Just 20 years old, the softball player had already endured six knee surgeries when her right arm went numb after throwing to home. Doctors diagnosed a separated shoulder, and Samantha Puzey had yet another round of surgery. Now she spends 15 hours each week with an athletic trainer at the University of Nevada at Reno, struggling to strengthen that stiff shoulder. She still can’t throw. And in cold weather, she feels a knifing pain in her arthritic knee.
For many athletes like Sam Puzey, college sports is riddled with chronic injuries that continue to vex the players throughout their college careers. Athletic departments at all levels of the NCAA report a steady rise in overuse injuries as athletes arrive on campus increasingly worn down from high-octane, year-round experiences in a single sport.
Their complex medical histories require heightened care from athletic trainers and team physicians, in some cases forcing colleges to spend more money on treatment and add more staff—with the expectation that they’ll work around the clock.
Injuries also inject an added layer of worry for coaches: As recruiting occurs at younger ages, coaches say they find it necessary, especially if a scholarship is at stake, to learn whether an athlete has sustained a serious injury. And they must guess whether a player will get hurt—or burn out—between the time a commitment is made and the time the athlete actually sets foot on campus.
“They’re coming with baggage,” says John Davis, the longtime head athletic trainer at Montclair State University, a Division III college in New Jersey. “It becomes more difficult to try and manage them.”
Over the past five years, he has seen the annual number of treatments at his facility nearly double, to 4,713 last year. It’s hard to keep up. “There are some people we want to do more with but we can’t, because we don’t have the personnel,” says Mr. Davis, who works with two other full-time athletic trainers to care for Montclair State’s 450 athletes.
That “baggage” is troubling to Mark Hyman. The parent of two athletes, one of whom blew out his elbow at the end of a frenetic Little League pitching career, he has written two books on the repercussions of the fast-paced youth-sports industry that sets the stage for college athletes.
“We haven’t turned the corner on this,” Mr. Hyman says of the injury epidemic. “If anything, it’s getting worse.”
An Unpredictable Problem
The traffic jam in the athletic training room is as much a function of what athletes do before they get to campus as what they do once on it. As athletic programs move away from the now-quaint notion of limiting practices to one discrete season for three or four months, athletes are spending most of the year training, practicing, competing—and getting hurt.
This shift has required most athletic trainers to work long hours to accommodate early-morning and late-night practices. Their duties have also expanded to include meticulous record-keeping of athletes’ treatments in the training room as well as a complete grasp of their increasingly complex medical histories.
Overuse injuries present constant, and unpredictable, challenges, and often require a great deal of individualized attention. At the University of Georgia, for instance, athletes complaining of an overuse injury usually receive an exhaustive “workup” to find the cause of the injury. That might include a diagnostic test like an MRI, or a bone scan, or blood tests to determine if vitamin levels are deficient. It might also include a biomechanical analysis. Once athletic trainers identify the injury and decide on a course of treatment, they also have to figure out how best to keep the athletes active and in shape without aggravating the injury. And they must determine how to prevent the injury from happening again.
Unlike acute injuries, such as, say, a broken bone, overuse injuries tend to creep up over time, and heal at an unpredictable pace. They can start out as aches and pains in ankles, shoulders, knees, or other joints. Very often they flare up because of repetitive stress to muscles and joints, but sometimes other factors contribute: the biomechanics of how an athlete’s foot strikes the pavement, for instance. Without rest or rehabilitation, the chronic pain can intensify. Sometimes the student requires surgery.
The ups and downs of overuse injuries are familiar to Glenn S. Fleisig, who directs the research operations at the American Sports Medicine Institute, in Birmingham, Ala., where he runs a biomechanics lab and studies the movements of injured athletes. It’s hard to foresee when an athlete who has overtrained might actually get hurt, he says.
While still in high school, some young players sustain adultlike injuries brought on by too much training, he says. Other athletes withstand years of rigorous training only to suffer a devastating injury in college from the cumulative effects of wear and tear.
One thing appears abundantly clear, though: “If you play a lot of sports as a kid, you end up being more worn out by the time you get to college,” Mr. Fleisig says.
It’s a familiar experience for many athletes and their parents. Around 44 million Americans participate in youth sports. And year-round dedication to one sport, along with participation in as many games and showcase tournaments as possible, is often seen as the best way to catch the attention of college coaches.
That devotion can also be the quickest path to an injury: About half of all pediatric sports injuries result from overuse, according to recent studies.
The Drive to Succeed
Athletic trainers say they see the fallout every day. Stress fractures, tendinitis, and chronic, painful injuries to shoulders, knees, Achilles tendons, and ankles—all are hallmarks of overuse. And while not all sports suffer equally from this type of injury—football players, for instance, don’t encounter it as often as runners, swimmers, and gymnasts do—its presence has altered the workload for athletic trainers.
“It’s very common these days for an athlete to come in and have this array of injuries that were not really taken care of properly,” says Charles Thompson, head athletic trainer at Princeton University. “We have track athletes who really end up running two years. They can’t really get started with their college career till they take care of their high-school injury.”
And the commitment in college is significant: A recent NCAA study showed that Division I athletes spent more than 32 hours a week on their sport during their regular season; football players logged more than 40 hours. At most competitive programs across all three NCAA divisions, it’s common for athletes to train hard in their off-seasons, too, taking part in scheduled practices with a coach present and, far more frequently, in sessions where no coach is present. When summer rolls around, many stay on campus to lift weights and work out. Others compete in summer leagues, cramming a full schedule of games into a few short weeks.
“Every sport has become a 12-month sport now,” says Ron Courson, director of sports medicine at Georgia, who has a staff of 22 to care for 600 athletes. “Everybody wants to be the very best they can.” He describes the environment this way, with a touch of concern: “If one mile’s great, 10 miles is better.”
Competitiveness has landed them a coveted spot on a college team. But athletes’ drive can also keep them from easing up when they’re hurt.
Brittni Yates, a volleyball player at Nevada, is struggling with that as she recovers from shoulder surgery and a concussion. She says following orders to hold back makes her feel vulnerable.
Rest, she says, “isn’t an option for me. My spot will get taken, and I’ll be resting on the bench.”
Mr. Courson, who added a new athletic-trainer position to his staff this year, in large part to deal with an increase in overuse injuries among track-and-field athletes, says it’s often his job to push back against a culture in which athletes and coaches alike feel the need to do too much. “The body needs rest,” he says. “And sometimes you start to question whether we’re giving them adequate time to rest to do all the things we’re asking of them.”
‘Think Beyond This Moment’
Some coaches, mindful of the injuries some of their athletes had when they began college, blame youth sports for perpetuating a climate that makes time away from sports impossible.
“It’s become a business,” says Steve Simmons, men’s soccer coach at Oregon State University. “And the business is, ‘We’re going to give these student-athletes a platform to get a scholarship.’”
Mr. Simmons and other college coaches complain about parents who, they say, fail to recognize how difficult it is to land a spot on a college team, and push their children to the brink of injury—or beyond. Of the tens of millions of teenagers who take to the fields and courts and pools each week, Mr. Simmons points out, only 400,000 or so actually make it onto an NCAA team.
Some coaches say they want to spread the word that more is not always better. A few even say they’d prefer to have multisport athletes on their rosters.
Gregg Parini, swimming coach at Denison University, is one. “When we sit down to talk to a prospective student, I want to know if they’ve played other sports. If they’ve played other sports, I know I’m getting a better athlete,” says Mr. Parini, whose program won the Division III national championship last year. “If they’re posting competitive times but haven’t necessarily been immersed in it at a real high level, that tells me their best swimming is clearly in front of them.”
But as much as some college coaches disparage the youth-sports scene, they have come to depend on it. They also contribute to it: Camps and clinics that draw thousands of teenage athletes may help foster a culture of “too much,” but they’re where many coaches go to scout out their next batch of athletes.
And once on campus, athletes push themselves in the off-season and during the summer not just because they want to get better or hang on to their starting spot. They want to impress the coach. Even if it means risking injury.
For Andrew Wilson, chronic injuries were a fact of life when he was a basketball player at Florida State University. He competed for the Seminoles in six seasons, from 2000 to 2006, his playing time repeatedly disrupted by medical concerns. During his fifth season, Mr. Wilson was recovering from surgery on his Achilles tendon, which had wreaked havoc his previous season. Still feeling the pain, he began receiving cortisone shots from his team physician before every game.
“I know it wasn’t the safest thing,” says Mr. Wilson, who was a three-year starter for Florida State and is now an assistant basketball coach at the College of Charleston. “But it would literally wipe away the pain for the game and for a two-to-three-day period afterward. I just wanted to be out there so bad, I really didn’t care.”
Today, Mr. Wilson, who has not suffered any long-term consequences from the injury or the shots, has adopted a more cautious attitude toward injuries. “I definitely look at it differently now as a coach,” he says. “I don’t think I would encourage a kid to get that many shots, or go through such extremes, just to be out there on the court.”
For athletes who can’t, or won’t, go to the lengths that Mr. Wilson did, overuse injuries can end a career. And coaches, along with athletic trainers and team physicians, have to learn how to deliver that unwanted verdict.
Kerrie Beach, head women’s gymnastics coach at Bowling Green State University, found that it’s never easy—no matter how much pain the athlete has endured.
“I’ve had three athletes become student coaches because they’ve had to retire because of medical reasons,” she says. “With all three, we’ve had to have that difficult conversation: ‘You’re going to have to think beyond this moment. You’re going to have to think about your life, and the quality of life you want to have.’ In this age group, it’s particularly hard for them to think beyond right now.”
Pressure to Heal
Sam Puzey, the softball player from Nevada, is stuck very much in the present. Eight months after her shoulder surgery, she still dwells in the purgatory of chronic injury: Her afflictions are not career-ending, but they are bad enough to keep her on the sidelines for months. Gritting her teeth through physical pain is only part of the challenge.
Every day she worries about proving, despite all the injuries, that she still belongs on the team at Nevada—the same university where her father played baseball; her mother, too, played softball; and where her older sister is the most decorated softball player in the Wolf Pack’s history. She’s determined to stay.
“I put pressure on myself,” says Ms. Puzey, who has turned 21. Her healthy teammates can push harder than she can right now, and she knows it. So she applies her dedication to softball in rehab instead. “I’m trying to catch up and prove that I deserve to be there, because a lot of the time I can’t do the stuff they’re doing because I’m injured,” she says.
Mr. Davis, the athletic trainer at Montclair State, tries to instill that cautious optimism in athletes as they file through his facility each day, from the early morning hours till late at night. In the nearly 30 years he has spent in the university’s athletic training room, he has learned an uncomfortable truth about college athletes: The biggest reason they stop playing is because they have a nagging injury that just won’t get better, he says. “They think, ‘If I stop playing, the pain will stop.’”
But Mr. Davis keeps tending to a room full of athletes because he doesn’t want them to stop playing. He just wants them to stop hurting.
