The final weeks of August each year are the “last reprieve” for Dr. Neeru Jayanthi, an Atlanta-based sports medicine physician.

That’s because as students return to school and resume sports, the injuries start rolling in.

“We actually prepare for it as high schools and contact sports start opening up,” said Jayanthi, who runs Emory Healthcare’s Sports Medicine Research and Education division. “With the clinics, we already expect to see more volume.”

More children go to the emergency room for sports-related injuries in September than at any other time of the year, according to an analysis of two decades of hospital data by GateHouse Media.

Football accounts for more than half of all sports-related visits in September for patients under 18. ER trips due to soccer and volleyball injuries also peak that month.

The numbers come from the National Electronic Injury Surveillance System, a database run by the U.S. Consumer Product Safety Commission for more than four decades. Some 100 hospitals around the country participate, sending detailed data about a broad spectrum of ER visits to the commission.

Not all sports injuries peak in the fall. Wrestling- and basketball-related ER visits are at their highest in January. Meanwhile, softball and baseball injuries tend to spike in May.

Sports medicine experts say athletes are more at risk for injury at the beginning of the season because they tend to jump back into intense training even though their bodies aren’t conditioned for it.

The pattern has been noticed even at the most elite levels of play, like in the NFL, where officials are weighing whether to shorten the preseason due to the prevalence of injuries.

Many youth sports lost participation in recent years, according to the Sports & Fitness Industry Association. Not only are parents more aware about the risk of injury, but kids also increasingly are rejecting the high-pressure atmosphere of competitive sports, said Jayanthi.

“It’s great for kids to really want intensity,” he said, “but there’s a cost to that as well.”

 

Risks of concussion

 

Charelle Tootle, a mother of two from Kansas City, Missouri, said her teenage son Parker withdrew from football due to those concerns.

He sustained a severe concussion in 2014 while trying to eke out a few more yards on a first down. It was just before his first season as the high school’s varsity quarterback. The recovery process caused Parker to miss months of school, and the fear of permanent damage was too much to endure — even for their football-obsessed family.

“What my son went through, it’s not worth it,” Tootle said. “When your child is laying on the field, knocked out, there’s nothing scarier. And looking back, I would say no to football.”

Football does tend to have high concussion rates, according to Safe Kids Worldwide, which used the same ER data to examine injury rates by sport in 2013. Other activities like ice hockey and wrestling had even higher concussion rates.

In Ohio, football was the top sport among boys for participation in the 2017-18 school year, with 42,637 players of both sexes, according to the National Federation of State High School Associations. For girls and overall, the top sport in Ohio was track and field, with 51,389 boys and girls participating.

"Every sport is safe if the right things are followed,” said Ali Flury, Safe Kids’ sports safety program manager. “You do your pre-participation physical, you do your warmup and stretch routine every single day, you drink water, you wear the appropriate equipment.”

ER visits for football-related injuries among older youths dropped dramatically after peaking in 2010 at 12,064, according to the data. Eight years later, ERs treated 7,713 football-related injuries. But a higher percentage of those injuries were concussion-related.

Emergency room physicians say they are encouraged to see more young athletes asking questions about concussions and overuse injuries.

A law went into effect in Ohio in 2013 requiring the removal of young athletes from play when a concussion is suspected, until a health-care professional approves their return. A 2017 study conducted at Nationwide Children's Hospital found that such laws have significantly reduced the rate of repeat concussions, which can be especially dangerous.

 

Rest and heal

 

Annie Slater, a pediatric emergency medicine physician in Seattle, emphasized making sure young athletes take appropriate time off after an injury.

Even an ankle sprain weakens tendon and soft tissues, she said. Athletes who fail to properly heal put themselves at risk for further injury.

“I see kids come in and they just want to play their sport, and they just want to get back on the field,” Slater said, “but my biggest thing is you have to rest.”

Parents also need to think critically about how many competitive sports their child can effectively handle, said Dr. Irene Tien, a Boston-area pediatric emergency medicine physician.

“Bodies do need a rest,” Tien said. “It is actually productive to rest.”

Jayanthi, who is a lifelong tennis player, encourages parents let their children guide the sports selection and intensity level.

Instead of focusing solely on safety, parents should also consider the psychological, social and health benefits of sports, he said.

For example, while football may score lower on physical safety, it’s among the sports that ranks the highest in both psychological and social benefits.

“I want to remind people that sports is a great, great avenue for young folks and young people,” Jayanthi said. “Let’s not look at the data and say move away from sports — because now you have kids playing Fortnite.”