What the Body Is Telling You
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Episode Summary
Todd Merkow sits down with Dr. Eric Dean — Medical Director for Sports Medicine at HonorHealth, former Division I football player at the University of Arizona, team physician for the San Francisco Giants and multiple professional sports organizations, Medical Director for Scottsdale Unified School District Athletics since 2009, and father of two daughters who have both completed their youth sports journey. Dr. Dean has been practicing sports medicine in the Valley for nearly 25 years, and what he has watched happen to young athletes' bodies over that time is, in his own words, insane.
The conversation opens with Dr. Dean's own origin story: a Gen X kid from the Midwest who played football, basketball, ran track, and wrestled all the way through high school before earning a scholarship to play football at the University of Arizona. He didn't know he wanted to go into medicine until his junior year, when a series of injuries — broken thumb, sprained ankles, a couple of concussions, a knee sprain — put him in close contact with the team physicians and athletic trainers at U of A. He liked what he saw. The problem was that he had spent his first three years taking mostly football classes. His counselor delivered the good news and the bad news in the same breath: great GPA, almost none of your credits count toward pre-med. He buckled down, took summer school, loaded up to 18 hours his fourth and fifth years, and got there.
The heart of the episode is what Dr. Dean has watched happen to the age of surgery over his career. When he started practicing, the typical ACL tear was a junior in high school playing football. Now it's early high school, and the female soccer population is driving a significant portion of those numbers. Tommy John surgery — UCL reconstruction — used to be a college-age or minor league procedure. The average age is now a sophomore in high school. He has watched professional baseball players come back from their second and third Tommy John surgeries. The age of surgery is going down. The number of surgeries per athlete is going up. And the driver, in his view, is almost always the same: early specialization, year-round play, and a youth sports industry that has figured out how to monetize the fear of missing out.
More is not always better. When a kid is coming off a growth plate injury, a lot of times I just tell parents: less is more right now.
Dr. Dean is precise about the mechanics of why this happens. He walks through the Q angle — the hip-to-knee geometry that puts female athletes at structurally higher ACL risk — and the hormonal component that can cause connective tissue to relax during certain phases of the menstrual cycle. He explains growth plates in terms every parent can understand: wet cement at the end of every long bone, hardening during hormonally-induced growth spurts. If a kid is in a growth spurt, playing through pain, and that growth plate is inflamed — one pitch, one kick, one sprint can physically pull it open. He sees it constantly in baseball elbows. He sees it in soccer knees. He sees it in cheerleaders' backs and wrists. The injury that looks like tendinitis today can become a surgical emergency tomorrow.
Girls need to have fun to play well. Boys need to play well to feel good about themselves. It's a little bit different mindset.
The coaching section of the episode is one of the most practical in the series. Dr. Dean coached his oldest daughter's competitive softball club team for years, and he ran it the way you would expect a sports medicine physician to run it: efficient practices, purposeful conditioning, mandatory breaks, and a standing policy that if a kid made the school basketball team mid-season, they were welcome to miss practices and tournaments. Five or six girls from that team went on to play Division I softball. He makes the point directly: the coaches and scouts at the next level are not looking for the kid who has played one sport since age ten. They are looking for multi-sport athletes with less mileage on their bodies. He asks his professional baseball patients what other sports they played. Out of sixteen players he saw for physicals on a recent Monday, thirteen had played multiple sports.
Your kid's going to throw 95 or he's not. There's very little you're going to do about that — and very little you should be doing in youth sports to try.
The episode closes with a rapid-fire round and a clear two-part prescription for parents: let your kid play multiple sports for as long as physically possible, and give them real breaks — not playcations, actual vacations. The professional athletes he takes care of go home at the end of their season and don't touch a ball for weeks. Youth athletes with open growth plates need that at least as much.
If you have an athletic kid and they're blessed enough physically and mentally to make it to the next level, they will be found. You don't have to be at every single camp practicing five days a week.
Top 5 Takeaways
The age of surgery is going down, and the number of surgeries per athlete is going up. When Dr. Dean started practicing, the typical ACL tear was a junior in high school. Now it's early high school, with female soccer players driving a significant share of those numbers. Tommy John surgery used to be a college-age or minor league procedure. The average age is now a sophomore in high school. He sees professional baseball players coming back from their second and third Tommy John surgeries. This is not a coincidence. It is the direct result of early specialization and year-round play on bodies that are not finished developing.
Growth plates are wet cement. This is the most important thing in the episode for parents of kids between roughly ages 9 and 16. At the end of every long bone, there is a growth plate — a zone of developing tissue that hardens during growth spurts. If a kid is in a growth spurt, playing through pain, and that growth plate is inflamed, one pitch, one kick, one sprint can physically pull it open. What looks like elbow tendinitis today can become a surgical emergency tomorrow. If your kid is in that age range and has persistent pain anywhere, get them to a doctor. A plain film X-ray in the office is often all it takes to catch it before it becomes catastrophic.
Female athletes face compounding ACL risk factors that most parents don't know about. The Q angle — the geometry from hip to knee — is wider in women by design, which puts different stress on the ACL. Hormonal fluctuations during the menstrual cycle can cause connective tissue to relax, increasing susceptibility at certain phases. Add fatigue from overuse, a growth spurt, and underdeveloped quad strength, and you have a recipe for the injury Dr. Dean sees most often in his female youth patients. Strength training — real strength training, not just sport-specific drills — is the most effective prevention tool available.
The coaches and scouts at the next level are actively looking for multi-sport athletes. This is not a philosophical preference. It is a practical one. Multi-sport athletes arrive with less mileage on their bodies, better overall mechanics, and lower surgical risk. Dr. Dean asks every professional baseball player he sees for physicals what other sports they played growing up. Out of sixteen players he saw on a recent Monday, thirteen had played multiple sports. The youth sports industry has convinced families that specialization is the pathway to the next level. The people doing the recruiting at the next level disagree.
Efficient practices protect bodies. Dr. Dean coached his oldest daughter's competitive softball club team for years and ran it with a clear philosophy: purposeful practices that ended before fatigue set in, conditioning that was game-specific rather than punishing, and a standing policy that kids who made their school team in another sport were welcome to miss practices and tournaments. Five or six girls from that team went on to play Division I softball. The lesson is not that less practice produces better athletes. The lesson is that exhausted, overused bodies break down, and broken-down bodies don't develop.
The red flag phrases are 'he's just hurt, he's not injured' and 'my mom or dad is making me play.' Dr. Dean named both of these in the rapid-fire round without hesitation. The first comes from parents who have confused pain tolerance with safety. The second comes from kids who have lost the ability to advocate for themselves because the stakes feel too high. Both phrases should stop a parent cold. The first one is how growth plate injuries become surgeries. The second one is how burnout becomes permanent.
Letting your kid quit is a decision worth being proud of. Dr. Dean named it as the one decision he was most glad he made as a sports parent. He followed it up with the broader point: if your kid doesn't make it to the next level — by choice or by circumstance — that is not a failure. The athletic kids who have been part of a team, learned to compete, dealt with adversity, and developed leadership skills will always have a leg up. The sport was never the point. The person it was building was.
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