Here, TrueSport Expert Nadia Kyba, MSW, President of Now What Facilitation, explains how coaches and caregivers can work together to prevent a workaholic culture from infecting youth sports.

Understand the pressure athletes face on all fronts

As parents, coaches, and caregivers, it’s easy to look at young athletes and feel as though they live an unburdened existence. But between school, sports, work, relationships, friendships, and the growing pressures presented by social media, young people are subject to huge amounts of pressure, says Kyba. To you, as an adult with bills to pay and many demands on your time, it may not seem like your athlete should be struggling to do it all. However, your athlete doesn’t have the same experiences as you, and for them, this point in time is the busiest and most pressured they’ve ever been.

Stop promoting a ’no pain, no gain’ mentality

Hard work is good—but it’s easy for hard work to turn into overwork. Unfortunately, as adults, we tend to either ignore athletes who are overworking, or worse, we praise their efforts, says Kyba. Rather than praising an athlete for showing up to practice despite pulling an all-nighter to study for a final exam after a late shift at the restaurant where they work, consider giving that athlete a pass to catch up on sleep. We live in a culture that touts the idea of “going above and beyond,” but an athlete who’s already at risk of injury or illness due to fatigue shouldn’t be pushing harder, they should be taking care of their physical health.

Understand how workaholism applies to youth sports

While you can’t control the amount of homework or after-school work an athlete has, you can control the environment you’re creating for them in terms of sport. Kyba has noticed two big issues on this front. One issue is the number of tournaments now taking place over holidays, on weekends, and throughout the summer. There’s also a growing pressure for young athletes to be in a single sport all the time. That leaves no time for multi-sport play, other school activities, and of course, even unstructured time with friends.

More Guidance for Coaches

Set boundaries at the beginning of the season

“At the beginning of the season, it’s important for coaches to talk to the kids and parents before they start registering them into tournaments,” says Kyba. “Find out what’s important to them: Maybe a tournament over Labor Day weekend works well for everyone, but Thanksgiving is off limits for many families. You’ll have to negotiate and compromise, since not everyone will have the exact same preferences, but try to take all the athletes’ needs into account.”

Kyba notes that it’s particularly important for coaches to not just consider Christian holidays, but to respect the range of religious and cultural traditions that athletes on the team may observe.

Don’t reward athletes for workaholic tendencies

We often praise those who “go the extra mile.” But in youth sport, pay close attention to an athlete who’s consistently going above and beyond—doing an extra weight room session, literally running the extra mile, and pushing beyond their capabilities to the point where they’re at risk of injury or exhaustion. It’s your job as the coach to pull them back, not urge them on. Even if they’re getting results in the short term, that kind of attitude and effort isn’t sustainable in the long term.

Don’t penalize athletes for cultural or religious observances

It should go without saying, but an athlete who’s observing a religious or cultural holiday or tradition should never be penalized for it. “For example, for some athletes, observing the Sabbath or fasting during Ramadan is a very important part of their religion,” says Kyba. “In your eyes, this may interfere with practice or competition, but you should never make an athlete feel guilty for their religious or cultural choices.”

More Guidance for Caregivers

Listen to your athlete

As Kyba noted earlier, it’s easy as a parent to roll your eyes when an athlete says that they’re feeling stressed out or exhausted. But take your athlete’s feelings seriously, and respect and validate those feelings. If an athlete seems as though they’re struggling to do everything, try to help them prioritize and potentially even trim out some of the activities and extracurriculars that are causing stress. This may even involve a discussion with a coach about cutting down the number of practices your athlete attends, even if it’s just for a couple of weeks.

Help create boundaries for your athlete

As a caregiver, you do have the ability to affect change on the team. If the coach is considering adding a tournament over Thanksgiving weekend or Christmas week, the parents of the athletes can create boundaries that protect their athletes from overwork and allow them to have vacations and time away from competition. While you do want your athlete to be able to advocate for themselves, sometimes you do still need to step in.

Watch your language around work and sport

Athletes face such high pressure in school and sport, and parents can unknowingly add to it with casual observations about athletic or academic scholarships. More often than not, Kyba says, your child is already aware that they may need a scholarship in order to afford a university education—constantly bringing it up, even in a seemingly positive way, can contribute to an athlete developing workaholic tendencies.

Help your athlete understand your family values

“Often, workaholic culture clashes with an individual’s values,” Kyba says. “If you and your athlete value spending time with family and friends, you need to help your athlete respect those values. Often, workaholic cultures lead to putting all your energy into just one aspect of your life, which jeopardizes other core values. You need to help your athlete find balance.”

____________________________

Takeaway

Workaholic culture has seeped into youth sport and young athletes who are subjected to a  workaholic environment in school or sport are at higher risk for burnout, injury, illness, and mental health issues. Coaches and caregivers need to work together to ensure that athletes are training and competing in a team culture that values hard work, but not workaholism.

Given that concussion treatment today is very different than it was several years ago, Michele LaBotz, TrueSport Expert and sports medicine physician, is explaining the latest information on concussion protocols. Remember, it’s important to speak to your athlete’s doctor and athletic trainer to create the best recovery protocol for each individual athlete, but having this updated information allows you to ask the right questions and best advocate for your athlete.

According to the American College of Sports Medicine, 1.8 million sports-related concussions happen annually in youth under age 18 annually. This number can be devastating, especially since many athletes who sustain concussions struggle to return to play, particularly in high-impact sports. But concussions are an unfortunately common part of many sports, and all too often, are unavoidable. So, how can an athlete best recover?

One fundamental change during recovery has been the move away from prolonged periods of rest and time away from school. This may be a surprise, especially for coaches or parents of older athletes who have long been told that athletes with concussions need to be kept in dark rooms, forced to rest, and stay away from screens and exercise. “The pendulum has been swinging the past number of years in terms of concussion treatment,” says LaBotz. “The things we believe now are quite different from what we were telling people a couple of years ago.”

Now, LaBotz says, there’s a lot of good evidence that getting kids back into physical activity early—after a day or two of taking it easy (unless other injuries require more rest)—can be helpful for recovery. This doesn’t mean showing up at practice and doing sprints, though. Instead, athletes should start with low intensity physical activity like walking or spinning on a stationary bike.

“As long as they’re able to participate in physical activity without a significant increase in symptoms and without undue risk of another head injury, they can continue,” says LaBotz. “Those prolonged periods of inactivity are not good for the athlete, on any level.”

LaBotz believes part of the reason this return to activity aids recovery is the element of isolation that can happen when an athlete is forced to rest, skipping school and practice. “We know that when these kids are socially isolated after concussion, that appears to lead to prolongation of symptoms,” she says. “The days of keeping kids out of school, or away from social activities with friends, for weeks at a time are over.”

Even screen time recommendations have changed. While screens often aren’t optimal for those suffering from acute concussion symptoms, LaBotz notes that because many young people engage in social interactions via the computer versus in real life, keeping them away from all screens may do more harm than good.

“The Academy of Pediatrics still recommends a maximum of two hours of non-academic screen time per day,” she says. “But as long as kids are not having a significant increase in symptoms, maintaining those social connections with friends via screens is very reasonable.” LaBotz notes that for those who do experience symptoms with screen use, reducing screen brightness and/or increasing font size may help. “Even playing with different background colors can make a difference,” she says.

Furthermore, going to major events like prom or graduation can be safe for athletes dealing with concussions, says LaBotz. “I tell parents that if there is an important social or family activity, it’s fine for them to participate, as long as the activity does not involve risk for additional head injury” she notes.  However, LaBotz does add that it’s important to have a plan in place if the athlete feels concussion symptoms start to increase. “They have to have an ‘exit strategy’ where they can retreat to a quiet place or be able to leave and go home if symptoms become much worse” she says.

According to the American College of Sports Medicine, concussion recovery typically takes between two and four weeks for young athletes. Concussion recovery is not linear, and  symptoms may come and go during this recovery time, says LaBotz. It’s normal for symptoms to seem to go away, then come back, particularly with strenuous mental or physical effort. “I often reassure patients and families that a slight increase in symptoms with light exercise or schoolwork is okay, and the athlete can continue,” she says. “But, if there’s a big increase in symptoms, then that is a signal that the athlete is doing too much and needs to back down.”

When it comes to concussion recovery, there is no substitute for the passage of time. But there are some symptoms, such as issues with balance, vision, or neck pain that often benefit from dedicated treatment and rehabilitation, particularly if they are not improving with time, adds LaBotz. Working with a physical therapist or athletic trainer to address these issues often helps to reduce concussion symptoms and shorten recovery periods.

The last outdated piece of concussion advice is the concept that the third concussion needs to be your last concussion. “There’s no magic number for concussions,” says LaBotz. “It used to be that after three, you were out of the sport. Now, recommendations are much more individualized and the decision-making process takes multiple factors into account, and not just the number of concussions.”

One problem with sustaining multiple concussions is that it seems to increase the likelihood of recurrence. “In some athletes, we see that after a concussion, the threshold for getting another concussion appears to go down,” LaBotz says. “I’ve seen athletes who have had a couple of concussions, and they come to see me with symptoms of a new concussion but don’t remember sustaining a hit. In these cases, it may take less of a hit to sustain a concussion for them now. And again, in those cases, considering a switch to a non-contact sport may be advisable.”

Although many concussion treatment recommendations will continue to evolve, it is important to remember that the following criteria for return to contact sport after concussion has NOT changed:

• Athletes must be symptom-free at rest and remain symptom-free during several days of a progressive “return to play” protocol
• Athletes must be back to their pre-injury level of school performance and cognitive function
• Athletes must be cleared by a health care professional before return to sport

More research is still needed in the concussion arena, and one area of interest for LaBotz is regarding the potential effects of subconcussive head impacts. These happen when smaller impacts to the head are sustained (like heading a soccer ball or hitting your head after a tackle in football). At the time of the impact, there’s no pain or symptomatic aftereffects. But those hits accumulate over time, she says. “Really, the less force that goes across the brain, the better,” she adds.

___________________________

Takeaway

Concussion protocols have changed in recent years. Athletes should return to easy, light movement within a day or two of sustaining a concussion to improve recovery outcomes and they shouldn’t be kept in social isolation. Work with athletic trainers and medical professionals to create an optimal return to play plan for your athlete, and remember, athletes must be cleared by a health care provider to return to play after sustaining a concussion.

Unfortunately, stress fractures are very common in young athletes particularly in runners, dancers and female endurance athletes.  Studies have shown that up to 5% of middle school and high school runners experience stress fractures each year.  However, while some injuries simply cannot be prevented, the risk of stress fractures can be reduced for your athletes, and early detection and treatment can lessen the impact of the injury and have your athlete back on the field sooner.

Here, Dr. Michele LaBotz, TrueSport Expert and sports medicine physician, explains three reasons that stress fractures are so common, and what you can do to help your athletes.

1. Sudden Increase in Activity

“During the height of the pandemic, athletes were out of sport entirely,” says LaBotz. “Many of them stopped playing sports and stopped exercising altogether. Then, as things began to restart and reopen, students were so excited to go back and start playing their sport again that they did everything quickly. They started training and competing again and didn’t gradually increase their volume and intensity. Too much, too soon can lead to stress fractures.”

2. Lack of Variety

As more athletes specialize in sports from a young age, the risk of injuries like stress fractures has increased. This is partially because athletes are often doubling or tripling up on practice and competitions as they play for school and club teams and getting extra professional coaching on the side. Not only does this lead to an increase in volume but also to a lack of variety of movement, especially in sports like running or sports that favor one side of the body or one major muscle group. “The lack of variety for young athletes is a big problem,” says LaBotz. “As a coach, you can make sure that even if your sport doesn’t offer much variety, you’re filling in those gaps with drills and strength training that involves moving the body in a variety of different directions, rather than those that emphasize more repetitive movements.”

3. Athletes Focusing on Weight Management and Restriction

“We see in both young men and women that there are many young athletes suffering from relative energy deficiency in sport (RED-S),” says LaBotz. “These athletes are often harboring the assumption that there’s a ‘best weight’ or ‘best body type’ for their specific sport, and trying to force themselves into that particular mold.” But having symptoms of RED-S and not taking in enough nutrients to support the body’s work output can greatly increase the risk of stress fractures.

How To Reduce Risk For Athletes

Break Workout Patterns

For sports like gymnastics, a variety of movement is built into every practice. But sports like running can often get very repetitive. However, they don’t have to be. Workouts should vary in both type and intensity. LaBotz states, “Hard workouts should be hard; easy workouts should be easy; and rest days are for recovery. Athletes are often tempted to add in “extra” training on easy or recovery days, but this really increases the risk for all kinds of injuries.”

“Especially for endurance athletes, make sure that every workout is not just going out for a long, slow distance run, but rather, including some plyometrics movements, adding in some strength training, and making sure athletes are moving laterally rather than just moving forward—anything that breaks up movement patterns,” says LaBotz. “You may need to consult with an expert for the best strength training or plyometric maneuvers, but the addition of this kind of variety shouldn’t be overlooked.”

Increase Volume Slowly

A general rule to remember is that any increases in training volume or intensity should be a maximum of 10 percent per week, says LaBotz. Rapid increases in training are a primary cause for stress fractures.  Make sure that you’re leaving plenty of time for athletes to recover, and only adding the volume that’s safe and necessary.

Check Nutrition

LaBotz recommends ensuring athletes are getting adequate levels of both calcium and vitamin D when it comes to avoiding stress fractures. We know that prolonged low levels of vitamin D can increase an athlete’s risk of stress fractures, so it is important to ensure that your athlete’s levels are optimized. (As a coach, you can’t test their vitamin D levels yourself, but you can recommend they get their levels checked at their doctor’s.)

Read more about calcium and vitamin D-containing foods here.

De-Emphasize Weight and Body Type

Make sure your athletes understand that lighter isn’t better. “There’s a range of best weights for every athlete, for every sport,” says LaBotz. “Lighter is not always better, and weight loss often involves significant loss of muscle as well, which detracts from athletic performance. Lighter can be a lot worse if it’s too light.”

If you’re coaching a sport that emphasizes lightness or has an ‘ideal body type,’ it’s a great idea to bring a registered dietitian to a practice to speak with the team about optimal fueling habits. At minimum, make sure athletes know how to contact a registered dietitian if they’re concerned about fueling or body composition.

Spot Symptoms Early

1. When is the athlete experiencing the most pain? Stress fractures will often begin with gradual onset of pain toward the end of a run or other activity, but when they stop, the pain will dissipate. As stress fractures progress, pain then becomes persistent after activity as well. This makes stress fractures different from many other common athletic injuries, like shin splints where the pain is often more noticeable after the activity, but while moving, it’s not too bad.
2. Where is the pain? “With stress fractures, often when you ask an athlete where it’s sore, they’ll be able to take one finger and point to the exact spot that hurts during impact activity,” says LaBotz. (With an injury like shin splints, the painful area tends to be more broad and often involves both legs.)
3. How is the pain changing over time? “At first, a stress fracture is only painful during activity, but gradually, if left untreated, it will get worse,” says LaBotz. “Eventually, it will be painful most of the time, often waking an athlete up at night.”

Understand the Role of Recovery

Lastly, make sure athletes are taking time for recovery—especially athletes who are playing multiple sports or competing for multiple teams. “Coaches and athletes need to understand that there is a little bit of “micro-damage” that happens to bone during training,” says LaBotz. “At the end of a given training session, the bone is actually weaker than it was before. But, the bone gets stronger during the recovery period following the training. Oftentimes, athletes and coaches don’t recognize that training induces damage, while strength building actually happens in the period of time between the training sessions. Athletes must take recovery seriously if they want to see improvements in performance as well as in health outcomes.”

___________________________

Takeaway

Pay attention to how quickly your athletes are increasing their training load, especially after any elongated breaks from sport. Ensure that athletes are getting a wide variety of movements in their training, ideally incorporating some amount of strength training regardless of the sport they play. And finally, take pain seriously: If you suspect an athlete has a stress fracture, have them get checked by a professional, as early detection can speed up the recovery process.

Here, Dr. Michele LaBotz, a TrueSport Expert and sports medicine physician, explains how you can be your own greatest advocate when it comes to early injury detection as well as injury prevention.

Your Injury Risk Increases After Injury

You read that right: LaBotz points out that your biggest risk for injury is having a prior injury. If you do have a prior injury, it’s important to ask yourself (or a coach or athletic trainer) if you’re doing everything you can to rehabilitate the injury and to prevent it from recurring. Often, we get so excited to return to play that we neglect the physical therapy exercises we were given, or we ignore recovery advice in hopes of getting back to our previous level of play faster. But a slow and thoughtful return to sport after injury will better set you up for success and help avoid another injury from occurring.

Your Injury Risk Increases During Growth Spurts

As an athlete who may still be growing, it’s important to understand that during and after a growth spurt, you may be more prone to injury. “Injury risk goes up around the time of peak growth. When an athlete is growing fast, their proportions change, and that can lead to a lack of coordination” LaBotz says. “Oftentimes, during these periods of growth, an athlete will temporarily lose their sports skills, so then they train even harder because they want to get the skills back. But really, what they need to do is step back and focus on the fundamentals, build strength, build endurance, and build power. The sport specific skill is going to come back, but if you push too hard, you will likely end up injured.”

Your Injury Risk Increases If You’re Trying to Lose Weight

Some sports have weight classes and you may be encouraged to drop to a lower weight category if you fall at the low end of the one you’re currently in. Many sports don’t have weight classes, but do have a stereotypical ‘ideal’ body type that a coach may be promoting. Whatever the case, we know that young athletes often feel pressure to drop weight or maintain a certain body type for their sport. Underfueling and overtraining in pursuit of weight loss can make you more prone to almost every injury, from stress fractures to overuse injuries.

Here are a few sport-specific injury prevention strategies for sports that tend to have high injury rates:

Running

Running can cause injuries, but there are ways to prevent many of them, from stress fractures to overuse injuries. In running, your goal should be to prevent stress fractures—or at least, catch them early. It can be tempting to not want to tell your coach or trainer about a pain you’re having in your shin whenever you run, but the earlier you can catch and diagnose a stress fracture, the faster you’ll be able to heal. (Tip: An early stress fracture usually hurts toward the end of a run, but not when you’re standing still. It will also typically feel like it’s coming from one specific place rather than a larger area.)

You can also protect yourself against overuse injuries and even help prevent some acute injuries by adding variety to your workouts, including things like strength training in addition to running during practice. Understand the importance of proper recovery as well as good nutrition basics—ask your coach to bring a registered dietitian or athletic trainer to speak to your team about these topics if they haven’t already!

Weightlifting

Weightlifting is a great way to prevent injury. However, when weightlifting is your primary sport, focusing on lifting heavier and heavier loads can cause injuries.

“First of all, it’s important to understand correct technique, and maintain that correct technique even when you are training hard,” says LaBotz. “We see this all the time: the technique breaks down when you’re on the last rep or the last set, and that’s where injuries can occur.”

You may also be focusing on training a specific muscle group, like your pecs or quads. This can prove to be problematic if you’re not strength training the opposing muscle groups as well. “I see young male athletes trying to build their chest muscles, and they ignore their shoulders and upper back,” says LaBotz. “The same is true for training the quads but neglecting the hamstrings.”

Make sure that your weight training program balances out your muscle groups, otherwise you’re opening yourself up to injuries now and more problems later. It’s also important to keep core work consistent—a strong core can prevent many of the common injuries those who weightlift tend to experience.

Contact Sports

Contact sports may be purposeful, like wrestling, or may simply be sports that often end up with bodily contact made, like soccer or hockey. To prevent injury in these sports, start by understanding what the rules and regulations are in your sport when it comes to contact, and ask your coach to create a set of guidelines for practice as well as in competition that keeps dangerous contact to a minimum.

If your sport includes protective gear, make sure yours fits correctly. If you recently hit a growth spurt, you may need new pads—poorly fitting pads won’t help you, says LaBotz. Always let a coach know if you don’t feel like your practice setup is safe, whether it’s rule- or equipment-based.

As with running, adding strength training and mobility work to your routine can also be helpful when it comes to injury prevention, says LaBotz. If you’re not sure what type of gym work to do, ask your athletic trainer to help you create a routine designed to reduce your injury risk.

Lastly, remember that if you’re an adaptive athlete (if you’re in a wheelchair or use another adaptive device), you may be prone to other types of injuries. For instance, wheelchair athletes tend to end up with upper extremity stress fractures, so pay attention to injury signs!

________________________

Takeaway

As athletes, you’re at a risk of injury from your sport. However, there are steps that you can take–and that you can encourage your coach and your teammates to consider—that will make you less prone to injury. Ensure that you take the time you need for recovery, engage in a variety of different movement practices, and get help for small issues before they become big problems.

Here, Dr. Michele LaBotz, TrueSport Expert and sports medicine physician, explains the role of an athletic trainer, helping you to understand how to access and best take advantage of the services that they offer.

What is an Athletic Trainer?

An athletic trainer has a high-level designation as a medical care professional. According to the National Association of Athletic Trainers, “Athletic training encompasses the prevention, examination, diagnosis, treatment and rehabilitation of emergent, acute or chronic injuries and medical conditions.” Athletic training is recognized by the American Medical Association and the Department of Health and Human Services as an allied health care profession and is highly regulated.

“People throw the term “trainer” around without recognizing that athletic trainers are certified and licensed health care professionals who are specifically trained in this capacity,” explains LaBotz. “Many states even have mandatory athletic trainer coverage in the schools—and athletes and families should be aware of their services.”

(Coverage in schools varies by state. If you’re not sure if your school has an athletic trainer, ask the coach or phone the school’s main office to check.)

Understand the Role of an Athletic Trainer

“The main responsibility of the athletic trainer is to advocate for the safety of the athletes in their care,” says LaBotz. “They can often run ‘interference’ between the athlete and the coaching staff. Young athletes are often really intimidated by their coaches, and the athletic trainers can serve as a buffer or a go-between.”

Additionally, athletic trainers may be tasked with assessing if athletes are in a safe environment. This can include protective gear and equipment, or simply determining if it’s too hot, cold or stormy to play. “In the summer, it’s the athletic trainers who make sure that good cooling opportunities are available on site if there’s a risk for heat injury,” says LaBotz.

They also help set return to play protocols based on current science and approved standards of care. “Athletic trainers help implement the return to play plan, not just after an injury, but even after an illness like COVID or a concussion,” says LaBotz. “Anytime there are graduated stepwise progressions to returning to play, the athletic trainers are there to prevent the athlete from being their own worst enemy. We know kids want to get back to sport quickly, so the athletic trainer is often the one who has to hold them back. The athletic trainer serves as an enforcer in this role.”

Urge Your Athlete to Communicate with Their Athletic Trainer

While an athletic trainer can help an athlete with a huge range of things, it’s hard for them to help an athlete who isn’t asking for help. Most schools will only have one athletic trainer for all the athletes, so the demands on their time are endless. Because of this, it’s important to urge your athlete to connect with the athletic trainer if they need help.

“An athletic trainer can be incredibly helpful since they often are seeing athletes regularly and may be more likely than the coach to notice if something is amiss,” says LaBotz. “But, if the athlete is hiding it from the athletic trainer, there’s no way for the trainer to help. There needs to be an open line of honest communication between athletes and trainers.”

It may help if your athlete understands that an athletic trainer’s goal is not to keep athletes away from sport. Rather, it’s to let them participate safely.

You Can Also Communicate with the Athletic Trainer

If your athlete is currently injured and is already working with a physical therapist, an athletic trainer may simply be a second set of eyes checking in on the rehabilitation efforts, possibly communicating directly with the coach to decide on the best return to play setup for your athlete. “Sometimes, the athletic trainer can take the lead on the rehabilitation process,” says LaBotz. “If an athlete is already doing physical therapy, the athletic trainer can still be a key part in getting them from rehab mode into return-to-sport mode, helping design ways for an athlete to continue to practice in a way that’s safe.”

If your athlete is currently rehabilitating an injury, speak to their athletic trainer and the healthcare provider you’re working with, and ensure that they can share feedback and notes with each other. If the two aren’t in communication, make sure you’re sharing information from the rehab specialist to the athletic trainer to keep them informed.

“If the healthcare provider is giving information that the parents think would be helpful, share that with the athletic trainer,” says LaBotz. “Parents can make sure that the athletic trainer is part of the broader ‘health care team’ for the athlete.”

The goal here is to avoid “silos.” Often, healthcare providers and athletic staff aren’t speaking to each other, and a lot of important information can get missed, often delaying an athlete’s return to play.

_______________________

Takeaway

Athletic trainers can be the greatest advocate for your athlete. They can help prevent and treat injuries and prescribe the best protocols for return to play. They can also serve as a bridge for communication with a coach if an athlete is concerned about a lingering injury or illness but is unable to adequately communicate their concerns to a coach.

Several recent systematic reviews can help sort out some of these discrepancies, but determinations of “best practice” regarding stretching are certainly subject to some controversy and future change, and it can be incredibly difficult to figure out the best advice to give a young athlete. Here, Dr. Michele LaBotz, TrueSport Expert and sports medicine physician, shares what we know now about stretching.

Static stretching—where you stay in one position and hold a stretch for a specified amount of time—was the original standard for stretches done by athletes. The original static stretching logic back then was simple: if you did a lot of static stretching, you would prevent injury and perform better.

However, over the years, that concept was ‘debunked,’ and some research came out showing that static stretching could decrease performance and increase injury risk. “After that, static stretching, whether before working out or as part of a warm-up routine, fell out of favor,” says LaBotz. “That’s when dynamic stretching became more popular.” As the name suggests, dynamic stretching is more movement-based, with athletes actively moving through the range of motion. For instance, bending over to touch your toes and holding that position for 30 seconds would be a static stretch, while leg swings would be a dynamic stretch.

But then, a recent meta-analysis looking at a series of studies done on stretching found that the uproar against static stretching was a “little overblown,” according to LaBotz. As with many things in the health and fitness world, the studies that initially scared people away from doing static stretching were more nuanced than headlines made them seem. However, there are still important caveats for athletic trainers to be aware of.

“It turns out that, in some cases, static stretches may actually help prevent injury,” says LaBotz. “It may also help to increase range of motion, which can potentially help with performance in a lot of different sports. But it doesn’t mean every athlete should be doing static stretches every day.”

So, what does this mean for you as an athletic trainer?

Variable effects for endurance vs. non-endurance athletes

“For high-performance athletes in non-endurance sports, avoiding static stretches as part of the warm-up may still the best protocol,” LaBotz says. “There are some studies that show small decreases in speed and power immediately following a static stretch warm up. However, other studies in endurance athletes show some improvements in running economy and decreased perceived effort after a warm-up that included either static or dynamic stretches.”

Understand your athlete’s growth phase

“Flexibility is particularly important for athletes who are in a rapid phase of growth,” says LaBotz. “As a young person grows, their bones grow first, and then the muscles and the tendons all stretch out to accommodate them before catching up. While they’re doing so, the athlete’s flexibility goes down, since there’s naturally more tension on the muscles and tendons.” So, if an athlete suddenly seems less flexible and has recently grown an inch or two, that’s not a cause for alarm. LaBotz explains, “Sometimes just maintaining flexibility requires dedicated effort during these growth phases.”

Understand what a ‘good stretch’ feels like

Stretching should never be painful, says LaBotz. Part of the reason stretching got a bad name was because athletes would sometimes be forced into stretches that were too intense. (You may be able to recall a physical education teacher pressing down on your upper back to ‘help you’ go further in a seated forward fold, taking the stretch from pleasant to painful.) “A good stretch feels like a bit of a pull, maybe a small amount of discomfort, but there should never be pain,” says LaBotz. Always err on the side of caution!

Find modalities that work for your athlete

LaBotz is a fan of combining different modes of stretching and improving flexibility and mobility, including static stretches, dynamic movements, equipment like foam rollers, and assisted methods like dynamic nerve glides, where the athletic trainer helps the athlete move through a range of motion that helps open up tight spots.

Incorporate static stretches at the right time

“Stretching is always best when the body is warm,” says LaBotz. “It’s great to do stretching as a cool down after practice—or if you want to do a stretch session before practice, still start with a warm up to get the blood flowing.” And when it comes to adding static stretches, especially around practice, aim for two holds of around 20 seconds each. “You don’t want to overdo it,” says LaBotz. “Too much of a good thing is not a good thing.” For rapidly growing kids, having some kind of stretching protocol most days of the week is ideal.

Skip stretching for more flexible athletes

The caveat to stretching for young athletes is that for naturally flexible kids, stretching isn’t the best use of their time. If an athlete is extremely flexible or even struggles with hypermobility, LaBotz notes that they need to spend that time working on stability and strength.

Check posture and mobility

“There are a couple of patterns that I’m noticing in young athletes now,” says LaBotz. “Many now have the ‘head forward’ position, often from being on phones or computers for most of the day. It sets these kids up for increased risk of back pain, as well as shoulder injury because it puts the shoulder in a bad position. Make sure that they’re doing some stretches across the front of their chests to open up that area.”

Individualize recommendations to your athlete’s specific sport

After assessing general posture, mobility, and flexibility concerns for an athlete, consider the sport-specific stretches that would be performance-enhancing. LaBotz reports, “A thrower, for instance, should focus on stretching out the posterior capsule in their shoulder, but for a swimmer, you would do the opposite and stretch out the anterior.”

She also encourages athletic trainers to think beyond the basics and consider less-common stretches, such as hip stretches for a thrower since lower body rotation is important. “Pay attention to the whole kinetic chain,” she says. “Every athlete is going to come in with a different set of strengths and limitations, meaning they need to build up certain aspects to improve performance in their specific sport.”

 ___________________

Takeaway

Based on the latest research, athletic trainers can feel comfortable recommending both static and dynamic stretching after analyzing what will best serve an athlete based on their sport, body type, existing flexibility, and injury history.

“Athletic trainers have such a strong influence on the athletes they work with,” says Dr. Michele LaBotz, TrueSport Expert and sports medicine physician. “And teaching athletes the importance of recovery is one of the most valuable things an athletic trainer can do. Athletes already know the importance of training hard. But they also need to pay attention to their recovery.  If you’re going to train at high intensity, then you have to recover ‘like you mean it.’”

So, what exactly does that look like? ATs can support recovery by helping athletes understand the importance of sleep, how to dial in nutrition, and how to reduce stress and strain, both physically and mentally.

Sleep Duration Matters

When it comes to sleep, it’s hard to overdo it for young athletes.  In fact, athletes between 13-18 years old need 8-10 hours of sleep per night, and athletes 12 and under need 9-12 hours. Recent evidence shows that these recommendations are not only important for health, but for athletic performance and injury prevention as well. This means actual sleep (not just time in bed) and the amount required for young athletes is higher than the 7-9 hours of sleep recommended for adults. For busy student-athletes balancing full school, sport, and social schedules, getting that amount of sleep can be incredibly difficult.

Research has shown that nearly 70 percent of adolescents get under seven hours of sleep, and LaBotz thinks the number is likely even higher than that, especially for busy athletes. “Junior year is a real pressure cooker year for students, and it’s not uncommon for student-athletes to laugh and say, ‘How the heck do you expect me to be able to sleep 8-10 hours a night?’” says LaBotz. “Between schoolwork and practice, there aren’t enough hours in the day. But if performance is a priority, then sleep should be too.”

Acute loss of sleep from an all-nighter may leave students feeling drained, but chronic sleep deprivation is the bigger problem, says LaBotz. “You don’t feel tired when chronically sleep deprived, but that’s when injuries and illness are more likely to occur. Performance will also suffer. If an athlete is not getting enough sleep, extra time sleeping is going to be better than the equivalent amount of extra training.”

Dial in Sleep Hygiene

As an AT, you won’t be able to control how much an athlete sleeps, but you can counsel them and send recommendations home to help create an optimal sleep environment. Aim for cool, dark, and quiet in the bedroom, and keep that space as uncluttered as possible.

Recent research shows lower sleep time and quality when screens are in the bedroom. We know this is tough for teenagers, but if they take their sport seriously, it’s key! Encourage athletes to avoid too much screen time before bed and practice a nighttime routine that helps them wind down.

For athletes who are consistently “under-sleeping,” LaBotz often recommends that they set a sleep schedule by the clock rather than going by how they feel. “The first couple nights can be a little rough,” she says. “But if they can stick with it for a week or two, they often notice a big difference.”

Dial in Post-Practice Nutrition

While overall good nutrition is critically important to recovery, the biggest gains are made with the post-practice or post-game meal or snack. “The big gap in nutrition that I see most frequently is a lack of consistency and appropriate fuel intake, especially immediately following a training session,” LaBotz says.

After a hard or long effort, athletes require a combination of carbohydrates to replenish glycogen stores and protein to aid in the rebuilding of muscles. Often, LaBotz says that athletes are picking one or the other, rather than combining them. Endurance athletes tend to focus on carbohydrate intake, while those in strength-based sports often focus more on protein. In reality, the blend of the two is what makes for the best recovery fuel.

“Ideally, an athlete is getting some form of carbohydrate within 20 minutes of finishing a workout,” she explains. “This might even be a sports drink and some fruit while in the locker room or during the post-practice team meeting. It doesn’t have to be complicated. And then, ideally within an hour of practice, the athlete should have a full meal that contains a good balance of carbohydrates and protein.”

While a meal after practice sounds simple in theory, when games and practices run late in the evening, it can be hard to make time for a meal if an athlete isn’t getting home until 9 or 10 p.m. But even in that case, it’s important that your athlete is having a protein and carbohydrate-rich snack ahead of bedtime at minimum. Otherwise, they’re missing that valuable recovery window, and potentially negatively impacting their sleep by going to bed under-fueled. They’ll also head into practice the next day already low on fuel. If this is the case for your athlete, consider these simple snacks and easy meals for late night practices.

Find a Mindfulness Routine

While physical recovery is important, mental recovery is critical as well. TrueSport Expert Kevin Chapman, PhD, clinical psychologist and founder of The Kentucky Center for Anxiety and Related Disorders, is a fan of helping athletes find a mindfulness practice that works for them. “Doing some form of meditation is very important,” he says. He also recommends having a mental health professional or sports psychologist as part of your network if possible. While an athlete may not need to work with a mental health professional right now, as an AT, it’s helpful to have recommendations available if an athlete does begin to struggle with something in life or sport.

Recover on Recovery Days

Training leaves the body a bit broken down, and the biggest gains happen during recovery periods. “Beyond sleep, it’s important for ATs to emphasize that rest days are meant to be actual rest days,” says LaBotz. “Often, athletes have this idea that more is better, and think that recovery days should be used to work with a personal trainer or sneak in extra cardio, but athletes should spend 1-2 days per week away from structured sport training or competition.”

This can be especially tricky if you work with an athlete who is on multiple teams, either for the same sport (on a school and travel team) or in multiple sports. Often, those athletes won’t have recovery days because the overlapping schedules don’t leave any day empty. In that case, as an AT, your authority and advocacy may encourage coaches to find the best options for rest and recovery days for these athletes.

“It’s ideal if ATs are able to help an athlete avoid double practice sessions or weeks without rest days,” says LaBotz. For example, if an athlete is on a school soccer team and in a travel soccer program, they can likely skip one of the team’s strength training sessions each week. Most coaches actually prefer that athletes aren’t doubling up on practice, conditioning, and competition.

“It can be hard, but ATs have the relationships with the athletes, and the authority and expertise within their programs, that make them ideally suited to advocate for good recovery practices,” LaBotz adds. Sometimes, you’re the only person in an athlete’s life who has this overarching point of view, and you can make a big difference.

________________________

Takeaway

As an AT, you’re in the unique position of ensuring that your athlete is recovering physically and mentally. This means taking time off during the week, getting plenty of high-quality sleep, and prioritizing the right nutrients after a workout or competition. It also means supporting an athlete’s mental wellness, whether that’s through meditation or access to mental health professionals.

Dr. Michele LaBotz joins the TrueSport Expert Series to discuss how parents and athletes can work with doctors, athletic trainers, and coaches to get the best results treating and returning from sports injury.

Learn more about Michele LaBotz.

The goal for two-a-day practices is usually to get athletes ready for the season, but if not done correctly, they can actually increase your risk for injury and leave you broken down before the season even begins. If you’re struggling, you’re not alone, and it might be time to talk to your coach.

Here, Michele LaBotz, TrueSport Expert and sports medicine physician, shares a few simple ways to tell if two-a-day practices are becoming too much.

1. Performance Decreases

Are you struggling to do workouts that used to feel easy? Has your performance plateaued or gotten worse? Several hard practices in a row may lead to short-term performance decreases, but LaBotz notes that any time you notice a steady decline in performance and do not recover after a couple days off, it’s a sign that something is amiss.

2. Fatigue Increases

If you can’t shake feelings of fatigue, even after a good night’s sleep, that may be a sign of over-working and taking on too much in sport. It’s normal to occasionally feel tired, but if you wake up every morning feeling like you’d rather bury back into the covers, you might be pushing yourself too hard. And if you feel tired but are struggling to sleep, that’s an even more urgent signal that something has to change.

3. Frequent Illness or Injury

Can’t shake that head cold? Is your nose constantly running? Has your throat been scratchy on and off all semester? Prolonged or frequent minor illnesses are often signals that you’ve been pushing too hard, and not giving your body a chance to recover. The same is true for persistent or frequent injuries; if that ankle sprain early in the season keeps flaring up, or your knee pain has not gone away, you likely haven’t given your body enough time or resources to recover properly.

4. Lacking Motivation

If you’re losing interest in your sport, that’s a sign something may be off, especially if you are typically a highly motivated athlete. Often, when we’re heading into burnout or overtraining, our motivation lags because our brains are trying to slow us down. Be honest with yourself: Are you dreading practices? Have you stopped enthusiastically encouraging your teammates? You’re the best judge of your feelings. A coach may not notice you’re starting to lack motivation, but you can pick up on that cue and adjust as needed.

5. Under-fueling

Overtraining and under-fueling often go hand-in-hand, especially if you’re working or going to school at the same time. You need to make sure that you are getting adequate fuel (carbohydrates) and protein throughout the day to give you the energy for high intensity training AND the capacity to recover and build muscle. If you don’t have easy access to healthy meals or snacks, speak to your coach or someone at your school, as often there are programs that can help.

Schedules often get tight during two-a-days, so make sure you’re taking the time to actually eat meals and snacks around your practices. Skipping a few meals here and there as you rush around will accelerate the symptoms of overtraining.

6. Your coaches are unaware that you are training twice a day

Two-a-day practices can be hard enough to handle when one coach is writing the workouts and scheduling the sessions. But when you’re balancing two separate teams, it’s even more likely that practicing twice a day is unsustainable. Many young athletes fall into this category.

For example, say you have swim practice in the morning for your club team, and after school, you’re in soccer practice until dusk. Or you’re doing strength work in the gym three times a week like your track coach suggested at the end of last season, but your cross-country coach for the current season has no idea you’re lifting heavy the same day you’re doing hill intervals.

You should let your coaches know of any practices or conditioning that you are doing for other teams, because often, they can create a mixed schedule that allows you to show up to the important practices, skip less critical ones, and not double up on strength or conditioning efforts. This can help give you the best chance for success in both sports, and minimizes your risk for injury.

What can you do if two-a-day practices are unsustainable?

If these signs sound familiar, it’s time to talk to your coach(es). Remember, coaches want you to perform at your best, and what works well for you when it comes to training might not be the same as what works for a teammate. Just because your teammate is breezing through these double-practice days doesn’t mean your athletic ability or performance is worse. There’s no trophy for who spends the most hours practicing, and if that practice is leading you to injury and burnout, you’re doing more harm than good.

_________________________

Takeaway

Remember, the goal for two-a-day practices is to get you ready for the season…not to break you down and burn you out before the season even begins. If your performance is suffering, you’re always tired, or you’re frequently injured or ill, you may be at risk of overtraining. Don’t be afraid to ask for help if you feel like two-a-day practices are too much for your physical or mental wellness. A good coach will work with you to help you prevent overtraining and get the most from these practice sessions.