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Hurt too soon

Torn ACLs, other big injuries hit young athletes

BY JEFF EVANS, Californian staff writer
jevans@bakersfield.com | Saturday, Jul 19 2008 10:49 PM

Last Updated: Monday, Jul 21 2008 8:09 AM

Mariah Alvidrez remembers running side by side with a player from Fresno-Bullard High School during December's Garces Holiday Soccer Tournament.

"Right before I planted my right foot, she shoved me," said Alvidrez, then a 15-year-old sophomore at Liberty High. "My right leg hyperextended and snapped."

The injury: a torn anterior cruciate ligament in her right knee.

Garces High's Sarah Reed was participating in a one-on-one soccer drill in June 2007. She was 15 at the time.

"I went to turn and cut, and (my knee) popped out of place," she said. "I thought it was just another injury that would take a week to heal."

But it, too, was a torn ACL.

In early January, Ridgeview High's Yesenia Reyes was playing against Stockdale. She went back to defend against a player and went in for a tackle.

"She had just kicked the ball and her knee rammed into my right knee," Reyes said. "It just totally crushed my knee. My knee popped out of place."

It also turned out to be a torn ACL.

This type of injury is becoming more common with younger athletes, coaches and trainers say, noting that in the not-too-distant past, one would typically only see adults hampered by these injuries.

And there's an added wrinkle: girls and women are apparently suffering torn ACLs at a much higher rate than they were 10 to 20 years ago.

"We're seeing kids 12, 13 having knee surgeries," said Tim Terrio, owner of Terrio Therapy-Fitness, which has several clinics in Bakersfield.

Terrio added that serious knee injuries were "very rare" in that age bracket when he began his career 22 years ago.

David Rous, a physical therapist and vice president at Glinn & Giordano Physical Therapy Inc. in Bakersfield, says the same thing.

"I don't have the numbers to back it up, but yes, it's more than a gut feeling: We're seeing a lot more of these type of injuries with younger people," Rous said. "I'm definitely seeing younger kids getting these surgeries done, ACL reconstruction."

Some orthopedic surgeons are reluctant to perform ACL repair surgeries on still-growing youngsters because the procedure involves drilling through the leg's growth plates, risking a stunting of still-to-come growth. But with more youngsters impacted, surgery is often the only way an athlete has any chance to resume playing athletics.

"You can do it, but you've got to be very careful of where the growth plate is," Terrio said.

"As physical therapists, we see surgeons have gotten very good at (repairing ACLs)," Rous said. "They're making strides in what they use for the surgery, how they place the ligaments, so you have a return to your God-given knee. They've gotten better at that and it's taken awhile for them to get there."

Once families are confident the surgeon can perform procedures safely, it's a no-brainer.

"It was either get it fixed or never play again," said Alvidrez, who underwent surgery Jan. 17. "My parents wanted to get it fixed. Me, too."

Alvidrez said she is far along in her rehabilitation and hopes to be medically cleared to resume playing soccer by the end of this month.

Reed, who underwent surgery in August, said she was medically cleared to resume playing soccer in May.

"My therapist said I was very quick (healing), quicker than normal," Reed said. "I would say I'm pretty close to normal, but I'm a little afraid. It's more mental than physical."

Reyes, who will be a senior in the fall, delayed her surgery until May 30 and is early in her rehabilitation phase.

She said she has given Cal State Bakersfield a verbal commitment to play soccer when she begins college in the fall of 2009. Reyes said she won't play soccer at Ridgeview this season, her senior year.

"They barely got me on the treadmill ... so I'm maybe five or six solid months away," she said of the timetable for getting medically cleared to play. "What is best for me? Is it high school, but if I go back and I'm not ready and I get hurt again, is that worth not going to college? I've made the decision not to play."

Theories abound as to why more girls and women are suffering ACL injuries but no one has come up with surefire medical reasons.

Terrio said he thinks a factor is the huge increase in the number of girls participating in sports compared to years ago.

"There are so many more girls active now," he said.

Nicole Van Dyke is the women's soccer coach at CSUB. She is also an assistant coach for the Bakersfield Brigade Gunners Under 18 Gold club team, which has Alvidrez, Reed and Reyes on its roster.

"Injuries are quite common, but not at the very young ages," Van Dyke said. "The knee injuries start kicking in with young girls when they start going through puberty.

"At the college level, it's even worse with all that wear and tear. In the last year-and-a-half, we've had five ACLs on the college level, and those three kids on the U-18s."

Van Dyke said she started coaching youngsters when she was 18, before she arrived at CSUB as a high-scoring forward.

"Just the knee injuries with the females is a scary thing," she said. "When you have a sprain, you just tape them up and let them play. A knee injury — you have to deal with for so much longer."

Van Dyke added: "Most of the knee injuries are noncontact, just a twist or a turn. It's probably 50-50, contact to noncontact. It's a serious issue with women's athletics. It can be a whole year by the time they come back from it."

Ron White, executive director of the Golden Empire Youth Tackle Football League, said serious knee injuries are rare within his organization, which offers tackle football for boys ages 7 to 14. White said he can recall only one ACL injury in the 10-year history of the organization. Occasional broken bones and sprains are more common, he said.

"It is a collision sport, and there's a reasonable expectation you'll see minor injuries," White said. "But ACL and MCL (medial collateral ligament) injuries are almost nonexistent."

White added: "Absolutely you could get hurt. But we think the risk is reduced with proper technique taught, wearing pads and good coaching."

The two biggest local volleyball clubs have not been struck by catastrophic injuries in recent times.

Jennifer Zuffinetti, director of the Kern River Volleyball Club for the last 10 years, said she has seen an increase in injuries overall, but not knee injuries. Club membership is 110 girls ages 10 to 18.

"We had a few freak knee incidents, but no one has blown out a knee in a year," Zuffinetti said. "We see a lot of ankle injuries, which happens no matter what you do. ... And the other thing we're seeing is a lot of back problems. If kids don't stretch or strengthen their core, the lower back takes a beating with all the jumping."

Tom Clarke, who runs the 125-member Club Jamba Volleyball Club, said the number of severe knee injuries to his club members has dropped.

"Two to three years ago, they were very prominent," said Clarke, who is also the Bakersfield High School volleyball coach. "I think kids are training right and paying attention to what their body is saying."

Both volleyball clubs are getting help from the outside to help reduce injuries.

Kern River is working closely with the Terrio group — it practices at the southwest Bakersfield Terrio Resnick facility — and has hired former CSUB athlete and coach Matt Touchstone as a strength and conditioning trainer.

"He works with all the kids," Zuffinetti said. "So many of these kids are doing this year-round, you're demanding more. They weren't doing the proper strength, stretching and conditioning. We're doing it now."

Clarke said personal trainer Kurt Wingate from Glinn & Giordano is working with Club Jamba.

"We've brought them in to do a lot of training stuff and treatment," Clarke said. "I think in volleyball we've nipped (severe injuries) in the bud. We've prevented a lot more of them."

Eric Mahanke, a former Fresno State and Bakersfield Blitz football player, said he thinks the increase in youth injuries is directly related to the hours the younger athletes are required to spend with their respective sports.

"These kids practice every day, sometimes twice a day with their club teams and school teams going at the same time," said Mahanke, who is the strength and conditioning coach for the Terrio organization. "They do not get the strength training that's needed. They get over-training."

Proper strength-building training will help prevent injuries and help shorten the recovery time, Mahanke said.

The key word is "proper."

Improper technique or body movement often contributes to injuries, Terrio said.

"You can learn a bad movement pattern and still be successful with it," Terrio said. "But eventually the body will break down because that's not mechanically the way that move is meant to be made."

Terrio added: "You go out to youth sports and you see people with no control over their body — you have people who can't control their body going full speed.

"If your body mechanics are fine, great. But if not, something's got to break down. It's a simple physics problem. Energy has to be distributed somewhere. Without proper body mechanics, it's going to find a weak link in the chain. And wherever that weak link is, it's going to go."

While the number of girls participating in sports has grown, how youngsters pass their free time has changed, and Terrio thinks that is related to some injury issues.

"What's missing now that wasn't there 15 years ago: kids playing," Terrio said. "Kids don't play anymore. They're not out running around being kids. They're at home playing video games and then they go to their practices or they'll go to their skill lessons.

"You go by parks and you don't see kids playing baseball or basketball now, the things we used to do."

Terrio pointed out another offshoot of extensive surgeries, especially to knees, becoming more common.

"One thing not enough people are looking at: We're doing a lot of surgeries on these kids, 13, 14 years old," Terrio said. "What will these joints look like when they're 30, 40?

"We're only now seeing the '80s and '90s athletes hitting middle age after all the surgeries they had. They're now in their late 40s and 50s and they've got arthritis, limited motion, a premature total knee (replacement).

"A total knee lasts 15 years. So if you get a total knee at 50, you'll need something else done at 65.

"Now we're starting the process with 14-year-olds. Does that mean we're going to have people at 30 having a bunch of knee problems?"

Teaching better technique and improving strength may cut down on some severe injuries, but Rous noted there's no way to eliminate all injuries.

"This isn't just about football and males," Rous said. "Any sport where you're leaping, landing and cutting has its (injury) risk.

"I don't think sports are dangerous. My kids play them. But you jump for a header in soccer, or you go for a rebound in basketball — sometimes the muscles don't react the way you expect."