by Phil Welsh, PT, DPT, ATC. ~ Premier Physical Therapy | Charlotte FC Academy
Image by: MLS Charlotte FC
The notion has long been that strength training for youth athletes is a bad idea. What if it stunts their growth or reduces their sports performance? And what if they suffer long-term consequences from overtraining? All of which are valid concerns. But we can't ignore the benefits of strength training for young athletes because if we do, they may fall behind the abilities of their peers, which may limit their chances of getting noticed by college coaches and eventually making it to the professional level. Strength training is an essential component of building well-rounded athletes, but it needs to be approached in the right way.
"Strength and movement is a progressive learning experience from birth through the teen years." ~ Dr. Phil Welsh
From crawling to walking, then running to jumping, each phase builds upon the next, and when steps are skipped, often children begin to develop imbalances that may affect athletic performance as they age. This growth and development is all connected to motor control, the neurophysiological system learning how to communicate between the brain, spinal cord, nerves, and muscles to produce repetitive, exact movement. Without the foundation of motor control, children have difficulty progressing and gaining new physical abilities.
Many athletes and parents of young athletes approach me with the idea that "stronger is better." However, their vision is cemented in strength and power, and often they've attempted strength training without structured guidance, which may increase the risk of developing imbalances. Over time, these imbalances lead to an increased risk of injury, which may impact their future in competitive sports.
When I watch these young athletes perform bodyweight squats, their knees buckle, and their backs round through the movement. This is not an appropriate foundation to build upon. It becomes a question of priority, with the primary need to work on foundational motor control before introducing compound movements like squats, lunges, and bench press. If compound exercises are continued, it may predispose the athlete to potentially severe orthopedic concerns, such as sidelining ligament injuries.
In my practice, I start with the basics of movement relative to an athlete's sport. If they are a soccer player, we focus on engaging the lateral glutes to coordinate and facilitate the relationship between the hip and knee for running, cutting, jumping, and kicking. For young baseball players, we focus on the relationship between the shoulder, shoulder blade, thoracic spine, and the hip and lower body balance because a breakdown in this chain can limit efficiency and performance.
With running, it's more about the thousands of repetitions and maximizing motor control and posture with each step. While each runner's mechanics may vary, I look at a runner's natural gait pattern and work with that athlete to prioritize efficiency while creating a strength program to promote longevity and reduce injuries. In each of these sports, these motor control relationships are complex but essential for athletes looking to perform at their best.
Strength training is an excellent tool for athletes of all levels. In general, 12-13 years of age is when we suggest introducing a resistive training program. Still, if an athlete struggles with mechanics and control, we revert to a bodyweight program to further reinforce a solid foundation.
What are the most common injuries you treat in the clinical setting for youth?
This ranges quite a bit. I see lower extremity pain from poor biomechanics (patellofemoral pain syndrome, Achilles tendonopathy, etc.) that can be addressed relatively quickly once the cause of the problem is determined and treated. This gets accelerated significantly when I use the performance-based biomechanical analysis hardware. Part of my rationale is to take care of these "minor" biomechanical abnormalities early because otherwise, they have a habit of manifesting into chronic bad habits causing ACL tears, meniscus tears, Achilles rupture, etc. I'd much rather prevent one of those than have someone go through the pain, cost, surgery, rehab, time away from sport/mental decline, etc., associated with it. Kids are otherwise pretty resilient, and I'll see fractures occasionally, sometimes from falls, sometimes sports injuries.
In your opinion, what's the most complex injury to overcome as a youth? How long would you say this injury would sideline a young athlete?
The scale varies so wildly here that I can't possibly give an answer less than an entire book! Growth plate fractures can be challenging, especially if their Salter-Harris type inhibits their future growth. Sometimes the patients/clients with a repeat ACL tear can be the most difficult. They've been through it once before, dealt with the pain, time away from the sport, the considerable amount of rehabilitation that goes into it, etc., and then BAM! It happens again to the same knee. Unfortunately, I've seen this a handful of times (I didn't rehab them the first time), and it can be devastating mentally. You almost have to do more work mentally than physically (not completely true, but you know what I mean). For that, you're looking at 9-12 months out, but the timeline is so varied based on the individual in front of you, and I've seen it take longer than that.
Why would you say that biomechanical analysis of young athletes is essential? Is it to prevent imbalances from developing? Is it purely to maximize performance?
It's both to prevent and treat biomechanical imbalances and improve performance. Which one is more important is up for debate. I touched upon this in the first question, how poor mechanics can cause pain but eventually serious injuries and chronic dysfunction (ACL tears, Achilles rupture, etc.). Next time you're at the park and see a 10(ish) year old running, check out their form. Often it's riddled with extraneous movement and inefficiency. So my focus is to treat these imbalances to move more efficiently and reduce future injury risk.
From a performance perspective, this can be seen with stride length for runners; for example, if a marathoner does tightrope running, it may cause them to develop hip FAI, trip, fall, or pronate excessively. If they tend to overstride, they waste energy on the x-axis, yielding less available energy to propel forward on the y-axis. So having the available biomechanical analysis tools can be extremely helpful in tailoring recommendations to the person in front of you.
Why did you decide to get into healthcare? It's not an easy field to be in. Yes, it can be rewarding, but in this day in age, it has its fair share of ups and downs.
Personal injuries through soccer and cross country led me to work with a PT, and I was fascinated by the experience. So by the end of high school, it was either PT or medical school. I'm happy to have chosen PT. MDs and DOs (usually) have very little time to spend with patients and build relationships. PTs and OTs get more time to spend with patients, improving trust levels, and they tend to feel more comfortable asking you questions than they do their doctor. I did two years of home health PT in North Carolina when I moved here, and people would constantly ask about medication recommendations (which is beyond my scope of practice after basic questions were answered). Still, it's fulfilling to know they trust in your opinion.
Dr. Phil Welsh 980-766-9740