Ask the PT: When Should Kids Start Lifting Weights?
Yukiko Matsuzaki PT, DPT, OCS, SCS from the Hospital for Special Surgery shares her wisdom.
With all due respect, none of us want to see Yukiko Matsuzaki. As a Board-Certified physical therapist specializing in the treatment of children and adolescents with orthopedic and sports injuries at New York’s Hospital for Special Surgery, Matsuzaki has treated every type of sports injury imaginable. Some are freak accidents but so many, far too many in her opinion, are the result of overtraining. Matsuzaki is extremely passionate about overuse injury prevention by educating parents and caregivers. She wants to see more kids navigating their youth sports journeys in good health and less sitting in her office awaiting rehab instructions.
I’m thrilled to let you all know that beginning today Matsuzaki is going to be a Good Game regular! Today, we’re starting with a few general burning questions that I think will apply to most of you lovely readers and one from a VGGer (Very Good Gamer - our premium subscriber tier which you are all very welcome to join ☺️).
The plan moving forward is to check in with Matsuzaki every 6 weeks or so and hone in on a different sport and its specific issues to share with you all. But for now, please enjoy this primer.
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GG: What sports are you seeing the sharpest rise in injuries?
YM: This is difficult to answer because I’d have to look into our database and consider the epidemiology, plus it depends on the type of injury. But if we’re talking overuse injuries, not something like an ACL tear, the big sports are soccer and basketball. We see a lot of shoulder injuries in volleyball and swimming, too. But I also think it’s because there are more kids participating in those sports than some others. Early sports specialization is definitely contributing to it. It's an area I’m very passionate about, especially because it’s not so black and white. It’s not that specialization is bad for you, per se. But many kids also don’t condition, don’t stretch at home or rest. They don’t take care of their body.
GG: With overuse injuries, is there a silver lining, like maybe it’s a wake-up call to the parents and athletes?
YM: Overuse injuries can happen again. They can be recurrent. And kids who come back will say they have new pain. And we’ll say you have to treat it; you have to do these exercises. They say, ‘ok great,’ but don’t follow through. Sometimes it takes the second or third recurrent injury for the parents to actually hear what I’ve been saying. That’s often the case. The first time I see them back, it’s like we never talked about it, as if the treatment plan went in one ear and out the other. Some people listen from the get-go but the majority, it’s not until the second, third, even fourth time back that they realize they need a change in behavior.
GG: What is the role of stretching when it comes to injury prevention in young athletes?
YM: I think it’s super important in kids who are actively growing. We can’t put an exact age on it because certain boys grow quicker. When they’re 10, they may have a huge growth spurt. When these kids are having an active growth spurt, they should be doing extra stretching with focus on the big muscle groups like quads and hamstrings and glutes. If you’re an upper body athlete, then some shoulder exercises are important
GG: What about guidance for stretching before vs. after the activity?
YM: For kids, you want to do dynamic stretching before an activity. That would be things like buttkicks and Frankensteins where you’re constantly moving the leg and arm in a fluid motion. You don’t want to hold anything for 30 seconds.
Frankensteins are your friend.
GG: What is your guidance for kids and strength training?
YM: You should always be doing some kind of fundamental strength training. Strength training sounds like you need to go to the gym and lift weights, but it really can be achieved through regular movement.
When you think about the pyramid of sports training, most kids are training at the top of the pyramid which is about the top 5% of what you should be doing in youth sports. They’re practicing the sport and the skill over and over again. What they’re really missing is the base of the pyramid which is fundamental strength in the core and legs. Can you do a really good squat with good alignment and control? Can you jump with good alignment and control? Can you balance on one leg? So many kids can’t even balance on one leg for 10 seconds with their eyes open. It’s really bizarre. So many of these things can be improved by just doing the basic stuff. It could be side planks. Squatting into a chair. Just bodyweight stuff.
GG: Is there an age when it’s too young?
YM: No. Squatting down happens in toddlers. Toddlers know to move in the right way. You have kids. You remember when they were 13- or 14-months old learning to walk and they would go get something off the floor and actually bend down in the correct way. They have that, and somehow during the growth they lose it.
Some have this alignment called genu valgum where the knees come inward, what we would call knocked knee position. Other don’t align the hips to be sitting back and then their knees are migrating really far over their toes.
The growth spurts continue to mess with their ability to move correctly. You should be training correct movement throughout the lifespan so like when a kid is four, practice jumping off a playground structure – not too high, of course – but they should practice jumping off and bending their knees and making sure their knees don’t go in. Make sure they’re landing correctly and keep training.
In terms of tangible weights, maturity plays a role. If you can master the movement, whether it’s a squat or shoulder exercise, then you can add the weight or band. That’s really key. And it would go for a 16-year-old too. If they’re not ready, I’m not going to add any type of weight. If they’re 7, 8, 9, I don’t tend to use much weight, body weight is almost always enough.
GG: (Asked by a Very Good Gamer) My kid has been suffering from Sever's disease (heel growth plate pain). Is there anything I can do to accelerate the growth plate process?
YM: It sucks. It’s painful, and it’s annoying. There’s nothing you can do to accelerate it. The fact that he or she has Sever’s disease just means they’re growing which is a good thing. The main thing for this is calf stretching to keep the calf muscle flexible. While they’re growing the bones get longer, but the muscle flexibility doesn’t catch up quite as quickly which is why you end up with this tight calf which then pulls on the growth plate and becomes painful.
GG: Can you still be playing sports? Will it impact the growth process?
YM: Usually, it’s as tolerated. If it’s really bad then you should rest from running and jumping kinds of sports. You don’t need to be a couch potato, but you may need to modify your activities. Cycling would be good. Swimming would be good. This is just while they’re going through the growth spurt.
GG: What are some other growth plate issues we should look out for?
YM: The knee can be worse than the heel. There’s Osgood-Schlatter disease where there’s the bumpy thing in your tibia bone. That becomes painful. That’s at the bottom of the patella tendon. Then at the top of the patella tendon where the tendon attaches to the kneecap, that’s another location where people get growing pains. That called SLJ syndrome. With that one, you must not ignore your pain like a lot of soccer players do. If your pain is at an 8, 9, or 10 and you do one big shooting motion, you could pull it off the bone and it would fracture. But those cases are rare.
GG: What about the role of ibuprofen in getting through these various growing pains?
YM: I don’t recommend masking your symptoms with medicine unless it’s super critical. Like it’s a showcase or you need to play to go to the next round of a competition, that’s ok. But in general, it’s not a good idea to mask your symptoms because then you don’t feel it which is good, but you don’t know what is happening to your body. Pain is a way of your body telling you something, so I think its super important to keep an eye on it.
GG: If you could stand on a mountaintop and send a message to all youth sports parents, what would it be?
YM: To start, if your kid is specializing or is at some level that is very competitive where the parents say, ‘oh my kid is at an elite level,’ they must be at least resting one-two days from that sport. They also have to be conditioning.
So many kids train six days a week. and then they have competitions and tournaments. There are no rest days. And they don’t condition. They do no stretching. No strengthening. Nothing. I wonder how some of them can hold a racquet with their arm because they don’t have any strength. When you’re a young kid you can just plow through things as long as you have the skill, but at some point the body won’t tolerate that so you do need to have baseline strength. Fundamentals. Basic stuff. Nothing complicated. Core. Hips. Legs. General strength and flexibility are key for the growing athlete.
GG: Where does cardio factor in the conditioning?
YM: Cardio is more fitness than conditioning. I don’t know if you can be an elite level anything if your cardio is not up to snuff. But for general conditioning, if you’re a soccer player, get on the bike once a week. Those are different movements, and on a bike, you’re not pounding like you do in soccer.
GG: What about the multi-sport athletes? The athlete who has two basketball practices a week and three soccer practices and then games or tournaments on the weekends. Is that kind of load ok because it’s not the same sport?
YM: In general, kids who play multiple sports do better, mostly because different sports have different movement patterns, and that helps their bodies learn how to move differently. You gain a wider range of motion of movements, different strength. That wide variety of movement control can also be protective against injury. If you’re just a runner and you’re only moving straight forward, it’s such a repetitive motion. If you throw, say, tennis into that now you’re moving sideways. You have different muscles activated. Hip abductors can activate better. You throw some basketball into it, now you’re doing some jumping exercises. Those are all part of training. So yeah, doing different sports would make you a better athlete and be more protective against injuries.
Read more about Yukiko Matsuzaki PT, DPT, OCS, SCS and her patient stories here. And if you enjoyed our conversation, please consider sharing Good Game with a friend. Thanks for all the support!