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Better, faster, harder, stronger … there's no doubt that in the highly competitive, overscheduled world of today's youth, the potential for athletic injury is a clear and present danger.

Whether it's from overuse during a specific sports season, poor technique causing unnecessary wear and tear, or the lack of off-season recuperation as many sports move to year-round practice, orthopedic surgeons specializing in sports medicine are seeing higher incidence rates in a number of injuries among increasingly younger athletes.

"I think the incidence is on the increase because of how young children are when they begin playing sports and also how much they're playing," said Michael R. Jordan, MD, an orthopedic surgeon specializing in sports medicine and arthroscopy in the Murfreesboro office of Tennessee Orthopaedic Alliance.

At the recent American Orthopaedic Society for Sports Medicine, a report on the rise in "Tommy John" elbow reconstruction surgery among high school students raised red flags. The injury usually occurs in pitchers.

Jordan, who is team physician along with Tom Johns, MD, for Middle Tennessee State University and Rutherford County and City high schools, said that for most people, this particular problem comes from overuse rather than being a one-time injury. He explained there are a number of micro tears in the ligament that begin the slow process of a more pronounced and painful tearing of the ligament, which in turn leads to an unstable elbow. Typically, he said, there is a "straw that breaks the camel's back" moment.

Jordan noted the increase in surgeries could be in part because of the lengthy non-surgical recuperation time tied to this elbow injury and in part due to more predictable outcomes as Tommy John reconstruction surgery has evolved.

"As that operation gets better, fewer people are willing to wait to have the surgery," said Jordan. He pointed out that if a pitcher gets hurt during the season, takes a rest and rehab approach for several months, and then still needs surgery and recovery time, it is likely the athlete will miss two seasons of play.

"Even though most surgeons recommend a three-month waiting period with no training and performing physical therapy, some patients aren't willing to wait that three months," he noted. "I think a mindset of the American public is that we get things fixed, if something has a proven track record, rather than taking a more conservative approach."

Brandon H. Downs, MD, an orthopedic surgeon with the Centennial office of Premier Orthopaedics and Sports Medicine, said it was difficult to determine whether too many of the surgeries are being done because it's a subjective call. However, he did add, "A lot of people come in thinking they need the surgery, but don't. A lot of times you have to talk them down."

Downs called it a "challenging" diagnosis and said, "The ligament is difficult to visualize even with a good MRI scan." Typically, he continued, an orthopedic surgeon would piece together the history with the physical exam and imaging study before making a decision.

What isn't as difficult to see, Downs continued, is that some young athletes simply lose the joy of playing. He said many of them go from one sport to the next with no break and run the risk of overuse because, "They don't have the ability to think, 'I'm very tired. I need to stop for the day.'"

Generally, that job falls to coaches and parents. Although certainly the expectation is that TSAAA and NCAA coaches are aware of preventive measures and restrictions by age group for athletes, volunteer coaches in recreational leagues might not be as informed.

"Particularly as you get to middle school, high school and college … I think the coaches are very well aware," said Downs. "I'm not sure that knowledge has penetrated deeply or broadly younger than that." He added, "I think the parents and coaches should be very aware and watchful and make sure it is an enjoyable experience for the children."

To ensure recreational sports stay fun and safe, Downs and Jordan said there are plenty of good educational resources available for anyone who works with young athletes.

Although knowledge of the rules and limitations are the foundation to avoiding injury, knowledge alone isn't the only necessary step.

"Adherence to it is the problem," Jordan said. "There's a great desire to win sports in the United States."

Jordan added that overuse is a very real danger for any athlete that concentrates on one sport year-round. He noted that the same muscles and joints are used over and over without giving the body a chance to rest.

"Especially in young athletes that have growing, changing joints, too much stress isn't good," he said. "At some point every year, a period of joint rest and cross training is important. We educate people they need to cross train so other muscles around the joint get strong."

To help stress these messages, both Downs and Jordan said healthcare providers have a great opportunity to talk with children and their parents during sports exams or routine physicals.

Downs said of utmost importance is determining medical risks before a child begins to play sports. An in depth history could help avoid tragic consequences such as those often attributed to hypertrophic heart syndrome. Assuming a child is medically fit to play, then Downs said providers need to take the time to counsel patients and parents on getting proper rest, balancing sports with academic studies and not to get too stressed over what is … after all … just a game.

Jordan added it is important to determine if a child is already experiencing any pain. If so, he said physicians and nurses should discuss resting and suggest the adolescent visit an orthopedist.

Downs added that for female athletes, it is especially important to discuss overtraining and how that could impact their menstrual cycle and affect bone health.

"They may never achieve their peak bone mass," he warned of girls who are underweight and train too hard. "It can set them up for stress fractures now and osteoporosis and insufficiency fractures down the road."

"People don't want to hear it, but it's not all about winning," noted Jordan. "It's about playing the game safely."

That said, both surgeons stressed the many positives of sports including learning to play as a team, handling victories as well as defeats, and putting forth effort.

"Like most things in life," Jordan concluded, "moderation is the key."

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