Jack Everett sat on his living room couch wearing a back brace, eyes glued to a massive TV set playing his favorite video game, NHL 2013.
"I'm the Boston Bruins," the 10-year-old said as he deftly worked the video controls. "The guy that just shot was Milan Lucic. He's a really good guy on our team."
Whether at home or during recess at his elementary school in suburban Los Angeles, Jack's young life now is about sitting still.
"Well, I can eat lunch with friends, and I play cards," Jack says. But his classmates are out running and jumping outside.
That's a big change from last year, when Jack played club soccer, with multiple practices and games in a week.
"He was doing a morning endurance workout and afternoon skill session," says his mother, Marcia Riso. "About two hours for each. The coach would often have extra training on the weekend and/or scrimmage. Games were played on the weekends, including tournaments, which were two days long."
Then his back started hurting during games.
His parents thought probably it was a pulled muscle. A sports chiropractor gave Jack massages and muscle stimulation. But it didn't help. Finally, at a tournament in Orange County, the pain became unbearable. "I played, like, one or two times," says Jack. "And then I just couldn't do it anymore."
Jack Everett had broken a bone in his back. The official diagnosis was a pars stress fracture in his lower back. Jack's doctor said the injury was due to overuse.
"Who knew," says his mother, "that elastic little kids can break?"
Sports medicine doctors say they've seen a rise in overuse injuries among young athletes like Jack. The toll on knees and ankles is well-known. But many parents are surprised to learn that children can injure their backs, too.
Jack was all in with his beloved soccer. He joined a club team that practiced and played 11 months out of the year. Riso says she and Jack's father wanted their son to play several other sports, too, so he wouldn't burn out.
But Jack was as adamant as a 10-year-old can be. It was all soccer, soccer, soccer.
"So we thought," says Riso, "this is what he wants to do and he's great at it. Why not?"
But low back injuries like Jack's can keep young athletes laid up for months, according to Dr. Neeru Jayanthi, an associate professor of orthopedic surgery at Loyola Medicine in Maywood, Ill.
Jayanthi studied more than 1,200 young athletes, and found that lower back injuries were the third most common injury in athletes younger than 18, after knees and ankles. He presented the data last year at the American Academy of Pediatrics conference.
Almost half of the back injuries were severe enough to sideline kids for one to six months and put them at future risk for long-term back problems.
These back injuries are most often caused by repetitive bending, Jayanthi says, combined with high levels of sports participation.
Young athletes can reduce the risk of back injuries by not spending more hours a week than their age playing sports, Jayanthi says. Also, they should not spend more than twice as much time playing organized sports as they spend in gym class and unorganized play.
Jayanthi also recommends something that many young athletes and parents would find inconceivable: Don't specialize in one sport before late adolescence.
That's easier said than done in the midst of a youth sports juggernaut that puts a premium on hypercompetitive training and playing at the earliest ages.
Jayanthi understands the dilemma. And like any man of science, he seeks data to prove a point. A comprehensive review he published in the Journal of Sports Health examined the impact of early specialized training. "And if you look at all sports," he says, "there are only two types of sports where specializing early leads to greater success later."
He says those sports are gymnastics and diving, because young athletes in those sports have to compete before becoming fully mature.
Publishing a paper is one thing; it's another to convince what Jayanthi calls "the stakeholders" in a culture dedicated to intense youth sports. Coaches, sports organizations, sports manufacturers and, yes, parents. Like Marcia Riso.
"We thought, wow," Riso says. "Jack's getting excellent training. He's got an excellent coach. He's working so hard. He could really do well in this sport. And he's starting so young — we thought that was a positive. Because it is so competitive. ... And it's so much about winning. Which isn't a bad thing. I believe in healthy competition. But ... "
When Jack Everett finally takes off for good the back brace he wears most of the day, he'll have a different sports experience, says his mom. The plan is to diversify — doctor's orders, in fact. Riso says it makes her kind of sad because Jack loved his soccer team so much. But not as sad as it makes her watching her son cope with injury and inactivity.
And there's a silver lining.
Once Jack is able, physical therapy to strengthen his core and his glutes should make him one strong little kid. Riso told him at the end of it, "he'll have 12-pack abs.
"And he's very excited," she says.
RENEE MONTAGNE, HOST:
And then there's the other end of the spectrum - kids who move too much. Doctors have noted with alarm in recent years the increase in overuse injuries among young athletes; kids playing many, many hours, especially if they play just one sport. The toll on knees and ankles is fairly well-documented. More surprising is an increase in serious lower back injuries, as NPR's Tom Goldman reports.
(SOUNDBITE OF VIDEOGAME, "NHL 2013")
TOM GOLDMAN, BYLINE: The videogame "NHL 2013" is as close as Jack Everett gets to playing sports these days.
JACK EVERETT: I'm the Boston Bruins. And the guy that just shot it was Milan Lucic; he's a really good guy on our team.
GOLDMAN: Whether in front of a screen or at a table during recess at his elementary school in suburban LA, Jack's young life is now about sitting still.
JACK: Well, I can eat lunch with my friends, and I play cards.
GOLDMAN: Understand - this is a 10-year-old boy who's not just active, according to his mom, Marcia Riso.
MARCIA RISO: He's got a motor.
GOLDMAN: A motor that sputtered and stalled last summer. Increasing lower back pain that Jack's parents figured was a muscle pull, finally went over the top during a soccer tournament in Orange County.
JACK: I played like, one or two times. And then I just couldn't do it anymore.
GOLDMAN: Jack Everett broke a bone in his lower back. The official diagnosis was a stress fracture because of overuse. Jack was all in with his beloved soccer. He joined a club team that practiced and played 11 months out of the year.
GOLDMAN: During the summer of his injury, Riso says at times, Jack was doing intensive training or playing four hours a day. Riso says she and Jack's father wanted Jack to play other sports as well so he wouldn't burn out; maybe flag football or swimming. But Jack was as adamant as a 10-year-old can be. All soccer, all the time.
RISO: So we thought, you know, this is what he wants to do and he's great at it, and so why not?
GOLDMAN: Had they asked Dr. Neeru Jayanthi, a sports medicine doctor at Loyola University, outside Chicago, this is what he could have told them.
DR. NEERU JAYANTHI: I personally was seeing a lot of young athletes with - in the sports world, what I would consider devastating low back injuries and stress injuries that were keeping them out for months and months.
GOLDMAN: As a way to quantify what he was seeing, Dr. Jayanthi led a three-year study of more than 1,200 young athletes. The findings revealed this: Lower back injuries are the third most common injuries among athletes under 18. Many of those injuries - nearly 40 percent, in the study - are severe enough to sideline kids for one to six months and put them at future risk for long-term back problems.
JAYANTHI: The typical causes of acquired stress injuries in low back are often related to extension or leaning back a lot in their sport, with high levels of sports participation.
GOLDMAN: Especially participation in one sport. Dr. Jayanthi advises against specializing in one sport until late adolescence. As he likes to say...
JAYANTHI: Early introduction, late specialization.
GOLDMAN: But easier said than done.
(SOUNDBITE OF BROADCAST")
UNIDENTIFIED ANNOUNCER: Hello, and welcome to Blair Middle School, site of the boys' middle school championship game - here on Channel 47...
GOLDMAN: How, exactly ,do we achieve Dr. Jayanthi's ideal of more free play, diversity in sports and less intensive training for younger kids in the midst of a youth sports juggernaut where middle school basketball games are on live TV?
The doctor understands the dilemma and like any man of science, he seeks data to prove a point. He published a paper in the "Journal of Sports Health" examining the impact of early, specialized training.
JAYANTHI: And if you look at all sports, there is - two types of sports which specializing early leads to greater success later.
GOLDMAN: Gymnastics and diving, he says, because you have to compete before becoming fully mature.
Publishing a paper is one thing; it's another to convince what Dr. Jayanthi calls the stakeholders, in a culture dedicated to intense youth sports training - coaches, sports organizations, equipment and clothing manufacturers, and yes, parents like Marcia Riso, who admits she and Jack's father were caught up in it as well.
RISO: We thought, wow, Jack's getting excellent training. He's got an excellent coach. And he's starting so young; we thought that was a positive.
JACK: To take it off, I take off one Velcro strip and then the big one.
GOLDMAN: Jack Everett now wears a back brace most of the day. When he takes it off for good, he'll have a different sports experience. No question this time, says his mom. The plan is to diversify - doctor's orders, in fact. Marcia Riso says it makes her sad because Jack loved his soccer team so much, but not as sad as it makes her watching him cope with the injury.
And there's a silver lining. Once Jack is able, physical therapy to strengthen his core and his glutes should make him one strong little kid.
Tom Goldman, NPR News. Transcript provided by NPR, Copyright NPR.