Early Season Pain in Student Athletes (...and what to do about it)
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It's September, which means kids of all ages are returning to school. What this time may also mean for many is returning to sports practices. And with that may come pain.
Fall sports started in our own school district about 3 weeks ago, and since that time I have seen multiple student athletes on my clinic schedule, ranging from a soccer player with bilateral Achilles tendon pain; to a football player with an acute onset of neck pain after an old injury that was never addressed.
I'll stick with these two athletes for example purposes here, because I would argue that the majority of pain that young athletes experience at the start of any new sports season, regardless of the sport, stems from just a couple of reasons.
So, just why does a healthy, young student athlete experience pain, especially in the early season, without a mechanism of injury?
There was a sudden increase in demand of the muscles, connective tissue, and joints: Simply put, the athlete was not properly prepared for the start of the season. Whether it was a lack of conditioning in the off-season, or not doing the appropriate training for their body and sport specifically, the rigor of regular practices suddenly puts too much demand on the body and the place with the greatest impairment or limitation will be where the pain manifests. The soccer player on my schedule is a prime example: In this case, the athlete had been playing soccer, river surfing, and generally staying active all summer. So why the sudden bilateral Achilles pain? Because he has tremendously tight muscles, particularly all along the back of the legs. Without addressing this, and with the increase in miles run over the course of a week on the soccer field, the pull where his gastrocnemius and soleus muscles converge and form the Achilles tendon, which in turn inserts at the base of the calcaneus, became too much, thus causing pain right at the base of the heel. (If you want to geek out on the anatomy and go deeper on what I'm talking about, check this out.) A simple, but specific, pre-practice stretching routine improved this athlete's pain by 90% after just one week. This same example may be extrapolated to other areas of the body. If for instance, a cross-country runner has foot, knee, or hip pain, after just starting to pick up miles and speed in practice after having not run much during the summer, the demand on their body is too much and the root issue needs to be addressed. It's a relatively simple fix that your physical therapist can evaluate and then provide resources to help.
Muscle imbalances or tissue impairment from an old injury were never correctly addressed initially: Here's where my high school football player fits in. He hit his head HARD multiple times last season, compressing the spine. While he fortunately never got a concussion, it caused severe neck pain. As with most athletes, he played through it and finished his season. The neck pain improved substantially once football season ended, so he never pursued physical therapy after. However, here he is on my caseload, just 3 weeks into this season, with excruciating neck pain and decreased motion of the neck to where he has a hard time looking over his shoulders. And this is a 17-year-old, healthy athlete otherwise! His corrective exercises include neck strengthening and motor control training to learn how to correctly engage his core muscles while properly using the appropriate neck muscles for certain movements (which means, turning OFF other muscles that are working over-time because his other muscles are weak). This is a classic example of a muscle imbalance issue in combination with tissue impairment. He will do his corrective exercises at home to address the muscle imbalance piece, and I will assist in the clinic with impaired tissue and joint mobility in order to improve his pain and overall motion.
The rehabilitation looks different for these two athletes, but the outcome is the same: After a proper examination by a physical therapist to identify the source of their pain, they are provided tools to make the appropriate corrections. Pain is then eliminated so that they can compete at a high level the rest of the season.
So, what do you do if your student athletes find themselves in a similar situation with a new onset of pain at the start of a sports season? Give a couple of these suggestions a try:
Mobilize what's tight: "Mobilize"....a fancy word for Get it movin'! This may mean they need to stretch what you know is tight and shortened; or do "mobility work", which targets trigger points, fascial tightness, or even joint stiffness. Stretching is stretching --so that's pretty self-explanatory, although there are often right and wrong ways, so talk with your physical therapist if you have questions. In my experience, young athletes (and many adults for that matter) think stretching is boring and don't give it the time it deserves. In that case, disguise it as something else, such as a dynamic warm-up or yoga. If they have known trigger points in a muscle, using a foam roller or lacrosse ball are great tools to help reduce the myofascial pain that those trigger points elicit. (Check out this blog post addressing trigger points in the neck see how to use a lacrosse ball. Foam rolls are used similarly, only on larger areas of the body like the hips, legs, and calf muscles.)
Strengthen what's weak: This one's a little tougher to self-diagnose. If your athlete has seen a physical therapist, personal trainer, certified athletic trainer, or other trained coach in the past who told them what to work on to improve overall mechanics, start there. Otherwise, I'd suggest an evaluation with your sport physical therapist. They will be able to watch your athlete move in a sport-specific way and have the trained clinical eye to see their areas of weakness. The "weakness" may be in terms of shear strength, or it could be learning to control their body in certain movements. Either way, payoffs are huge in terms of reducing pain, future injury prevention, and improved performance once those areas are addressed.
When in doubt, get in touch with your deep core: I suggest this to people, and often the response is, "Oh, I do sit-ups and planks all the time." Great. Keep doing them if they're working for you. And also, I will argue that there's a sea of exercises that are available --and I'll say necessary-- for athletes to do to recruit their deep core muscles while doing everything from daily tasks to high-level competition. Once this connection is made and trained, the athletes' body control improves drastically. My favorite program out there right now is The Bloom Method. It's an on-demand fitness program marketed toward pre- and postpartum moms. However, the hundreds of classes they have are applicable to every human body. I've given this program to one of my chronic neck pain patients for example, and she returned to the clinic after a couple of weeks with this program glowing how basic movements like rolling over in bed or bending over don't hurt her neck anymore. Deep core work for the win!
If you've tried these tools and your student-athlete is still experiencing pain, schedule an evaluation with your physical therapist. After a thorough evaluation, they will be able to create a personalized plan to get your athlete back to the court or playing field in no time. Happy fall sports season!