Sports specialization and misguided parenting practices have led to undue stress on athletic youngsters, with physical and psychological consequences now exacerbated by the quarantine. Pediatric orthopedist Nirav K. Pandya, MD, defines age-appropriate levels and types of activity, provides resources to offer parents, and discusses return-to-play guidelines for COVID-recovered kids.
mm. All right welcome everyone. Um to the webinar. Thank you, thank you for joining me today. Um and this is obviously an issue that's very dear to my heart. It's obviously become heightened in the pandemic. So both use sports and kind of return to use sports in the context of the pandemic as things get under control. So feel free to obviously send questions to Tabatha and I'm going to go through this talk and we have a couple different objectives uh in terms of what we're going to talk about here. Number one I think it's important for any talk to. Number one review the epidemiology of youth sports because I think in order to understand how we're going to return to use sports, we first have to understand where we are and where we were going into the pandemic. We're going to dispel some misconceptions about specialization and I think sports specialization has become even more prominent during the pandemic. As really the only access to sports has been in private settings. So we're going to talk about some of the risks and very limited benefits of specialization. We're going to talk about some common injury patterns you may see as kids get back into sports after covid 19, we'll discuss the impact of Covid has had on youth sports. And then um I think probably some of the biggest take on points will understand the return to play recommendations for patients who may have had covid or are returning to sport in the context of a pandemic that hopefully will be getting better over the next several months. So kind of first kind of talking more about, you know, how you sports culture is kind of transformed over the past 10 to 15 years. I think if you want to summarize it this side does it does it really well. And you know, for most 34 and five year olds, you know, when a lot of us on the, on the webinar here, we're playing sports, it was about just going out and having fun. You signed up for whatever your parents signing up for, you played sports, you played out in the yard, but now it really sports is transformed in this area of sports training, where kids are trying to the same skills rather than just be out there to have fun and the same sort of pattern or sports participation has been present in the pandemic as well too. Now, currently, in terms of epidemiology, their 5.5 million Children who are involved in in school sports and their 30 million Children who are involved in out of school sports. Um, and that's really important to know, in terms of the differentiation in terms of where kids are playing right now, you know, with the decreasing funding in terms of physical education programs in public school funding, most kids now are basically accessing sports outside of school. If you actually look at the pandemic, this number is actually seven or eight fold right now, because most kids are either only getting zoom pE classes and school based participation, particularly California, it doesn't exist. So the vast majority of people who are accessing sports are doing so through the through the means of private clubs which are very problematic in the context of the pandemic. And as I mentioned before, this arise um in private sports participation has occurred with a concurrent drop in school based physical education, with only 29% of all high school students participating in daily PE classes. And now in the electronic era right now um it's almost only 10% of kids have access to daily P. E. Even in electronic form. So we really have a large group of kids who are not able to participate in uh physical education classes. So the problem really is right now and in the pandemic that young athletes are specializing in sports And certain positions at an earlier age, they're more than 3.5 million Children under the age of 14 who have been treated annually for sports injuries. This group of kids particularly have immature bones, they have insufficient rest after injuries, that poor training and conditioning which all contributes to injuries. And these clubs sports are continuing during covid and the fact is that we already had a problem before the pandemic with these clubs sports and they're continuing kids are basically handing money over. Parents started to participate in an environment which is leading to more injury and also leading to more sickness which we'll talk about a little bit later in the talk. So, to kind of give you a sense of how this problem is magnified pre pandemic. Over the past five years, we've seen a 400% increase in youth CCL tears over the past decade. That's because kids aren't playing sports in the right way, they're not going out and basically doing free play. And if you look at the data, this has particularly been an issue for high school. women who play basketball and soccer. You can see the tremendous amount of risk of this particular group has, which is only going to be worse than his kids contribute or go back into sports. Um, once the pandemic is better under control in the California Interscholastic Federation, let sports uh continue. So the problem we really faced with right now, pre pandemic was that we had a highly elite group of athletes who are specializing at young age who are susceptible to injury. We had another group of Children who basically we're not having any activity at all because they didn't have access in terms of their school, they didn't have access uh to clubs, sports because their parents can't afford it in any thrown uh covid. And that's basically muddied everything where you have kids who are now getting injured or not being active even more so because of all the different concerns or the pandemic and people who have money who may live in certain socio economic groups are continuing to play club sports and contributing to lead to more injuries. And other group of kids who are becoming more and more inactive, which is leading to a whole set of problems as well. To particular when they reintegrate into activity in the summer. So the clinical part of youth sports is is easy. You know we we know how to fix an A. C. L. We know how to fix the meniscus, we know how to treat shoulder instability. But it's a non clinical part of things particularly the pandemic which is very difficult. It's a social aspects of things. The emotional part of things is tremendous. The emotional impact on kids whose life revolves around playing sports um is um tremendous. And now that they're not playing sports anymore. The mental health issues are are very very big. So I think that's a large issue in terms of what things are going to be, what things are going to be happening and if you look at professional athletes not playing is it costs them millions of dollars. So when Steph curry injures something they keep him out for more than he needs to in terms of his healing time. But they treat them with extreme caution because they understand that getting this injury, health is the most important long term thing. But if you look at this youth athlete comes to our clinic, even in the context of the pandemic, these parents have this anxiety right now that their child is going to lose a scholarship and Covid is increases anxiety, which we'll talk about a little bit later and they feel that these scholarships going to disappear because their kids aren't keeping up with everyone else. And these athletes who have very, very severe injuries are treated without caution and this is a problem that we have to deal with really counsel parents as they move forward. The real problem is why is this happening now? Why? When I grew up, it was Michael Jordan era and kids were playing multiple sports. Why in this quote unquote Lebron era of sports, are our kids specializing right now and why is it getting worse during the pandemic? And I think it's all about societal pressures right now. You know, back when we were playing sports 10, 15, 20 years ago, maybe even more for some of the people in the audience, we played sports and then we live the rest of our lives. But now we have social media, we have parental pressure, we have coach pressure, we have peer group pressure and there's a lot of pressure to perform well and to basically achieve skills rather than achieve basic, just pure, you know, cardiovascular fitness, physical fitness, etcetera. And Covid has increased parental anxiety around sports. I think it's probably the most important thing we need to remember as we treat patients in our office is that for a lot of parents who are chasing a scholarship, covid is totally upended their life. Their social group has changed. Um, there have this thought that there are other parts of the country or other other cities where kids are continue to play sports and they feel that there's a year out of organized sports is really going to impact their ability to actually get to the next level. And so a lot of these parents come and are willing to push their kids even when they're injured, they're basically having their kids hide injuries because they want them to participate. They're looking for any means by which they can actually get a training advantage. So I think that's really important to understand when you're seeing these kids and really make sure you're querying the parents and the kids to see how bad is our injury. What are their goals really emphasizing to them that this period of time off, it's not going to impact their ability. The only thing that this may actually do in a silver lining in sense is kind of stopped them from playing so competitively give them the time to do perhaps more free play and get back to a more normal level of activity for their age. So I think a lot of this chase has to do with this number where a lot of parents become frightened by the concept that, you know, a four year college will cost $200,000 and some studies say that in the next 5 to 10 years this will be 250 to $300,000. So there's this great financial pressure to get a scholarship. So they technically don't have to pay this great amount of money for their kid to get into school or potentially using sports as an avenue to get into these universities. And as a result, what a lot of parents have done is used utilize Eric since 10,000 hour rule Where he said that in order to achieve expertise, it's something you need to practice it for 10,000 hours at a time. This has been subsequently disproven. Even music as real parents here that they say, look, the only way that my kid can ever get, go to the sport is for a hit he or she to practice it all the time. So as a result, we're getting kids now are basically specializing at a sport year round at younger and younger ages because these parents falsely believe that in order to become a specialist at something, you need to be just playing that year round. And what's happened is an option of the pandemic is that because these kids don't have access to pE classes, they have access to their peer group. A lot of parents are basically having these kids in their backyard, throwing the ball hundreds and hundreds of times, having them kick a soccer ball, really developing skills, rather just taking them out and developing regular physical fitness or because there aren't those school based options, they're just having the kids sit around. So once again, it's that paradigm, the super specialist kid who is now sending them up for more injuries and other other group of kids who just don't have that outlet specialization is really driving this because there aren't regular outlets for these kids. And then you throw money into this as well too. And it becomes even more complicated because these youth sports entities that are available are religious interested in money. And there's a supply and demand issue when they realize that there is, they are the only option the pandemic for sports participation. They're charging more money and more of these clubs kind of popping up right now that are promising athletic activity, which may not be followed following covid precautions. They may not have the best interests of mine and a lot of these coaches don't even have the training to be running these clubs and they potentially are injuring kids and exposing our communities to increase burden of coronavirus. And if you look at the money, it's pretty startling news, sports become a $15.3 billion dollar industry and the pandemic has not changed that number at all. And I think a large part of this, we'll talk about this in the context of disparities. Alcove, it has changed. This Is that 63 parents will pay 105 up to $500 per month, Nearly 20% pain over $12,000 a year. And for a lot of families who are impacted by covid economically, They just can't afford that $12,000 a year or even $5,000 a year. So once again that entry in order to play sports, the pandemic has become even harder for a lot of families who maybe we're barely holding on financially and just don't have that option anymore. And as a result, free plays was before the pandemic is not encouraged and it's becoming even less encouraged right now. People feel that they need to be an organized environment, but I do feel that one silver lining for a lot of the younger kids especially is that in order to get activity out there, going to playgrounds, especially when san Francisco and Oakland, open them and if you actually think about it, it's probably the best type of training kids could be doing, going to the playground, running, jumping, working on balance, learning how to fall properly on a safe surface is probably the best thing that kids can be doing in terms of developing athletic activity. So perhaps one silver lining from the pandemic as we're getting people to play out in the park, do more active things, do things in a socially distanced manner and that may be the best thing for them long term as opposed to an organized activity. It's going back to all the things that we used to do when we were younger, younger athletes, younger Children who just wanted to be active. Now, you know, a lot of these parents where this anxiety stems from and once again, this is important as the council parents both in covid and hopefully post pandemic as we move along Is that the chance of actually they're young athlete actually making it to the next level is actually really, really low. So the chance of a high school athlete going professional is .006%, that's extremely low. But every parent feels that their kid has a chance to go professional. Then you get the next group of parents to say, well, you know what, my kid might not go professional, but they might actually get a college scholarship. And that chance is actually only 2%. So the number of people are actually paying for a club sports who will never get a college scholarship far outweighs those who actually will. And one thing that parents don't know is the actual average scholarship amount over four years is actually $11,000. And you saw that $12,000 amount. So most parents who are very well off are paying tons of money for their kids, who may never get to that next level in one year of clubs, sports has already outstripped the amount of money they will get paid for a scholarship over four years if their kid is even that 2% who gets it. And there are actually only six sports and the way that actually give full athletic scholarships, Football, men's and women's basketball, gymnastics, volleyball and tennis, and the two sports in the Bay Area, which are notorious for club sports, which are women's soccer in men's baseball, don't give full scholarships and parents don't know that. So they're handing over money to these clubs, sports thousands and thousands and thousands of dollars even more so on the pandemic because they're getting anxious And it's going to, they're not even get a full ride and they may not even get that $11,000. So it's important for them to understand the economic decisions in, in making and deciding where to have their kids play. And an outgrowth of this as well too Is that 20% of kids will drop out after use sports in the top three reasons they give our adults, coaches and parents and talking to kids and this is not backed up by any larger studies, but talking to a lot of kids right now who are just doing, who are doing club sports in the pandemic, they're beginning to hate participating in it even more because it seems to be just simply something that seems like a job right now. They have no other outlet. They're not getting to see their friends, but they're somehow getting shuttled off to these club sports practices where there maybe or maybe not wearing masks and they're being told to develop skills and they're going back in their house not interacting with anyone else. And for a lot of these kids, they can't quite understand why they can't develop those normal social relationships. Their parents are willing to take the risk to send them out to clubs sports practice, which actually is detrimental to their mental health As opposed to regular free play in regular social interaction, which actually going to be positive. So once again, I think parents need to understand that already in a normal normal mental health is being impacted by participating in clubs sports for more than 10-15 hours a week. And now they're basically going to this this kind of activity which has an increased amount of anxiety and stress placed upon it. My parents who already have this underlying anxiety for sports participation. So I think one of the most important things you need to tell parents, particularly your counseling them both in and hopefully after this pandemic is single. Sport specialization is not going to lead to an athletic scholarship, but what it literally two is burnout injury, even more social isolation and poor adult health, all the injuries that they get. So some of the data, you can kind of sight to parents when they come in. Uh and and this is probably one of the most important slides in terms of how much kids should be playing, particularly as a transition back into sports after, you know, being inactive or in general, even when they are super active is that there's a great study that was done by Nuri gigante was now out of memory and he basically found that The number of hours you should be playing sports per week is equal to your age. So basically for 10 years old you should be doing 10 hours of sports per week. When you get over that number you're probably 70% more likely to experience severe injuries. That's a great rule of thumb. Um about how many hours per week kids should be doing, particularly they reintegrate into sports after the pandemic. It's when they get higher than that level, they're going to start getting injured and probably want to drop that number a little bit down low, particularly kids up in super active during covid. Another example that shows that how kids make it to the next level. This is study at U. C. L. A. And they found that the vast majority of scholarship athletes actually specialist at a much later age. So once again encourage kids to play multiple sports, particularly when they reintegrate as opposed to just concentrated on soccer or baseball or basketball when sports are more available. And finally, we get one group of parents who always will say, I'm willing to take this risk if it's the only pathway professional sports, they're willing to number one, take the COVID risk and travel across the country. # two, they're willing to take care of the injury risk, um, that a lot of these parents, a lot of these kids will have by playing professional sports. And it's important to note that we do know and most people will agree that they know that sports specialization increases injury risk, but a lot of them will, will still say that, you know what, I think this is the way that what I need to do more to get professionally and what I'd like to tell a lot of parents is you can't become a professional athlete unless you are healthy and on the field. I think that's a really, really key thing to remember. And I coached at the collegiate level is too, as a collegiate track runner and then coached at the collegiate level as well too and help to recruit athletes. And the number one thing we looked at was injury history. I mean, obviously with the performance, number one, but if you had at risk of being injured, which came from you put in proper training techniques, doing too much training were less likely to want you on the team. So I tell a lot of parents the only way you're going to get, you know, get to the next level is if you're healthy, if you're healthy, then every college coach I want to work with you, particularly you have some baseline level of talent. But if you're injured, that's going to be a warning, a red flag for a lot of these coaches when you're looking to play at that level. But if you critically look at professional sports data and this is another thing, I think it's important as you counsel parents as they try to over integrate their kids back into sports after the pandemic is that the data doesn't hold out even for sports specialization. This is a study that we did here at UCSF looking at NBA first round draft pick. So I found the ones that actually played multiple sports in high school experienced fewer major injuries and had longer careers and those who played in one sport in high school. And these were elite level athletes had natural talent in that variable played multiple sports actually lead to a longer career in uh less injury risk. When you look at the NFL combine, 88% of individuals at the NFL combine. The elite of the elite athletes played multiple sports in high school. If you look at Major League Baseball, the most of them who had serious injuries were ones who actually specialist early on. If you actually ask most Major League Baseball players, they all said that you have to play multiple sports and most of their teammates played multiple sports. And we have a podcast here at UCSF uh six called 68 weeks and we interviewed Kevin Youkilis recently who was a two time world Series champion with the boston red Sox. Um, Hall of Hall of potential Hall of Fame candidate. And we asked them, you know, did most of your teammates play multiple sports when you, when you guys were on those winning teams, they said the vast majority then played multiple sports. And we asked them, do you feel that kids need to play multiple sports nor succeed? And he said, absolutely played multiple sports is much better. He wasn't burnt out on baseball, he was able to do multiple things in that that's what he felt was probably the biggest contributor him making it to the next level. And he tells the story of playing baseball and kind of going up and he didn't, he didn't think he'd play at the next level, just kind of kept going playing freshman sophomore year, junior year, he was playing multiple sports and he enjoyed it. And that's the most important thing. A lot of these kids who specialize just don't enjoy the sport. And I think that's the most important point. One emphasize the parents, particularly reintegrating kids that make sure his kids reintegrate, they're having fun. If they're not having fun, then you're set up for injuries as well as burnout as well too. So I think the key point is kids reintegrate both now and in 10 years from now is make sure they're playing multiple sports which is quote unquote active rest for me. You can play multiple sports and rest in other parts of your body, particularly as you kind of try to design a training program for your patients as they go back into sports. I think it's important to look as we kind of go in. The latter half of the talk is how is covid kind of specifically looking at the data impacted use sports participation and how has it changed the landscape? So when you look at the data project play, which is one of the Aspen Institute has some great data in terms of use sports and epidemiology. If you look at the past couple of years, past couple months, even though more kids are returning to sports important though that even though I am talking about a lot kind of quote unquote crazy sports parent, if you do actually query still a lot of people, a lot of parents still worry that their child will get sick by playing again. And that increases has gone up particularly look at California, did a lot of southern southern California, which is kind of a hotbed of you sports. There's obviously a lot more parental concern about going going back and this is just like with everything else that is stratified amongst, you know, individuals of color and those who are not. Um and particularly communities of color are more concerned about it and therefore they're the ones who are less likely to participate in these clubs. Sports, which is kind of, you know, widening the divide in terms of participation as well too. If you look at actual hours kids are playing right now, it's about six hours less per week on sports steering, covid. Um, and so I think that's one thing to keep in mind as well to when kids are reintegrating into sports, understand that they have been, there is a large segment of the population still has been participating participating less, um, than than than what they typically did one positive side. A lot of individual sports have taken taken up, there's more bicycling right now, a lot more kids are out running, but that has also brought up a whole new set of injuries in terms of, you know, individuals not knowing how much to run, uh, doing a lot of excessive weight training or bicycling improperly. So I think we're going to see a whole new set of injuries over the next couple months than when team sports start again, understanding where their activity level was before. An important point to note as well too, um, which, which I think is really troubling is the amount of youth sports tournaments that are still taking place. Um, private youth sports tournaments should not be taking place in California for the guidelines. They're still taking place particularly in northern and southern California and Northern being north of here, in the Bay Area, in south Orange County san Diego area. And these are super spreader events. There's been multiple events where, um, you know, these organizers come and you're getting a bunch of different households, a lot of them from out of state coming together and playing kids aren't wearing mask, families aren't wearing masks and there's a lot of community spread that's occurring. So I think from that standpoint as well too, we have to counsel parents if they want to participate in these tournaments that we should encourage them not to because there are other healthier ways that kids can participate. It doesn't spread covid, it allows you to protect, protect your neighbors in your communities. The other issue as well too is a lot of other states have different rules, particularly Arizona and texas Nevada. A lot of these families in California who are kind of at this chase for scholarship are traveling out of state, having their kids to play, being around 1000 different households and coming back to the communities with with risk of covid spread. So I think it's something important we need to consider in terms of general community health, which may not have been there with covid. So I think it's an important thing. We need to counsel parents not just about the injury risk, but what they may be doing to their community and they're more at risk family members about participating in sports in this, in this. In the current time, As I mentioned before, the California Interscholastic Federation has basically put a hold on school-based sports right now. They're supposedly on January 19 going to release some new guidance. I think the first sport that may potentially come back as cross country, um, where a lot of the practice can be socially distant and you can kind of change course and start times to decrease the risk of covid. But I think that currently right now with the surge that may get pushed back. But I do think we'll see some form of particularly high school based sports, um, in the spring or the summer, but I think will be very limited. I think there's a very low likelihood of any indoor sports and contact outdoor sports may may not be allowed. And tennis is another one where there's some talk of coming back, but once again, a very limited spring and summer sports season from a school based standpoint. Now, when it's currently right now, over the next couple of months, when covid is still kind of in the surge phase, I think, you know, you're still going to get some kids and families who want to reintegrate into sports. And I think it's important to assess their covid risk in the various fashion so that families can make an informed decision as well as you in terms of counseling members. So I think number one, um, the first thing I have to ask is, is somebody one of my child or any household members more vulnerable to becoming ill from covid 19. If there is someone who is vulnerable, I think there should be a strong note. Um, even though the child that maybe you know, fine, we know that obviously there's a lot of asymptomatic transmission from Children. And if you've seeing some of these videos of you sport tournaments where kids have their mass calf on its on their face, they're still celebrating afterwards. I mean, even in professional sports, like the NBA or like the NFL where you're seeing a lot of transmission, um, even with the best of protocols that can still happen. So there's anyone else you should definitely should not be playing. You have to talk about risk mitigation with this program. What are they doing in terms of distancing, in terms of contact trace, in terms of mask wearing. Um, and are they really taking a phased approach? Are they basically saying, okay, we're gonna have soccer, but we're just going to basically do drills, we're going to do team based practice within based within team competition. We're going to stay in our geographic area. Are we going to teams from different geographic areas? So I think that's really, really critical, um, in terms of assessing how your kids were playing, if they go back to covid. Um, and then, you know, in terms of the contact tracing, if someone's covid positive, how are they going to deal with it? They're going to let other families? No. Are they going to shut down the program? It's important to ask these important questions. A lot of these clubs don't have that, Right? And then I think internally, you also have to know if your kid's gonna be infected, should you avoid participation? Um, do you feel that you have a grasp on what covid symptoms are? And will you get tested or is there a daily screening program? How honest are you? Are these parents going to be and as your child old enough to understand why you need to physically distance? And I think that's important as well to a five year old may not understand why if you say six ft away, but a 17 year old may, so that may change the, you know, the level of maturity of your child in their age, determine whether they should be physically distancing what mask procedures in place. I think masks should be at all times during practice, any program that says we're going to take off mask for a certain period of practice you should veer away from because of the risk of spread. And I think also there's a legal aspect of how comfortable are you signing a covid waiver, like if the coach doesn't listen or they're exposed at a tournament and someone gets sick or is hospitalists or worst case scenario has a death? Are you comfortable signing the waiver particularly there is a gross violation of Covid precautions at this club sport program. Um I mentioned our podcast before. Um if you like to go with this a little bit more in depth in terms of some of the logistics is going back into a sports both from a youth sports level, as well as a professional level. We've had three or four people on who specifically talked about this. Um, we had a general episode about returning to Covid. We had dr bob Wachter who was um internal medicine doctor at UCSF was kind of one of the nation's experts on Covid. He gives some insights and how um we can return to sports safely. We had john Solomon, who who works at the Aspen Institute where I showed a lot of that initial data, We talked to you about youth sports and covid and you get kind of a large scale professional perspective as well too. We had Sarah Spain on from ESPN to talk about it. So kind of tackles this from various different lenses. I think it's a great resource also for parents as well to um, to kind of hear from different people because I think a lot of times when they come into our office, they feel we're just preaching to them. But sometimes hear people who are second distance from the office, talk about some of the risks and considerations can be helpful. And right now, I think it's great to look at some of the resources that's about the NBA right now, some of the struggles they're having in terms of reintegrating sports, Even trying to handle a group of 12-15 individuals and some of the problems with that. So I think it's an important thing to consideration to make sure that parents and yourself are very involved in terms of the nuances of testing, contact tracing and risks of playing. Now for the segment of us that may actually have covid patients who are positive and trying to get them back into participation in some form. This is a, this was actually published in Jama Jama cardiology where they talked about how to clear patients back to activity, who may have been covid positive. And most of us do you know that there are unknown cardiac and respiratory risks and I think the regulatory risks are actually pretty um, you know, pretty you know known that you have shortness of breath, etcetera. I think the cardiac risks are still unknown. There was Candy johnson who was a player for University of florida basketball collapsed. We felt may have been related to mild car died from covid. There are other professional athletes have had Marquardt artist. This is a very kind of in depth detail, you know, kind of algorithm for getting patients back. So I think particularly the higher level high school athletes, I think it's important to have a set in stone program for how you're going to clear them to go back to activity because of myocardial. The heart risks are real. And I think it's important to make sure we're clearing patients appropriately if they get them back uh, into sports. So this will be obviously my slide. Um, it was publishing I think it was Jama cardiology but obviously won't go through the details, you know, pediatricians and interim medicine dioxide Family Medicine Doctor can be more up to date with this. But there is definitely a very complex algorithms if patients are Kobe positive, come back just to make sure they're clear from a cardiac standpoint. But then just for your general athlete, who may not be covid positive and they're trying to get back into activity. What are some of the things specific things you can tell them beyond, you know, understanding having them understand the risk of sports participation. I think in general, you have a kid who's who's been following directions is basically all they've been doing is um pe maybe going out for a walk with their family and or maybe riding their bike When they reintegrate into sports. You want to ramp them up slowly over a period of 4-6 weeks. And that means maybe doing 25% of the volume the first week, Then 50 then 75, You have to be honest about assessing their fitness. So for a lot of kids, what can happen is that if they've been sitting around all daniel exercise, I've been getting us walking, putting them into a 3 to 4 hour club club sports soccer program. They're going to lead to injury to use an example. We saw this in the NBA and NFL, which I'll talk about in a second. You can get injured even with a lot of training beforehand. So I think that's important. You have to encourage parents and their kids to be honest about pain and how they're feeling in terms of them being winded. And you know, I have a 10 year old is very active, played a lot of sports pre pandemic and we're just out riding his bike. You know, a couple months in the pandemic is like, I feel tired and I, you know, I'm short of breath, I'm just out of shape. You'll be surprised how many, 89 and 10 year olds just like normally going to school running around the game a certain amount of cardiovascular fitness and they're not getting that anymore. So I think it's important to understand that when we just thought kids going to run out and they'll be fine, they'll be in shape. This is the first time in a long period of time. Our kids have an extended period of time off and we need to understand they need to ramp back in quickly. An eight year old may need some time to get their cardiac arrest story system back up to speed. So I think that's important to keep into consideration as we're, as we're ramping people back up. There's lots of resources on the web. Aspen Institute has this, I'll be happy to share this with people as well too. Their gradual programs that are out there for things like throwing uh, for things like running as well too, in terms of how to reintegrate kids back into these activities. So I think it's important to have a regimented program that families and parents can follow. Um, so they know how to get kids back in because it's easy for me to say go slow, but they're like, well, how many times can I throw, How much should I run? Um, so I think that there are programs out there that will help to guide parents, uh, and clinicians and helping parents get back to their sports properly. Other things that you want to look out for that may not necessarily manifest as quote unquote pain that can indicate that a kid maybe burning out even the early phases of sports reintegration. Number one, if that pain in the area after physical activity, that's a sign they're getting pain during activity, um, that without restricts performance, that may restrict performance as president rest. These are all warning signs of burnout and the need to really go slowly right now. Pain that's coming for a lot of these kids is due to inactivity and when they're inactive and they try to play sports and then set up for those more traumatic injuries that potentially could lead to an operation. So I think in general, when we ask, can I play through the pain, it's okay to continue progressing. If you have general muscle soreness that goes away the next day or some stiffness and initial it starts. But if you have pain that last for a couple of days, it comes at the beginning and gets worse. It's keeping you awake at night or changes how you run or do things and that's why we have to back off training. That's the golden rule of thumb versus getting back into shape, pain versus pain, that's over stressing your body. And I think we all are going to have to be prepared for injury risk like the NFL and the NBA. And it's gonna be heightened even with the best of training facilities, A lot of these professional athletes didn't have access to train during the early phase of the pandemic. And even when the professional sports came back, their amount of practice time went down. We saw the highest number of UCL injuries in the NFL this season, there were 40 actually 42. Now, as of, as of this past weekend, That several fold higher what we've seen before in the NBA has already had three cl tears in the first couple weeks of the season. They typically have 3-5. This is a direct result of lack of pre season training, lack of time being in an explosive real game situations. We're going to see this with our youth athletes as well too. I don't even have access to these training facilities, don't have access to play against other people and then suddenly going to jump into high intensity club sport training or even other types of training. So they need to take their time, they need to ramp soldier back in. So we don't see that increase in traumatic injuries that we saw in other professional sports. And lastly, as I finish up over here, I think it's important note from our from more of a kind of more holistic perspective is that one of the greatest impacts of Covid. Um you know, in general has been a worsening of disparities in terms of communities of color and families from lower socioeconomic status. Even before Covid, there's a huge disparity and use sports for only 30. About actually one third of Children between the ages of 6 to 12 Who made under $25,000 a year participate in team sports. For those who are over 100,000 over 65 to 70% of the participated. And Covid has heightened that. If you actually look right now, probably the data, this is more realistic than only 10 to 15% of families that come from lower socioeconomic areas or for communities of color are actually able to play, use sports. And families who have the money are actually participating even more levels because they feel they need the kids out there. And it's important to understand that because you're going to get two sets of parents who come into your come into the clinic, you're gonna get the parents whose kids were participating a lot and are going to get the injuries um that are due to overuse particular all they've been doing is specializing specializing specializing during the pandemic. And you have another group of kids who are going to be at risk for obesity, your risk of diabetes or risk of all those other problems. And they are going to be trying to integrate themselves back into sports. And the schools might not have the money to support them. They might not have the money to support them and they're also an injury risk. So I think it's important understanding even though the endgame is the sandwiches injury risk To make sure we're getting these communities to participate in sports in the appropriate fashion. So for some of the communities that have been specializing too much is getting to stop that specialization and the communities that haven't been able to participate. It's important to find those avenues for participation and support the local schools to bring back physical education school-based programs for some of these kids can participate and number one not get injured when they reintegrate back, into number two actually have an outlet to participate so their mental health can improve. And once again, another stat that shows that, you know, the economic burden of youth sports is increasing, particularly with in low income families. And my last point over here, if you really think of how this impacts everything, I think this is the greatest point. This is even worse than during the pandemic as well too, is that we think of college scholarships, it's something that should be a reward for individuals who can actually afford to go to college. And unfortunately what's happened is that scholarship obtain mint even for this few they get, it is really going to pay to families who can afford to, to kind of get in this game of playing sports. So in order to get a scholarship, you need to be on a club team in order to be in a club, you need to travel across the country so coaches can see you. So what basically happened, the only kids are getting scholarships for the vast majority of them are ones whose families come from very well off backgrounds. And so as a result, you're basically getting kids whose families can afford college who are actually able to play collegiate sports. And this is only getting worse than with the pandemic families who may have at least had the high school outlet basically to showcase their skills, their on club based sports. So those kids are not going to get the scholarship because they're not playing. As a result, the disparities are widening for a lot of these kids, you don't have that outlet as a means to potentially go to college to play sports. Disparities are widening and that impact is going to be huge. So I think it's a clinician, it's important for us not just to deal with the kind of the physical aspects of this, but advocating our communities for increasing participation amongst youth who come from certain communities, making sure the recreational options, advocating for our schools to bring school based sports back and kind of letting our rex and these clubs sports know that it's important to have the opportunity for families who may not be able to participate or may not be able to afford it to give them spots almost in a scholarship sense, so that the kids can play and then all the positive impacts that trickle down in terms of activity and physical health. And not only stick with these kids in the short term, but in the long term as well, too. So thank you very much.
