Random Thoughts from a Restless Mind

Dr. Darrell White's Personal Blog

Cape Cod

Posts Tagged ‘injury’

The Expense of Early Sport Specialization

My role in the horse world to date has been little more than loyal supporter. This includes my posts as head cheerleader, financier, and klutzy outsider comic relief (for example, I always seem to be over- or under-dressed). My ROI is measured in the smiles on my girls’ faces over the years. They have seemed to truly enjoy the process, the journey, sometimes with little regard to the outcome or the score.

Everything about the horse world is expensive. Really expensive, actually. There are lots of expensive sports out there to be sure. Golf, tennis, and hockey come quickly to mind. All have in common expensive equipment, coaching, and venues, even at the lowest levels of participation. Most other sports only become expensive when you add in the effects of higher level competition with the new burdens of professional coaching and travel. Think AAU anything, gymnastics or swimming.

One thing that sets the horse world apart is the Sugar Daddy or Sugar Momma, a usually over-monied individual whose sole role is to write checks. Big checks. Lots and lots of checks. Most whom I’ve met don’t really seem to enjoy hanging around horses, actually. Kinda like someone who owns a big boat but gets seasick in the bathtub. The other essential difference between a Sugar Daddy/Momma and a “Little League Parent” is that the Sugar Daddy/Momma doesn’t care a lick about the outcome of the event.

In a funny, very roundabout way this makes me think about youth sports, high school sports, and the behavior of parents in that world. Unlike the Sugar Daddy/Momma the youth sports parent is highly invested in outcomes, not only game by game but also in terms of reaching the next level. As in that level to which the ridiculously large percentage of participants never get. You probably think this is about going pro, about making a living at your sport. Nope. That number is so tiny and has been parsed so many times and so many ways that it’s not worth spending the electrons thinking about how few college athletes or minor leaguers make it to The Show. I’m not even talking about getting a scholarship to play a D1 sport.

What I’m thinking about is some fascinating facts about how few high school athletes go on to play a sport at any level in college.

Seriously, the numbers are comically low. Cut and past this for a look: http://www.ncaa.org/about/resources/research/estimated-probability-competing-college-athletics. For boys, only lacrosse and hockey are above 10%. More boys go on to swim in college (7.1%) than play football (6.8%). The statistics are similar for girls led by Ice hockey (24%), lacrosse (12.9%), and field hockey (10.1%); all other sports are in the low to mid-single digits. I don’t know about you, but with all of the teams sponsored by Division 3 colleges out there, along with the dearth of multi-sport athletes taking up more than one slot, these figures are really shockingly low.

How, then, can we justify the expense of early sport specialization, both in real financial terms, and in terms of the epidemic of injuries suffered through over-use and under-preparation?

On my most recent foray into the horse world I met a  youngster who plays on a volleyball team that uses CrossFit to enhance their fitness.  She no longer does her first-love sport, tumbling, because of a repetitive use stress fracture in her back suffered before she started to play other sports. All tumbling all the time wrecked her. How many young arms must we scar with a Tommy John “autograph” prior to obtaining a driver’s license before we suggest adding in a little winter reprieve from pitching? Isn’t it just a bit disheartening to think that the ACL tear rate in young female soccer players is higher than the overall NCAA participation rate for girls who played that sport in high school? Mind you, these are TOTAL participation rates, not the percentages of kids who got a scholarship to play D1. The list goes on and on.

Says here that the kids would be far better off playing more sports with their buddies in their hometown schools, both physically and mentally, than they are now joining elite travel programs and chasing after such a small number of slots at the next level. Probably have a better relationship with Mom and Dad, too. For sure Mom and Dad are likely to be better behaved. Throw in a little bit of fitness training that emphasizes proper mechanics in functional movements and maybe we can start a trend.

No Sugar Daddies or Mommas necessary, either.

Fitness as Health Marker

The human body as a machine is an endless source of fascination. Designed at this point in evolution primarily as a vehicle to carry a brain, our bodies can withstand famine, thirst, and physical stress beyond what our brains can imagine. When one part starts to fail we have a series of “fail-safe” backups in many cases that allow us to carry on. Interestingly, the greatest harm to our “vehicles” is actually excess (gluttony) and lack of physical stress (sloth).

Kinda Biblical, eh?

There is a complex daisy chain of effects that can ever be traced back to a cause when our bodies begin to break down. My own musculoskeletal system is failing me miserably, and it has taken the eventual unavoidable breakdown of one of those fail-safe mechanisms for me to finally figure out the original cause. Last month’s programming with its emphasis on our core was the last straw.

For the better part of a year I have struggled on and off with progressively worse failures of accessory muscles for mid-line stabilization. The posterior chain (gluteus maximus, hamstring, erector spinae) precisely balances your anterior chain (rectus abdominus) in maintaining a rigid core so that you can do, well, everything. Progressive movement failures in the gym (massive retrograde numbers in lifts, need for major scaling of loads) has now given way to rather plebeian challenges: spasms of the gluteus medius, priformis, and obturator (not to mention that rat bastard the extensor fascia lata) which sometimes drop me in the simplest of movements.

My initial reaction, of course, was to address what must be a weakness in these accessory muscles due to inattention. Surely this would be all that I needed to return me to my previous level of physical prowess. Naturally, since these “failures” were actually the fail-safes going down, accessory work on these muscles only worsened the problem by OVER-working the already overburdened.

How, then, did I figure it out? Well, as I noted, the chariot that rolls along carrying our brain is ever set to do its job, and eventually it sends up a signal when all of the backup systems failed. A tiny little dull ache appeared in my lower abs, an annoyance that escalated to Def-con 1 whenever I braced my anterior chain for any task whatsoever. There was no difference between a back squat or a “bear in the woods” squat–I could not use my abs to secure my midline, and guarding against the pain had shifted that burden to all of those little helper muscles.

A tiny little tear born in an area of inherited weakness turned out to be the cause. My friend the general surgeon describes the defect as “a dime with aspirations of becoming a quarter.” A half-dozen really smart folks had failed to see it, all of them equally fascinated by the epic failure of my Piriformae. And so it is that I will engage the knife as I seek relief on behalf of my accessory warriors such that they may return to their proper roles behind the front line of the midline stabilization battle.

What’s the point of all this sharing you ask? It’s pretty simple, really. Very basic. Each one of us is, or should be, engaging the CrossFit prescription of strength and metabolic conditioning aligned with proper nutrition in the pursuit of better daily function. Better, clearer thought. Stronger, leaner, faster bodies. In order to do so it is necessary that we are ever aware of those bodies, ever vigilant in our pursuit. CrossFit provides us a metric that allows us to monitor the machine that transports our brain. My performance began to suffer. I stalled, then backed up. Measurable and observable that I was failing at repeatable. To discover the root cause I eventually used the degree and manner of those failures to work back to the source. I think fitness as we describe it is best seen as a real-time marker for health. CrossFit approached properly is the thinking athlete’s fitness program, the inquisitive athletes health monitor.

Now to be fixed and resume my quest.

 

An Open Letter to Parents and Coaches of Girls Who Play Sports

Dear Coaches and Parents,

For more than 30 years I have had the good fortune to be a volunteer assistant coach for boys and young men playing football, basketball, and lacrosse, sports I played in high school and/or college. In this capacity I became very familiar with the particular dangers of concussions suffered while playing these contact sports. Indeed, one of my sons suffered a severe concussion as a high school lacrosse player, effectively ending his competitive career. I applaud the recent efforts being made at all levels of competition, especially in the area of gratuitous headshots in football, lacrosse, and hockey.

As a fitness coach for the last 10 years or so I’ve learned of another, all too common injury in sports, one that is disproportionally concentrated in the younger athletes: ACL tears in girls and young women. There is a veritable epidemic of ACL injuries in soccer, basketball, and volleyball. Girls are 4-6X more likely to tear their ACL playing these sports than boys. The numbers are quite simply appalling, and yet I hear not a word about this from any media source. Girls are being felled by this injury in droves but it seems no one is talking about how to prevent it.

Can anyone tell me why that is?

It’s not like this is a new phenomenon. A brief Google search turns up academic articles published in 1999. It’s also not as if these injuries are only of historical importance. The daughter of a friend was the third girl playing the same position for the same U17 soccer team for the same coach to suffer a non-contact ACL tear in 2015. Nor were they the only girls on that team so afflicted. When asked what changes had been made by the team or the coach in response to these injuries my friend shook his head. Crickets.

Can anyone tell me how this is OK?

The answer, of course, is that it is not OK. Not even a little bit. The causes underlying the increased risk to suffer an ACL tear in which a female athlete does not come into contact with another player are relatively well known. Studies have been done examining the way girls jump and land. As it turns out, girls tend to change direction and land with an outstretched, straight leg. Boys, on the other hand, do so with a flexed leg, reducing tension on the ACL.

If you watch girls running you can’t help but be struck by the valgus position of the knee when their foot lands on the ground; the knee is markedly inside the foot.  Girls tend to have stronger anterior muscles and therefore tend to be quad-dominant runners. They pull their upper leg forward through the contraction of the thigh muscles. Boys, on the other hand, are posterior chain-dominant runners, pulling their legs up through the contraction of their glutes and hamstrings. Without a strong posterior chain to counteract the effect of the quadriceps, the ACL is again under increased tension, magnifying the risk caused by knee position.

We know why the injuries occur, and as it turns out we also know how to prevent them, or at least reduce their frequency: teach young female athletes safer movement patterns, and put them in strength and conditioning programs that specifically train their posterior chain. If you see this type of training you will recognize it immediately: it’s how we train boys.

Can anyone explain to me why this is not occurring with young female athletes right now?

Even at the highest level of women’s sports we still see non-contact ACL injuries. For example, in 2011, 6 of the 21 members of the U.S. Women’s National Soccer Team had suffered an ACL tear at one point in their careers. However, in more recent years there has been a decrease in these injuries at the professional level because teams are training their female athletes in better neuromuscular recruitment patterns, which creates sounder movement. Athletes are doing strength and conditioning programs that emphasize strengthening their glutes and hamstrings. Hence, we are seeing dramatically fewer ACL tears at the highest levels of women’s sports. There is no way to justify not doing the same thing for girls early in their careers.

Proven templates already exist to do just this. Simply utilizing the off-the-shelf PEP program of stretching and plyometrics has demonstrated meaningful decreases in the incidence of ACL tears. Rather than use such a basic program when it comes to high quality movement patterns, why not look to someone like San Francisco’s Dr. Kelly Starrett? The founder of Mobility WOD and author of “The Supple Leopard”, Dr. Starrett is a consultant to dozens of collegiate athletic departments. He recently took over training for an elite 150-member girls volleyball program with the specific aim of reducing ACL injuries in those athletes. His teachings on proper movement mechanics are peerless, as a quick perusal of his book will attest. Perhaps we should be looking at what he is doing.

Jeff and Mikki Martin have been training kids in Southern California, the epicenter of youth soccer, for well over a decade. Their protocols include meticulous attention to the type of mechanics taught by Kelly Starrett and emphasize the importance of strengthening the posterior chain beginning around age 10. As the developers of the original CrossFit Kids program and more recently founders of The Brand X Method™, they have trained hundreds of young girls who play soccer without a single one of their athletes suffering an ACL injury while under their care. They arguably have the longest track record of successfully and safely training youngsters. Perhaps we should be looking at what they are doing.

One thing is for sure: it is not OK to continue with the status quo. Simply doing what you have always done is nothing less than condemning a high percentage of your girls and young women to suffering an ACL tear and all that goes along with it. The nature of the sports in which we see an epidemic of concussions is such that the only way to prevent them is not to play those sports. This is not the case with non-contact ACL tears in soccer, basketball, volleyball and other sports played by girls. Prevention is possible through the institution of training programs that emphasize the teaching of new, safer movement patterns, as well as strengthening the muscles of the posterior chain.

I’d like to propose a 3-part solution to this problem. First, we would like to offer training to coaches in how to teach better basic movement patterns. One of the most fundamental goals for those of us who utilize The Brand X Method ™ to train kids and teens is to create a cadre of coaches who can do this. We hope that this can become a core part of in-season team training. Secondly, we wish to make available our coaches, and coaches who share our concerns and philosophy, to train your athletes to have a stronger posterior chain. The data supporting the inclusion of weighted squats, deadlifts, and power cleans both in season and out of season is compelling. Our coaches are experts in teaching the proper mechanics involved, and our athletes progress in a safe and measured fashion.

Lastly, the data supporting the inclusion of full-body functional movements executed at relatively high intensity is equally compelling when it comes to not only injury prevention, but also in developing stronger, faster, more durable athletes. The Brand X Method ™ is a proven program that emphasizes proper mechanics and safety. It is the latest version of a program that has been creating highly athletic youngsters and teens for more than 10 years. This type of physical fitness directly translates to more capable and confident athletes in all of the sports mentioned. At CrossFit Bingo our Alpha X Youth Athletics program is available to train your athletes all year round, either individually or in team settings.

It’s time we all start talking about these non-contact ACL injuries in girls’ sports, just like we have been talking about concussions in boys’ sports. Parents should be asking what is being done on behalf of their daughters. Coaches should be committed to stopping the epidemic of non-contact ACL injuries in their female athletes.

We can help.

 

Darrell E. White, M.D.

Co-Founder, CrossFit Bingo

Co-Founder, Alpha X Youth Athletics

 

 

Lessons from a CrossFit Athlete Moving On

Gutted. Just a deep, sickening sadness when I heard the news. I confess, I wasn’t watching the Regionals feed, just reading and studying and occasionally glancing at various SM feeds. They all blew up at the same time, precisely 5 minutes after Julie Foucher’s achilles tendon did the same.

I wanted to throw up.

To be honest, while I would be saddened by any injury to a Regionals competitor, Julie is a friend, someone I know face-to-face. Seeing her hurting was a more personal thing for me and for all of Clan bingo. We know her story and we know her people. It felt like watching my neighbor’s kid get hurt, the one who always made you smile when you saw her outside playing. Her tears brought ours.

There is some anger out there in CrossFit land about this, and we will soon be hearing condemnation of not only the movement during which the injury occurred, but also by extension the entirety of CrossFit itself. Julie does not seem angry (we’ve not yet spoken; I’ve seen the same videos you have), and for whatever little it’s worth I’m not, either. I think this is misplaced, this anger, and that it speaks to a continuing and fundamental misunderstanding of the differences between training and competing, between CrossFit and The Sport of Fitness®. As such it bears examination and illumination. Again.

Julie Foucher, and competitors at her level, is a professional athlete. She is paid for her outcomes. Paid for performance. As such, like every other professional athlete, she accepts a higher degree of risk in both her training and her competitions. This is a fact of life in every athletic pursuit. Full stop. As sports evolve one hopes that leaders strive to make essential aspects of those sports safer, but at some point it becomes impossible to increase safety without removing essential.

Smaller engines and slower speeds would certainly reduce crashes at Indy, but then it would be a commute, not a race.

Being injured in the heat of competition is very disappointing; being injured in training more so, because that which you do to become better has made you worse. The safety bar is therefore raised higher in the gym than in the arena. Indeed, the further we are from the pinnacle of performance in any competitive endeavor, the more important it becomes to emphasize safety.

Regarding the movement in question today, the Box Jump, this is rather straightforward: step down in training, and step down in competitions entered for your own entertainment and enlightenment. Again, Full Stop. You are not Julie Foucher. I am not Julie Foucher. It is folly to conflate a competition in which you perform functional movements at relatively high intensity against a clock and fellow recreational athletes with the CrossFit Games.

This, in turn, illustrates the folly and fallacious thinking of extrapolating a ruptured achilles tendon in an elite athlete at the highest level of competition to the conclusion that CrossFit is dangerous. Poppycock. Constantly varied functional movements performed at relatively high intensity is as safe as any other fitness methodology. It is especially so if you adhere to the classic progression, still taught at every CrossFit seminar: technique, then consistency, then–and only then–intensity.

The Sport of Fitness is also as safe as other sports. Injuries to women? How about the epidemic of non-contact ACL tears in young women playing soccer? The higher the level of amateur soccer played, the greater the number and higher the percentage of girls and women who blow their ACL. Not at the pro level though, because they train differently. Where is the outrage here? Achilles tendon injuries, you say? Ask your buddy the orthopod about middle-aged men who play basketball and racquet sports. It’s so common it’s a cartoon.

No, anger is misplaced here if it is directed toward either CrossFit or The Sport of Fitness. The best example of why? None other than Julie Foucher. What makes Julie such a special person is what she did and is doing after her injury: moving on. There is sadness to be sure. A sense that the journey ended too soon. A quest not quite fulfilled. After the tears, though, came a smile. Perspective. There was talk of fun. CrossFit with CrossFitters as fun.

We welcome Julie back to our world of training to be better at life. As she now steps down like the rest of us she has offered us one final gift as she moves on from competition: a smile and a hand up to each of us, a reminder that what we do is fun because we do it together. For that, and for the joy of watching her compete these many years, we in turn should holster our anger, dry our tears, and smile back at her in thanks.

 

 

CrossFit is Even MORE Dangerous Than You Thought!

Three CrossFit injuries in less than 3:00 last night at the Box. Incredible, huh? It’s truly unbelievable when you really dig down into the details: CrossFit is even more dangerous than anyone thought, even that trainer girl who took one whole CrossFit class. Wait until you hear the details.

I was just kinda hanging around after the WOD getting ready to coach the next class when Walt cried out and crumbled to the ground. “My leg! I got this pain and now I can’t stand up!” This was pretty ominous. A clear sign that CrossFit is too dangerous to even think about. Walt had just completed the WOD and now he had so much pain in his leg that he couldn’t stand up. Whoa, if that can happen from a WOD called “Death by Pull-ups” where the only exercise you do is pull-ups, if you can have leg pain in a CrossFit Box from pull-ups, I mean, that’s pretty dangerous. Not only that, but when the pain went away in 10 or 12 seconds Walt joined in the running sessions. CrossFit makes you crazy, too!

Once I calmed down–it seemed like a fluke, leg pain after doing pull-ups–the next group started coming in the door and meandering over to the white board to check out the WOD. “Death by Pull-ups”, the minute repeater. Do one PU in the first minute, 2 in the second, and so on until you can’t finish the required number in the minute. All of a sudden, another scream. “AHHHHHHH…I ripped!” One of the members got a rip on her hand just from reading the WOD on the white board. Now THAT’S dangerous. She didn’t even have to do the WOD, didn’t do a single pull-up, and she got a rip on her palm. Right about that time I’m starting to think maybe all those CrossFit haters who say CrossFit is dangerous are on to something.

A couple of minutes later and a small group of us was chatting about CrossFit. CrossFitters tend to do that. All of a sudden–BAM!!–I can’t talk. Oh man, the pain. That’s right. You got it. I threw my jaw out just talking about CrossFit. How crazy is that?! Not only did I not do a WOD, I wasn’t even looking at the white board in preparation for the WOD. Just talking about CrossFit and I got hurt! That’s just out-of-this-world incredible. I mean, can you even imagine?

So there you have it. Here, right here on the internet, is proof that CrossFit is even more dangerous than any of those other “CrossFit is Dangerous” posts says it is. In just 3:00 time we proved that CrossFit can hurt parts of your body you didn’t even use in the WOD. You can be injured and out of commission just thinking about the WOD. And to top it all off, you can’t even be safe talking about CrossFit. It’s true. It’s gotta be, right? Here it is posted on the internet, just like all the other posts. If you are getting your information from totally legit sources like this one, well, maybe you SHOULDN’T do CrossFit. When I told Walt I was writing this and his response was “no way I’m reading that.” Turns out the last time he read a post about CrossFit he sprained his left medial rectus muscle!

Honest! I’m an eye doctor, and you just read this on the internet.

The Role Of Adults In Youth Sports I: Safety

Among the many things that I have called over the course of my lifetime, none has been more meaningful than “Coach”. I spent time on the sidelines and on the bench for about 10 years coaching junior high school sports.  When my own children moved on to high school sports I retired to the committee rooms and the grandstands where adults who don’t coach play their role in youth sports.

There are three roles that adults can and should play in youth sports. First and foremost, all adults who are involved in youth sports should have as their primary goal the safety of the children playing the games. Secondly, kids who play sports should be guided by the adults around those games, taught by their elders not only about the games but also taught the life lessons that one can glean from playing sports. Finally, we ARE talking about kids here; the last important role that adults have in youth sports is to make them FUN!

Let’s start by talking about safety.

I suppose we should probably define youth, huh? There’s not much to debate the inclusion of grade school or junior high school kids. Sure, reasonable people can disagree about the importance of playing time and, when to start cutting kids and when to start playing to win, but through eighth grade there is simply no question that these kids would be considered in the “youth” category. In some quarters it might be a little more dicey with high school athletics, but when it comes to safety I don’t see how you can separate high school kids from their younger brothers and sisters. Protecting ALL of these kids is job number one for every adult involved in youth sports.

A quick word about college sports: the brightest, clearest dividing line between youth sports and sports as commerce, or job, is clearly the line that separates college and other athletic programs aimed at very young adults, and professional sports. But even here that line might be a little fuzzy. There are reasonable people who would say that Division I athletes on scholarship are the de facto professional athletes. I suppose I’d feel a little more comfortable with this if a larger percentage of these young men and women went on to earn a living from their sport after college. Certainly we can agree that divisions II and III in the NCAA would still constitute youth sports, don’t you think? For my mind only the most cynical among us would draw a line between divisions I and II when thinking about the safety of the athletes.

So, how do we ensure the safety of our children when they are playing sports? It starts at the very top with league commissioners and athletic directors. Every organization that sponsors athletic competition with youth participants, be it a league or a school or some other organization needs to be clear from the outset that job number one is keeping children safe. Commissioners need to set clear guidelines, rules that will be enforced that put safety first. No spearing in football. Elbows in on the basketball court. No head shots–not a SINGLE headshot–in hockey or lacrosse.

Each one of these directives needS to be clearly communicated to the athletic directors or program directors responsible for individual schools or teams. These men and women in turn need to hire or appoint coaches who will make it their primary mission to teach the children in their charge how to play the game safely. Not only must the coaches do this on the practice field, but as they roam the sidelines and pace in front of the bench they must bring this to the games as well. How many times have you been in the stands and cringed when a defensive coordinator screamed at his players, exhorting them to “take someone’s head off?” I can’t count the number of times I’ve been sick to my stomach watching a coach dance with glee as a long pole defenseman stands over the attackman he cross-checked in the back of the head. No amount of teaching in practice can withstand this type of “coaching”.

During games coaches need to look first to the well-being of their players; only after assuring that they are okay can winning and losing enter the equation. I’m certainly not proud to admit this, but I remember one clear instance where I probably should have kept a star athlete on the sidelines during a football game. I actually had my very favorite coaching job–I was the assistant to the assistant to the assistant backfield coach, responsible only for catching the kids doing something right and praising them for when they did. But I was the quasi-team doctor as well, and when our star halfback limped off the field with a sprained ankle, I really probably should have overruled the head coach, the offense coordinator, and the young man’s father and kept him on the sidelines, at least a little bit longer. Coaches need to allow themselves to be trumped by trainers and doctors.

The ultimate arbiters of safety, however, are the officials on the field. Whether it’s grade school, junior high school, high school, or even college sports, the officials who enforce the rules must make the safety of the participants their primary concern. Oh, I know, I know, the officials are supposed to be invisible, doing everything they can possibly do not to impose themselves on the game, not to affect the outcome of the game. The players should win or lose; the officials should not take a role. Blah, blah, balh. All well and good, until the retaliation for the retaliation for the initial hard tackle from behind results in a three ligament knee tear for that girl who was just about to get that shot off in soccer. All well and good, until they’re wheeling the center off on a stretcher, unconscious from the elbow he took to the jaw as he skated through mid-ice. All well and good, because the officials lost control of the game, allowing dangerous plays earlier for fear that they might “affect the outcome.”

Bullshit.

As far as I’m concerned the greatest responsibility for protecting our children on the various courts and fields of play lies with the officials. The referees and umpires who are right there in the middle of the game MUST protect the children playing the games. Dangerous play just cannot be allowed. Officials have lots of latitude, and every sport has rules, penalties for dangerous behavior. Blow the whistle! Throw the flag! Pull out that red card! Set the tone early and let it be known that dangerous play will not be tolerated.

My youngest child, in ways too many to count an athletic clone of his father, finished his high school lacrosse career sitting on a bucket on the sidelines, sobbing as he vomited. He was vomiting because he had just suffered a concussion, his third, this one the result of a vicious crosscheck to the back of his head. The play occurred just feet from the sidelines, yards from the referee looking directly at the play. Unbelievably, he hesitated. He HESITATED! He actually gave thought to not even pulling his flag. Eventually, out came the flag and the verdict was rendered: one minute for unnecessary roughness. Almost the smallest infraction in the game of lacrosse. One minute for a blatant headshot, right in front of the referee, right in front of Randy’s coach.

The trainer on duty, a lovely young woman, very empathetic… very concerned, hovered over him. Was he crying because his head hurt so much, she asked? No, he sobbed, he was crying because he knew he had a concussion, and he knew that that his role in youth sports was now over, his days as a lacrosse player now officially done because it was no longer safe for him to play. How many more, I asked.  How many more children would be hurt before that referee said enough? How many more ,I asked him out loud in a silent stadium, my voice the only sound, clearly heard by every ear in the stadium. Everyone turned to look at the father escorting his injured child off the field. Everyone, that is, save one.

Officials, indeed any adult, who will not protect the children who are playing have NO role in youth sports.