Emily Isaacs loves playing soccer so much that it hurts.
The sophomore at Ladue Horton Watkins High School is still recovering from a nagging hip injury she exacerbated last spring while starting on her school's varsity team as a freshman. Isaacs' doctor told her that her hip pain was caused from her muscle tearing away from the bone as a result of too much sprinting. That injury came after Isaacs, 15, tore her medial collateral and posterior cruciate ligaments in her right knee in November. She collided with an opposing player during a game with her club team.
None of her injuries has required surgery, and none of the visits to doctors, hours of physical therapy, doses of Motrin and nights spent on the couch with ice packs has soured Isaacs on playing soccer. In fact, the opposite is true.
While rehabilitating her hip, she has been limited to practicing two times a week this summer, instead of the regular three. She said there is nothing harder than watching her teammates run around while standing off to the side.
"I love playing soccer," Isaacs said. "I'm good at it. School, it comes so hard for me, and I have to work to keep up, but soccer, I just can't explain it. It's just natural to me."
Too much play, too little rest
What isn't natural is young athletes playing a particular sport for 10 months out of the year --- although it has become all too common in a culture that prizes competition, said Dr. Matthew Matava, the St. Louis Rams head physician and a father of three children.
It's a message that has been repeated by sports medicine specialists and championed by high profile pro athletes in recent years. Yet it bears repeating again this month with local youngsters scattered across football fields, soccer pitches and softball diamonds as another fall sports season gets underway.
An active kid is a healthy kid, but there is a limit. When it comes to preventing sports injuries, parents, coaches and athletes don't know when enough is enough, said Matava, co-chief of sports medicine for Washington University Orthopedics.
"The most common type of injuries we see are overuse," said Matava, whose two boys -- ages 13 and 9 -- play a range of youth sports. "People think the most common things are knees and ankles, and though those things do occur, the most common type are overuse injuries like muscle strains and stress fractures."
An array of statistical evidence compiled by sports medicine experts shows an alarming trend: Too many young athletes are succumbing to injuries that are preventable, simply because they're participating in playing and training regimens that are too intense for their young bodies to handle.
According to the American Academy of Orthopedic Surgeons, nearly 50 percent of all sports injuries sustained by middle school and high school athletes are overuse injuries. And of those overuse injuries, 50 percent are estimated to be preventable, according to the American College of Sports Medicine.
The signs of overuse
Matava doesn't need to see the numbers to know that there's a problem involving too many young athletes pushing their bodies too hard. He sees evidence of an overuse injury epidemic, as some sports medicine doctors have referred to the recent trend, nearly every day when he meets with young patients.
"I had a patient the other day, a softball player, who was bragging she had pitched in practice or competition for 365 days in a row," said Matava. "And she was wondering why she had shoulder pain."
As is often the case, Matava said the girl's father was also one of the coaches on her team.
He said it is always a bad sign when a "parent and the son come in wearing the same team jacket."
"It's typically the parents who drive it," he added. "It's not the kids who want to play so much. (The parents) see the multi-million dollar contracts signed by pro players, and the scholarships, and fame and fortune. I had one 13-year-old baseball player whose mother told me the son was their meal ticket. I can't imagine the type of pressure that puts on a kid."
Isaacs, for one, said her parents have never put pressure on her to maintain such an intense regimen, and that her willingness to play through injuries is borne out of putting her team first, and a love for competing.
The sophomore has hopes of playing soccer in college and sees her injuries as an unpleasant side effect of the type of commitment it takes to make those dreams a reality.
She has never considered scaling back the amount of time she spends playing soccer, in spite of all the pain she has put up with in the last year, especially last spring when she said she couldn't walk after her high school games.
"I would take a couple of Motrin and I would just play through it, because my team needed me and I would just go home and ice it and not stand up for the rest of the night," she said.
She added: "If I quit tomorrow, (my parents) would be totally fine with it. It's whatever I want to do."
A healthy way to play
Matava isn't against parents being involved in their children's athletic pursuits, but he is not a fan of young athletes specializing in a particular sport. It's an unhealthy trend spurred along mostly by adults, he said, and one, as statistics show, that seems to be getting worse, not better.
Instead of young boys and girls playing a variety of seasonal sports, as they used to, more often they are doing a particular sport for 8-10 months of the year.
"It's the rule of 'toos,'" said Matava. "Too much play and too little rest. You get into these select type sports where kids are on two or three teams that play all year around. They don't let themselves rest, and that's when you start seeing muscle strains and stress fractures."
In response to the rash of overuse injuries, the American Orthopedic Society for Sports Medicine launched a campaign in April called STOP, or Sports Trauma and Overuse Prevention.
One spokesman for the campaign is St. Louis Rams quarterback Sam Bradford, the No. 1 pick in this year's NFL draft. Bradford, in various interviews, has said that playing as many as five sports as a youngster in Oklahoma kept him injury-free all the way up until his junior season in college when he sustained a major shoulder injury.
In high school, Bradford starred in golf, football and basketball, playing on the same AAU team as Blake Griffin, the top pick in the NBA draft in 2009.
Another campaign spokesperson is former Braves and Cardinals pitcher, John Smoltz. He pitched for two decades in the major leagues. Smoltz said that most of his professional peers grew up playing a variety of sports, and that specialization in a particular sport like baseball doesn't necessarily guarantee long-term success.
Not that the message is getting through. An estimated 75 percent of young patients are suffering from some sort of overuse injury, versus 20 percent back in the 1990s, according to STOP.
Surgeons are also seeing four times as many overuse injuries in youth sports from five years ago, according to Dr. James Andrews, the campaign chair of STOP and president of the American Orthopedic Society for Sports Medicine.
Even more alarming is that 21 percent of young athletes report they have been pressured to play with an injury, according to the National Youth Sports Safety Foundation.
Matava said he constantly tells parents to encourage their children to play a variety of sports, just like those same parents did when they were growing up.
"What happened to developing different skill sets and different friends?" he said. "When you play different sports, you allow different body parts to rest."
Training to prevent injuries
Bryan Koch, the head football coach at Francis Howell High School in St. Charles, said he encourages all of his players to compete in other sports, preferably one for each high school season.
At the same time, he also wants his football players to participate in his off-season strength and conditioning program during the winter, spring and summer, even if they're playing baseball in the spring or basketball in the winter.
He said he firmly believes that type of year-round conditioning prevents injuries come football season, not the other way around.
"Yes, we want our kids to get bigger, faster, stronger, but we also want our kids to be as safe as they possibly can on the field," said Koch (right). Koch starred at Francis Howell himself before going on to play at the University of Illinois, where he was a three-year starter on the offensive line.
"If a kid comes out to play football, which is a high contact sport, and they haven't trained their body, they haven't strengthened their muscles, ligaments and joints to sustain that contact, then they're really putting themselves at a disadvantage," Koch said. "Our off-season strength and conditioning program is geared just as much toward preventing injuries and putting kids in a safe position."
The coach certainly has a basis for his argument on year-round strength training: Football is the sport with the highest rate of traumatic injury at the high school level and up.
That remains true in spite of all the safety advances with shoulder pads and helmets and a more informed, humane approach to preventing and treating injuries among coaches, especially concussions and heat-related illnesses.
Koch said he has his entire staff of 12 coaches assist on the team's equipment hand-out day to make sure players are properly fitted for helmets and pads. He and his coaching staff have also attended a variety of clinics put on by district or conference officials to make them vigilant of post-concussion symptoms and proper hydration.
During August, players are weighed before and after practice to make sure they're retaining enough water while toiling under the hot sun. Coaches are also always pushing players to hydrate --- before and after practice, and certainly when they're on the field.
"If it hits that 95 degree heat index, we do 15 minutes on and five minutes off," Koch said. "We give them a five-minute water break where they take their helmets off and our coaches are constantly yelling, 'If you're not thirsty, drink anyway.' Absolutely it has changed. You watch the movie 'Remember the Titans.' That's what our team movie was for week 1. Denzel Washington is quoted in there saying, 'Water makes you weak.' That is not the case by any means any more. When it changed, I have no idea, but since I've been coaching, that is definitely not a philosophy that you wanna take on."
Heads, shoulders, knees and ankles
Not that injury is unavoidable, in any sport -- even if a young athlete plays three different sports during the school year as opposed to just one, and no matter how many clinics parents and coaches go to on proper technique and proper equipment fitting.
Every year, more than 3.5 million children aged 14 years and younger are treated for sports injuries, according to the American Academy of Orthopaedic Surgeons.
What can be misleading is the severity of those injuries, Matava said.
The most common knee injury is a tear of the medial collateral ligament, which can heal without surgery 95 percent of the time, Matava said.
"Everybody always thinks it's the ACL, which does require surgery, but more often it's the MCL," he said.
And while tackle football is proven itself to be the leader among other contact sports for traumatic injuries, Matava said at the middle school and Pop Warner levels, he believes it is as safe as any other organized, contact team sport.
That's why he has let his 13-year-old son strap on shoulder pads and a helmet this fall, even though Matava's own mother didn't let him play football when he was a boy.
The alternative of not playing is worse.
"When they're younger, especially 8 or 9, they don't have the musculoskeletal injuries that you see later on," he said. "The players' size and weight is not as great. I'd rather (my son) play a sport, and potentially take the risk of an injury that isn't life-altering, instead of him playing on the computer all day long."
Click here for more information on how to prevent youth sports injuries.
Nate Peterson is a former sports editor for the Aspen Times and a freelance writer whose work has appeared in the Beacon, Colorado newspapers and the New York Times.
This article originally appeared in the St. Louis Beacon.