Sports Medicine

Motor Planning In Physical Therapy

The Essential Guide to Motor Planning in Physical Therapy

Understanding Motor Planning and Its Crucial Role in Physical Therapy

Motor planning, also known as praxis, is a fundamental aspect of human movement and function. It involves the ability to conceive, organize, and carry out a sequence of unfamiliar actions. This cognitive process is essential for everything from daily activities to complex athletic performances. In the realm of physical therapy, understanding and addressing motor planning is vital for helping patients regain and enhance their functional abilities.

What is Motor Planning (MP) ?

Motor planning is the brain’s ability to conceptualize, plan, and execute a series of movements. It involves several steps:

  1. Ideation: Formulating the idea of the movement.
  2. Planning: Organizing the sequence of steps required.
  3. Execution: Carrying out the planned movement with coordination and timing.

Motor Planning

Motor planning is a higher-level cognitive function that integrates sensory information, motor skills, and cognitive processes. It requires the involvement of various brain regions, including the frontal lobes (responsible for planning and decision-making), the parietal lobes (processing sensory information), and the cerebellum (coordinating movement and balance).

Why is Motor Planning Important in Physical Therapy?

  1. Movement Efficiency: Proper motor planning ensures movements are smooth, coordinated, and efficient. Poor MP  can lead to clumsy, awkward, or inefficient movements, which can impact daily functioning and increase the risk of injury.
  2. Skill Acquisition: Learning new motor skills, whether it’s a sport-specific movement or an activity of daily living, relies heavily on motor planning. Physical therapy often involves teaching patients new ways to move or compensating for lost abilities, making MP essential.
  3. Rehabilitation: For patients recovering from injuries or surgeries, regaining efficient motor planning is crucial for a successful return to normal function. This is particularly important for athletes who need precise and complex movements.
  4. Neurological Conditions: Conditions like stroke, Parkinson’s disease, and cerebral palsy can impair MP. Physical therapists work to retrain the brain and body to improve motor planning and execution in these populations.
  5. Prevention of Injury: Proper MP helps distribute physical stress evenly across the body, reducing the risk of overuse injuries and improving overall biomechanics.
  6. Development in Children: MP is crucial for developmental milestones in children. Physical therapy can support children with developmental delays or disabilities in achieving these milestones.

The Role of Physical Therapy in Enhancing Motor Planning

Physical therapists play a critical role in assessing and improving motor planning abilities. Here are some ways they address motor planning:

Assessment

Physical therapists use various assessment tools to evaluate motor planning abilities. These can include functional movement screens, standardized tests, and observational analysis. Assessments help identify areas of weakness or dysfunction in motor planning and guide the development of personalized intervention plans. To ensure a thorough evaluation and tailored treatment, consider scheduling an assessment with Dr. Robert or Dr. Tori at Balanced Physical Therapy. Their expertise can help you navigate your path to improved mobility and function.

Exercises and Activities

Therapists design exercises and activities that target MP skills. These activities often focus on improving the coordination, timing, and sequencing of movements. Examples include:

  • Task-Specific Exercises: Practicing specific tasks that the patient needs to perform in daily life or sports.
  • Obstacle Courses: Navigating through obstacles to improve planning and coordination.
  • Mirror Therapy: Using a mirror to help patients visualize and plan movements.

Repetition and Practice

Repetition is key to reinforcing motor planning and creating more automatic responses. Physical therapists encourage patients to practice movements repeatedly to enhance their MP abilities. Over time, this helps build muscle memory and improve overall movement efficiency.

Visual and Verbal Cues

Visual aids and verbal instructions can be highly effective in aiding motor planning. Physical therapists often use these cues to help patients understand and execute movements. For example, demonstrating a movement or providing step-by-step verbal instructions can make it easier for patients to plan and perform complex actions.

Sensory Integration

Motor planning is closely linked to sensory processing. Physical therapists may incorporate sensory integration techniques to help patients better process and respond to sensory information. This can involve activities that stimulate different senses, such as balance exercises, tactile stimulation, or proprioceptive feedback.

Motor Planning in Different Populations

Pediatric Physical Therapy

In children, motor planning is essential for achieving developmental milestones such as crawling, walking, and fine motor skills. Children with developmental delays or conditions like autism spectrum disorder may struggle with MP. Physical therapists use play-based activities and exercises to enhance MP in a fun and engaging way. These interventions help children develop the necessary skills for daily activities, school participation, and recreational play.

Geriatric Physical Therapy

For older adults, motor planning is important for maintaining independence and preventing falls. Age-related changes in the brain can impact MP, leading to difficulties with coordination and balance. Physical therapists work with older adults to improve MP through exercises that enhance strength, balance, and coordination. These interventions can help seniors maintain their mobility and reduce the risk of falls.

Neurological Rehabilitation

Motor planning is often affected in individuals with neurological conditions such as stroke, traumatic brain injury, multiple sclerosis, and Parkinson’s disease. Physical therapists use a variety of techniques to retrain the brain and body. This can include constraint-induced movement therapy (CIMT), where the unaffected limb is restrained to encourage the use of the affected limb, or task-specific training that focuses on relearning daily activities.

Sports Rehabilitation

Athletes rely heavily on motor planning for precise and complex movements. Injuries can disrupt MP, affecting an athlete’s performance. Physical therapists work with athletes to restore MP through sport-specific drills and exercises. This not only helps in recovering from injuries but also enhances overall performance and reduces the risk of future injuries.

Sports Rehab & Motor Planning

Case Studies: Motor Planning in Action

Case Study 1: Post-Stroke Rehabilitation

John, a 55-year-old man, experienced a stroke that affected the right side of his body. He had difficulty with MP, particularly in using his right arm and leg. His physical therapist conducted an assessment and developed a personalized intervention plan that included:

  • Task-Specific Training: Practicing activities of daily living, such as dressing and grooming.
  • Mirror Therapy: Using a mirror to visualize and practice movements of the affected limbs.
  • Balance Exercises: Improving coordination and stability through balance activities.

Over several months, John showed significant improvements in his motor planning abilities, regaining much of his independence.

Case Study 2: Pediatric Therapy for Developmental Delay

Emily, a 5-year-old girl, was diagnosed with developmental coordination disorder (DCD). She struggled with motor planning, impacting her ability to perform everyday tasks and participate in play activities. Her physical therapist incorporated:

  • Play-Based Activities: Using games and toys to make MP exercises enjoyable.
  • Obstacle Courses: Navigating through different obstacles to improve planning and coordination.
  • Sensory Integration: Activities that engage multiple senses to enhance sensory processing and motor planning.

With consistent therapy, Emily made significant progress, improving her MP skills and gaining confidence in her abilities.

Conclusion

Motor planning is a critical component of human movement and function. It plays a vital role in everything from daily activities to athletic performance. In physical therapy, addressing motor planning is essential for helping patients achieve their rehabilitation goals and enhance their overall quality of life. Whether working with children, older adults, or individuals with neurological conditions, physical therapists use a variety of techniques to assess and improve motor planning abilities. Through personalized interventions, repetition, and practice, patients can improve their motor planning skills, leading to more efficient and effective movement.

By understanding the importance of motor planning and its role in physical therapy, patients and therapists can work together to achieve optimal outcomes. This collaborative approach not only supports recovery and rehabilitation but also empowers individuals to live more active and fulfilling lives.

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Barbell Rehab Method: Physical Therapy

Barbell Rehab Method: Injury Rehab & Managing Chronic Conditions

Barbell Rehab Method (BRM)

The Barbell Rehab Method is an approach to physical therapy that integrates principles from strength training and rehabilitation to help individuals recover from injuries or manage chronic conditions. It emphasizes using barbell exercises to improve strength, mobility, and function while addressing specific movement dysfunctions or imbalances. Barbell Rehab Method: Physical Therapy

Barbell Rehab Method In Action

The Barbell Rehab Method is typically used in physical therapy during:
  • Assessment: The therapist assesses the individual’s movement patterns, strength deficits, range of motion, and any specific impairments related to their injury or condition. This assessment helps tailor the rehabilitation program to the individual’s needs.
  • Exercise Prescription: Based on the assessment findings, the therapist prescribes specific barbell exercises designed to target areas of weakness or dysfunction. These exercises may include squats, deadlifts, presses, rows, and other compound movements that engage multiple muscle groups.
  • Technique Instruction: Proper technique is crucial to prevent further injury and maximize the effectiveness of the exercises. The therapist provides detailed instructions on performing each exercise safely and effectively, paying close attention to posture, alignment, and movement mechanics.
  • Progression: As the individual progresses in their rehabilitation, the therapist gradually increases the intensity, load, or complexity of the exercises to continue challenging their strength and mobility. This progressive approach helps promote ongoing improvement and prevents plateaus in recovery.
  • Individualization: The Barbell Rehab Method is highly individualized, considering each person’s unique goals, abilities, and limitations. The therapist may modify exercises or incorporate additional strategies, such as mobility drills or accessory movements, to address specific needs and optimize outcomes.
  • Education and Empowerment: Throughout the rehabilitation process, the therapist educates the individual on proper body mechanics, injury prevention strategies, and self-management techniques to support long-term health and wellness. The Barbell Rehab Method promotes independence and self-efficacy by empowering individuals to actively participate in their recovery.
The Barbell Rehab Method offers a comprehensive and evidence-based approach to physical therapy that integrates strength training principles with rehabilitation principles to promote optimal recovery and functional outcomes.

Barbell Rehab Method For All Ages & Activity Levels

The Barbell Rehab Method can be applied to individuals of different age groups and activity levels by tailoring the rehabilitation program to meet each individual’s specific needs, goals, and capabilities. Here’s how it can be adapted for different populations:

Young Adults and Athletes:

    • Young adults and relatively active athletes with a higher fitness level may focus on restoring strength, mobility, and function to facilitate a safe return to sports or other high-intensity activities.
    • The rehabilitation program may include more advanced barbell exercises and progressions, such as plyometric variations, dynamic movements, and sport-specific drills, to challenge their strength and athleticism.
    • Through targeted strength and conditioning protocols, emphasis is placed on optimizing movement mechanics, enhancing performance, and reducing the risk of future injuries
Barbell Rehab Method: Physical Therapy For Young Adults & Fitness Athletes

Middle-Aged Adults:

      • Middle-aged adults may benefit from the Barbell Rehab Method to address age-related changes, musculoskeletal issues, or injuries related to work, daily activities, or recreational pursuits.
      • The rehabilitation program focuses on improving functional capacity, reducing pain, and enhancing overall quality of life by targeting weakness, stiffness, or dysfunction areas.
      • Exercises are selected and modified based on individual capabilities and goals, emphasizing improving movement patterns, joint mobility, and muscular strength to support daily activities and maintain independence.
Barbell Rehab Method: Physical Therapy For Middle-Aged Adults

Older Adults:

    • The Barbell Rehab Method can help older adults address age-related strength, balance, and mobility declines and manage chronic conditions such as osteoarthritis or osteoporosis.
    • The rehabilitation program emphasizes safe and effective exercises that improve muscular strength, bone density, joint stability, and functional capacity to support healthy aging and prevent falls or injuries.
    • Exercises are selected and progressed cautiously, considering factors such as joint health, balance impairments, and mobility limitations. Modifications may include using lighter weights, incorporating balance training, and focusing on functional movements relevant to daily activities.
Barbell Rehab Method: Physical Therapy For Older Adults

Sedentary or Deconditioned Individuals:

    • Sedentary or deconditioned individuals may benefit from the Barbell Rehab Method to improve overall fitness, health, and well-being and manage chronic conditions such as obesity, diabetes, or cardiovascular disease.
    • The rehabilitation program focuses on gradually reintroducing physical activity, building foundational strength, and improving movement mechanics to support long-term adherence and sustainable lifestyle changes.
    • Exercises are selected and progressed based on individual fitness levels and tolerance, emphasizing gradual progression, proper technique, and personalized support to overcome barriers and build confidence in physical activity participation.
Barbell Rehab Method: Physical Therapy For Sedentary or Deconditioned Individuals The Barbell Rehab Method can be adapted to individuals of different age groups and activity levels by customizing the rehabilitation program to address their unique needs, capabilities, and goals. Whether recovering from an injury, managing a chronic condition, or striving to improve overall health and fitness, strength training and rehabilitation principles can be effectively applied to promote optimal outcomes and enhance quality of life across the lifespan.

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Why Stabilizer Muscles are important

Stabilizer Muscles: Key To Injury Prevention & Optimal Function

What are Stabilizer Muscles?

Stabilizer muscles are crucial for optimal movement, injury prevention, and long-term physical health. Compared to prime muscle mover muscles such as the biceps/triceps (arms), pecs (chest), and quadriceps (upper thigh), the stabilizers are generally deeper within the body and closer to the joints they stabilize. Their primary function is to provide support and stability to joints during movement.

Why Stabilizer Muscles are important

 

Why Stabilizer Muscles Are Important For Everyone

Regardless of age or activity level, for several reasons:

  1. Injury Prevention: Stabilizer muscles help maintain proper joint alignment and stability during movement, reducing the risk of injury. This is crucial for athletes engaging in sports that involve dynamic movements and sudden changes in direction, as well as for older adults who may be more prone to falls and injuries due to age-related changes in balance and coordination.
  2. Improved Balance and Coordination: Stabilizer muscles play a key role in balance and coordination by providing support and stability to the body during various activities. By strengthening these muscles, individuals can improve their balance and coordination, which benefits athletes looking to enhance their performance and older adults aiming to reduce their risk of falls.
  3. Enhanced Functional Movement: Stabilizer muscles are essential for maintaining proper posture and performing everyday tasks such as walking, lifting, and reaching. Strengthening these muscles can improve overall functional movement patterns, making it easier for individuals to carry out daily activities efficiently and easily.
  4. Joint Health: Stabilizer muscles help stabilize the joints, protecting them from excessive stress and reducing the risk of joint injuries and degenerative conditions such as osteoarthritis. This is particularly important for older adults and individuals with joint-related issues or previous injuries.
  5. Improved Athletic Performance: Strong stabilizer muscles contribute to better movement mechanics, agility, and power generation in athletes, which can translate to improved athletic performance and reduced risk of sports-related injuries. Targeting stabilizer muscles in training programs can help athletes optimize their performance and excel in their respective sports.
  6. Functional Independence: For older adults and individuals with mobility limitations, maintaining strong stabilizer muscles is essential for preserving functional independence and quality of life. By improving stability, balance, and coordination, individuals can maintain their ability to perform daily tasks and activities without assistance for as long as possible.

10 Important Stabilizer Muscles

Some of the most essential stabilizer muscles throughout the human body include:

Transverse Abdominis:

This deep core muscle wraps around the abdomen and acts like a natural weight belt, providing the spine and pelvis stability.

Transverse Abdominis Stabilizer Muscle

Multifidus:

These small muscles run along the spine, and help stabilize the vertebrae, supporting proper posture and movement.

Multifidus Stabilizer Muscle

Rotator Cuff Muscles:

These muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) stabilize the shoulder joint, ensuring proper alignment and movement of the arm.

Rotator Cuff Stabilizer Muscles

Gluteus Medius:

Located on the outer hip, this muscle helps stabilize the pelvis and maintain balance, particularly during single-leg movements like walking and running.

Gluteus Medius Stabilizer Muscle

Quadratus Lumborum:

This muscle on either side of the lower back helps stabilize the pelvis and spine during activities like lifting and bending.

Quadratus Lumborum Stabilizer Muscle

Obliques:

Both internal and external obliques help with spine rotation and lateral flexion, contributing to core stability and preventing excessive strain on the lower back.

Obliques

Deep Neck Flexors:

These muscles support the head and neck, promoting proper alignment and reducing strain on the cervical spine.

Deep Neck Flexors

Hip Abductors/Adductors:

Muscles such as the tensor fasciae latae and adductor longus help stabilize the hip joint during walking and standing.

Hip Abductors/Adductors

Scapular Stabilizers:

Muscles such as the serratus anterior, rhomboids, and trapezius help stabilize the shoulder blades, allowing for proper shoulder function and reducing the risk of shoulder injuries.

Scapular Stabilizers

Pelvic Floor Muscles:

These muscles support the pelvic organs and help stabilize the pelvis, contributing to core stability and preventing issues such as urinary incontinence.

Pelvic Floor Muscles:

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Physical Therapy For Athletes

Benefits Of Physical Therapy For Athletes

Physical Therapy For Athletes

Physical therapy and sports medicine for athletes focus on the mechanics of your moving body. How an athlete’s body moves, what muscles and ligaments are used in each movement, and what are the strengths and weaknesses to work on in order to fully recover.

Working with a physical therapist will aid athletes in getting back on their feet (metaphorically and literally) quicker, safer, and more efficient.

Sports Injury Doctor

 

What is Physical Therapy?

Working with a Physical Therapist for athletes is like calling an auto mechanic for your car when you see a check engine light. Just like a mechanic will run the engine, listen for unusual noises, and watch the engine at work, your physical therapist will do the same after an athlete is injured.

In sports medicine, a physical therapist is a diagnostician. First, they assess the movements of your body to provide an accurate injury diagnosis, determine why the injury occurred, and consider other risk factors for future injuries. After your initial evaluation, your physical therapist will make a personalized treatment plan that includes a combination of hands-on orthopedic manual techniques, improving muscle strength, stability of the joints, optimizing mobility, and decreasing pain.

Orthopedic Manual Physical Therapy

For instance, if you’ve injured your Achilles tendon, they’ll examine it by checking the range of motion, level of pain, and how strong the associated muscles are. Then, a treatment plan to get you back on your feet is drawn up, including strengthening techniques, flexibility techniques, and other things designed to bring strength and mobility back.

Physical therapy is designed to bring function back after an injury holistically. What’s more, it’s also meant to prevent sports injuries by educating about proper moving techniques before the tendon ever ruptures.

Why is Physical Therapy Important for Athletes?

Relive Pain, Restore Function, and Prevent Future Injuries are the most important goals for athletes after suffering an injury.

Pain when moving is always unpleasant, but more so for athletes. Physical therapy has techniques for immediate pain relief (such as dry needling, Kinesio taping, or cupping therapy) to make all athletes more comfortable so they can progress to more advanced exercises in order to return to competition.

In addition, a physical therapist specializing in sports medicine has methods for bringing your body back from injury to get your body back into peak performance. Assessing what went wrong in your body allows them to formulate how to fix it and give tangible methods for strengthening the injury.

After an injury, strength, and mobility can be compromised. For instance, rolling your ankle on the field means it’s tender for a long time afterward and not supporting your weight as well. Maybe it won’t support your weight to run down the field anymore, or it supports your weight but hurts so much you can’t see the ball anymore. 

Physical therapy will help build the strength in that ankle back to where it was before the injury, eliminating the pain of that injury, as well as safeguarding against future damage. 

Sometimes an injury can take a long time to heal. In the meantime, strength is lost, and it can feel insurmountable to get it back. In physical therapy, we focus on regaining that strength safely and healthily to protect against re-injury. As a result, some people even feel stronger than before the injury.

Reducing Pain and Understanding Your Body

A physical therapist has specific training to understand your body and how sports injuries can happen. In physical therapy, we focus on fixing pain and reducing and preventing it. Physical therapists can suggest correct techniques and help you determine what works best for your body to keep it strong.

Sports Medicine Doctor

Then, we’ll work one-on-one with you to show you the proper procedures so that these sensitive areas of your body are taken care of so well you won’t have to worry about them. These strengthening techniques don’t only fix what’s broken but also help keep them from breaking.

The Value of Balanced Physical Therapy

When doing physical therapy, you want to choose professionals at the top of their field. Our doctors are movement specialists who understand how your body moves during your sport and all the stresses that come with training and competing at a high level.

With Balanced Physical Therapy, you are treated as individuals with unique needs. Our athletes work one-on-one with a certified Doctor of Physical Therapist and are not passed around between assistants, techs, or aids. Each treatment is 1 hour, allowing for the safest, most professional care.

Our doctors also have experience working with male and female athletes of all levels in a vast range of sports, including:

  • Track-and field
  • Football
  • Soccer
  • Basketball
  • Swimming
  • Gymnastics
  • Wrestling
  • Performance Arts
  • ..And more

Physical Therapy Prevents and Heals Sports Injuries

There are multiple disciplines in sports medicine. Depending on age, sports, and injury type, Balanced Physical Therapy has options that are proven to get you back to competing. Contact Us Today to speak with one of our licensed and certified Doctors of Physical Therapy or to get started with an initial evaluation.

 

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Preventing Overtraining Syndrome

Prevent Overtraining Syndrome and Overuse Injuries in Youth Sports

Helping parents, coaches, and young athletes understand overtraining syndrome (OTS), the specific injuries associated with overuse, early signs of detection, and general guidelines for training.

Overtraining in Youth Sports

With over 30 million youth sports participants ages 6 to 18, it is important for parents and coaches to know about overtraining syndrome (OTS), the specific injuries associated with overuse, early signs of detection, and general guidelines for training.

Every year more children and adolescents are participating in organized and recreational sports. This is a great sign in the fight against childhood obesity as it builds lifelong physical activity habits, promotes healthy competition, and builds skills for future opportunities. Unfortunately one of the downsides with increased activity in youth sports is the increased risk of overtraining, overuse injuries, and burnout.

What is Overtraining Syndrome (OTS)?

Overtraining Syndrome (OTS) is more commonly referred to as “burnout”. OTS or “burnout” is caused by intensely working the body for long amounts of time without allowing the time for rest and recovery.

The American Academy of Pediatrics describes overtraining syndromes as a “series of psychological, physiologic, and hormonal changes that result in a decreased athletic performance. With so many options such as football, gymnastics, swimming, wrestling, and tennis at all levels; kids have naturally become more likely to suffer from injury.

What is an Overuse Injury?

Overtraining can directly cause an overuse injury. Overuse injuries often include damage to bone, muscle, and tendons. These injuries can be classified into 4 stages:

  1. Pain in the affected area after physical activity
  2. Pain during physical activity, but not restricting performance
  3. Pain during physical activity that also restricts performance
  4. Chronic, persistent pain, even at rest

Because young athletes’ bodies are still developing, they are more susceptible to overuse injuries. Their bones are still growing, therefore cannot handle as much stress as fully developed adults. Generally, the best way to prevent major overuse injuries is to understand and identify the young athlete who is at most at risk.

If your young athlete is showing signs of injury, it is always a good idea to get a professional assessment. A physical therapist can diagnose the injury and provide a treatment plan to safely return to competition.  Contact Balanced Physical Therapy to schedule a free injury screening or comprehensive evaluations here.

Common Overuse Injuries in Youth Sports

Some examples of overuse injuries and risks that may result from overtraining in youth sports include:

Little league and travel baseball players can be at risk for throwing injuries such as medial apophysitis or “little leaguer’s elbow”. Too much overhand throwing, especially with poor technique, can result in excess inflammation and irritation in the elbow. This can have long-lasting effects on the medial apophysis growth plate.

A child or adolescent gymnast can be at risk for developing spondylosis (pain in the spine due to deterioration) when doing repetitive hyperextension and rotation while participating.

Preventing Overtraining in Youth Athletes

Young swimmers are susceptible to shoulder injuries such a rotator cuff or bicep tendonitis, shoulder impingement, and neck pains.

Track and distance runners often develop shin splints and stress fractures as a result of overtraining.

These injuries are commonly caused over time, and not suddenly. This is good news, especially for parents and coaches who know the signs of overtraining and overuse.

Signs of Overtraining and Burnout

Parents and coaches concerned about the possibility of overtraining have multiple ways to tell when a young athlete needs more time to rest and recover. The Boston Children’s Hospital lists common signs of overtraining that include:

  • Slower times in distance sports
  • A decrease in athletic performance
  • Decreased ability to achieve training goals
  • Decreased motivation to practice
  • Young athlete getting tired easily
  • Irritability and unwillingness to work with teammates
  • Disturbance in sleep schedule
  • Weight loss or appetite changes

How To Prevent Overtraining Syndrome

General guidelines suggest that to promote fun, develop skills, and achieve individual goals; a young athlete requires good training and rest balance. Some ways to prevent overuse injuries and burnout include:

  • Encourage young athletes to take 1-2 rest days per week. This allows time to recover physically and psychologically between competition.
  • Advise young athletes that their weekly training time, repetitions, or total distance should not increase more than 10% per week.
  • Encourage athletes to take a seasonal rest from a single sport for 2-3 months a year. Taking breaks and developing other skills are essential for preventing injuries.
  • Focus on proper nutrition, hydration, and sleep.
  • Be mindful and cautious when entering multiple tournaments on consecutive weeks
  • Be consistent with yearly checkups with pediatricians and family physicians. 
  • Emphasize that the reason we participate in sports is to have fun, develop healthy lifestyle habits, and improve athletic skills.

Using these guidelines, parents, coaches, and healthcare professionals can help keep young athletes injury-free. Mixing in rest days and diversifying the activities kids participate in can help tremendously when developing skills and avoiding burnout.

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