to life than the sport and to really cultivate the whole person. See the benefits of extracurricular activities, such as music, or activities that might relate to a profession down the road.
Our role as orthopedists is to get kids healthy so they can play their sport. But it’s so important to talk them through these injuries and tough times in a positive way. The parents and coaches who embrace that are really doing a good thing for their kids.
If your child has a sports injury, or chronic pain, call 215-348-7000 to contact us and schedule an appointment at one of our office locations in Doylestown, Warrington, or Newtown/Langhorne. We focus on personalized medicine and treating “the whole patient.” We will provide a thorough evaluation, diagnosis, and treatment plan (that may include physical therapy) that will support your young athlete through their injury.
