gpholley, Author at Catalyst Physical Therapy & Wellness Mission Valley San Diego




Sports participation is on the rise with an all-time high of an estimated 45 million participants in youth programs in 2019 [1].This increase in participants has led to the formation of more and more leagues, and additional pressure on athletes to compete more frequently. Let’s face it, youth leagues are making good money and there’s very few central organizations controlling how they roll out their schedules and coordinate with neighboring groups. Year-round competition has quickly become the new normal for sports, and kids are being pressured at earlier ages to keep up. With no down time and poor skill development forced into the diet of these youth athletes, there is bound to be a higher injury rate and early burnout [2].

It’s staggering that roughly 8 million of the youth athletes will be seen by their physicians, or report to emergency rooms annually with sports-related injuries [3]. The incidence of ACL injuries has increased over the last 20 years with peak occurrence taking place in high school female athletes [4]. With the overuse injuries on the rise and sport specialization trending at a younger age, we must pay close attention to our kids’ developing bodies and minds. Not only has early sports specialization (playing one sport for an entire year) shown a direct link to overuse injuries, but it’s also leading to an early burnout and eventual drop from participating in organized sports.

Research conducted by the National Alliance of Sports has shown that 70% of children drop out of organized sports by the age of 13. 

This is scary considering a large number of parents are quick to up the training regimen for their children in hopes of forming the next superstar the second they show an ounce of talent or affinity for a specific sport. Don’t get me wrong, I completely understand how exciting it is to see your child naturally excel at riding a bike, kicking/throwing/hitting a ball or climbing a wall. If your child shows a natural talent for kicking a ball and wants to be the next soccer superstar at age 10, it’s natural to think you should enroll them into the elite organizations offering year-round competition. But at what price? Would you still do that if I told you they were much more likely to suffer from a knee injury at the age of 14 or 15 that could put their career in jeopardy?

There’s no arguing that children need to be protected from early damage to their bodies during their formative years and puberty. The wrong dose of running, jumping, cutting, hitting, throwing can injure your child for the season, and threaten their long-term development. Being on the front lines of the physical therapy field now for over a decade, I’ve seen ACL sprains, growth plate injuries, and strains/sprains showing up in younger and younger athletes. This has me nervous because according to research, this likely won’t be the last time the majority of these kids are seen in a clinic setting. Getting injured early in life has also been shown to cause a myriad of other problems, like decreased bone mineral density, skeletal deformities, higher re-injury rates, and even increased likelihood of chronic pain in adulthood [5].

— If it looks ugly, chances are it’s not a matter of if but when their body will break down —

Repetitive movement patterns with faulty mechanics will lead to overloading (too much stress) in the growth plates, ligaments, tendons, cartilage, bones, and muscles comprising our skeletal system. It’s the simple fact that when you tell 10 kids to kick a ball, they’re going to do it 10 different ways. No coach can conjure perfect form for all of their athletes, but they must be able to recognize when poor mechanics need correcting to prevent irreversible damage to their athletes’ bodies. For example, take a 10-year-old, tall girl that has excessive shoulder mobility but poor core stability and tight hips from growing too fast. If you ask her to go up in the air and deflect a ball over the goal, or block a shot, there is good chance she’s going to drive her knees excessively inward upon preparing to jump, arch her back to ensure her hand gets in front of the ball, and fail to slot her shoulder correctly when blocking the shot. This may not always be the case, but if not corrected, it will undoubtedly lead to increased stress across the ligaments or growth plates in her knees, excessive force across her lumbar spine, and possible rotator cuff or labral injuries in her shoulder down the road.

So, are coaches to blame? Absolutely not! It’s the system that needs revamping. Each organized league must be held accountable to take the child’s development seriously. That can’t happen without pressure from the parents and health care field. We all must strive to pick out ways to assist the kids with movement training and coordination development. 

So How Do We Fix The Broken System?

Here are three of the most important ways I’ve found to develop youth athletes:

  1. Get screened by professionals to assist with proper physical development
  2. Increased time with cross-training to overcome their weaknesses 
  3. Insert “down time” into the annual schedule to recover properly, and rebuild

I’ll go into detail on each one of these below:


Athletic performance screening can help identify the individual challenges each athlete faces throughout the different stages of development. Why is it that we see the dentist every 6 months to assess our oral health, but physical health takes a backseat? Truth is, we should be giving our body the same focus and attention that we give our mouths. Annual physicals are not designed to thoroughly look at a child’s physical development. Rather than waiting for a child to report pain, we can get ahead of injuries by performing detailed assessments or screenings more regularly to ensure the movements they routinely perform are done correctly. This screening must mimic the common actions in the sport they play, and assess the areas of the body that research shows are often injured.

The screening can be performed for each athlete individually in a controlled setting, like a gym or clinic, or out on the fields. The goal of these screenings should be to identify the body’s weak spots and determine a corrective exercise program to promote proper athletic development. When completed on the team level, athletes can be categorized into different groups based on their physical abilities and given corrective exercises, drill work, and appropriate sports performance guidelines to allow coaches and trainers to better prepare the teams for the rigors of competition.


Cross training is often thought of as choosing a lower impact activity to insert in place of your main sport. For example, a soccer player might choose cycling or swimming instead of running to keep up their endurance levels between their heavy periods of competition. While this is one form of cross-training, it’s also important to consider the benefits of what a solid gym or weight training program can do for a developing body. Resistance training is commonly thought of as bad for youth athletes. This simply isn’t true. While I don’t condone spending 5 days a week in the gym following a strict strength training regime, I do believe the right corrective exercises inserted into a routine for kids can make all the difference when it comes to preventing injury. The trick is to make these exercises challenging, well-rounded, and fun. This will allow our youth athletes to form healthy movement habits, and develop coordination and efficiency that will protect the commonly overused areas of their bodies. 


Recovery is all too often an afterthought for developing athletes. While I’ll forgo the detailed description of how recovery affects our bodies both mechanically and metabolically, I will say that stress across muscles and joints must be monitored and controlled to avoid developing overuse injuries. Most professional organizations are aware of this theory now, and utilize different ways to monitor and alter training loads for their athletes based on the demands of the position they play and the competitive match/practice schedule. These organizations are taking note of how each athlete’s recovery for their body differs and charting ways to assist them in balancing their training bouts to allow for ample performance. Basically, they’re not just asking how the athlete feels anymore, but are now monitoring how their heart rates and body movement (e.g. range of motion, strength, blood chemistry) are adapting to the physiological stressors. This allows them to tailor the weekly workouts and guidelines for recovery for each athlete individually. This isn’t to say your 10-year-old athlete is also in need of this, but a simple rating of perceived exertion (RPE) and an awareness of down time each year (or directly after large amounts of competition) is warranted to ensure your child is not damaging their vulnerable areas and in risk of long-term injury. 

In closing, I hope you understand that not all athletes move the same, and the demands of each sport differ. It’s not the coaches job to identify the movement inadequacies and implement a corrective exercise program. Rather, it’s the organization and parents job to promote the health at all times of the youth athletes. This comes through education and strategic alliances with organizations that can help deliver proper warm ups, exercise guidelines, and physical screenings. By paying more attention to the quality of the movement early on in our kids’ development and creating healthy habits, we’re giving them the gift of longevity in becoming a life-long participant. Whether they go to the big leagues or not, having a young athlete learn the principles of healthy movement and balanced training loads will prove it’s worth over time, and cut down on the early drop-out rates that are trending in our current era. 

If you’re interested in learning more about ways to get our professionals involved with your athlete or organization, please fill out our questionnaire (athlete performance questionnaire) or check out the athlete performance section of our website to learn more (Read More). 

Brian Wilson, MPT



[1] State of Play 2019: Trends and Developments in Youth Sports. The Aspen Institute/Utah State 2019 National Youth Sport Survey. 2019 Sept; 3: 1-32.

[2] Difiori JP, Benjamin HJ, Brenner JS, Gregory A, Jayanthi N, Landry GL, Luke A. Overuse Injuries and Burnout in Youth Sports: A Position Statement from the American Medical Society for Sports Medicine. British journal of sports medicine. 2014 Feb 1;48(4):287-8.

[3] Pinyao R, M.P.H., Ashman JJ, Ph.D., and Akintunde A, M.S.P.H. Emergency Department Visits for Injuries Sustained During Sports and Recreational Activities by Patients Aged 5–24 Years. National Health Statistics Report. 2019 Nov 15; (133) 1-15.

[4]  Beck NA, Lawrence TR, Nordin JD, DeFor TA, Tompkins M. ACL Tears in School-Aged Children and Adolescents Over 20 Years. American Academy of Pediatrics. 2017 Mar; 139 (3).

[5] Fulton J, Wright K,  Kelly M, Zebrosky B, Zanis M, Drvol C, Butler R. Injury Risk is Altered by Previous Injury: A Systematic Review of the Literature and Presentation of Causative Neuromuscular Factors. International Journal of Sports Physical Therapy. 2014 Oct; 583–595 (9).



Moms have taken on many new roles these past few weeks.  From homeschooling to chief playtime officer.  So we’ve created a way to say thank you with a digital gift card! 

These can be used towards any service at Catalyst PT & Wellness:

    • Massage
    • Physical Therapy
    • Personal Training
    • Acupuncture

Digital gift cards are available in $25, $50 and $100 increments and do not expire.

Therefore, you can pick one up today and share with your favorite mom, aunt, sister, or friend that has gone above and beyond these past few weeks.

Thank you to Moms everywhere.  We hope their day is filled with love…and major pampering!



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As a biomechanical specialist that has made endurance sports my life, I’m often asked the question by my clients, “Do I need orthotics?”

Let me disclose that I personally use custom orthotics, and have found them to be one of the BEST ways to rid myself of chronic shin and foot pain. I’ll explain why later in the post. To help you decide if orthotics are right for you, here are five questions to answer and discuss with your practitioner/orthotics fitter:

1. Are orthotics something you plan to use to improve performance?

Some people don’t have pain, but have poor foot foundation, causing their balance and proprioception to suffer. Perhaps you have diabetes or a heart condition that limits the amount of blood flow reaching your feet. Poor sensation can lead to poor balance and faulty mechanics. This population can benefit immensely from using custom orthotics regularly, in all of their footwear, to improve balance and reduce the risk of falling.Athletes can benefit from orthotics, too, by correcting faulty loading mechanics at the foot, ankle, knee, and pelvis. These mechanical deficits are oftentimes the result of improper foot positioning, and thus shock absorption, when the foots hits the ground.So what’s causing an improper foot position? The answer is feet that are too rigid, or too soft.Orthotics can help your feet achieve a more beneficial platform, allowing your body to disperse forces more evenly to the neighboring muscle and joint systems.

2. Do you have pain?

Consider this: Where is your pain? How long have you had it? Does anything make it better or worse?For example, do you feel that every time you buy a fresh pair of running shoes the pain decreases? This may be an indicator that your foot craves more stability and needs assistance from an orthotic.If your pain has only recently started, then I’d recommend getting more bodywork (massage), and being seen by a specialist that can assess your biomechanics, flexibility, strength, and tissue “feel” to determine if your pain can be reduced without an orthotic.If your pain is chronic and you’ve already tried seeing a specialist with no improvement in symptoms, then it’s possible a custom orthotic can be used to decrease your pain. That said, the orthotic should be prescribed ONLY after watching your mechanics and assessing your foot properly. This ensures you get the correct style of orthotic, as well as a good prescription for bodywork that will help correct any imbalances within your muscle structure.

3. What type of foot do you have in non-weight bearing, and weight bearing positions?

If you have extremely flat feet, but no pain, then I wouldn’t recommend an orthotic unless you’re involved in a high-risk sport like soccer that has a ton of cutting, and you can’t control how far your knee dives in or out.If you have regular arches while sitting (you can see a crescent shape in the arch) but they drop largely with full weight bearing, then you might have a high amount of pronation and require assistance with controlling the speed of collapse.If you have high arches in both seated and standing positions, then you might have a high degree of supination that limits your success with dispersing forces in the ankle, knee, and ultimately the hip and spine.Again, having a qualified practitioner that understands how to measure and assess these different foot types will be necessary. I’ve seen plenty of over-pronators and over-supinators for whom I didn’t recommend getting custom orthotics because they have effectively compensated for their foot structure. It’s the people with poor foot structure, plus recurring injuries or pain that often need custom orthotics.

4. Are you willing to perform exercises most days of the week to improve your foot structure?

If you’re one of the unlucky people that have poor foot mechanics, pain, and hobbies/work that involve heavy impact, you still may not have to get custom orthotics. However, in order to avoid them, you’ll need to put in the work to make your foot both strong and/or flexible.Perhaps you’ve been labeled an “over-pronator” and you rushed out to buy the “Born to Run” book along with a pair of the Vibram 5-Toed minimalist shoes with the intention of gaining strength. Well, the disclaimer that must be included is this: it doesn’t happen overnight, and you have to be very diligent with your strengthening as well as with your foot recovery techniques to regain an arch, and get rid of pain.On the other hand, if you’re one of those rigid-foot-supinators that needs mobility, you’ll have to commit time to regaining flexibility in the ankle, toes, and hips. Increased motion at these joints allows for the foot and arch to collapse in a manner necessary for absorbing shock in the ankle and leg muscles, without stressing bones.So, if you’re willing to put in the effort, you might be able to save yourself some money, though, I’ve seen most people struggle to do so, and end up purchasing a pair after a few months of non-compliance. Rest assured, I don’t blame them. After all, I’m in the same situation, not making the time to change my feet.

5. What are your job, or daily life demands?

If you have poor foot structure, but work at a desk and don’t find yourself walking or spending long amounts of time on your feet, then you might not require custom orthotics. Perhaps you only walk casually, and on fairly stable surfaces. People that have this style of living often just require supportive shoes for their daily walks that have more rigid lasts built into the sole of the shoe to decrease shock. There’s even a maximalist movement by shoe companies now to thicken the soft cushioning in a shoe (although keeping the material extremely light) in an effort to create decreased impact forces in the leg, and a larger sweet spot with landings.However, if you have poor feet and a job that demands a lot of standing, or hobbies with high amounts of impact, you might find a custom orthotic to be your saving grace. In my experience, it’s not a matter of if pain will eventually creep into your legs, but when it will force you to be sidelined in some manner.I’ve seen the arthritic build-up in knees, hips, and spines developed from years of overdoing on poor foot structure. These patients show up in the clinic with back pain resulting from years of bad mechanics that could’ve been prevented. While I don’t prescribe them orthotics on the first day, I do have a conversation with them about the compensations their body has undergone to adapt to the stresses that ultimately begin in their feet. These stresses, when discovered at a younger age, can ultimately be reduced, allowing for less degeneration, but early identification is the key. Most of these people will end up in some form of custom orthotics once pain has set in, which will hopefully prevent surgical repair to worn out areas!

The most important thing to consider when deciding on orthotics is: what type is necessary? There are a myriad of choices out there ranging from $25-50 on the cheap side to $200-800 on the expensive side. While the cheaper orthotics can serve as a nice temporary support for your foot, they use weaker materials and base their design off a common posting angle that may not benefit your particular foot mechanical problem. On the other hand, the custom-molded, more expensive orthotic may not be the right choice for you either. The actual making of the custom orthotic relies heavily on having the correct expert assess your foot both statically and dynamically under different loads, or ground reaction forces. Without an expert that understands how to assess your foot under different stressful situations, it’s nearly impossible to get the correct orthotic prescribed.

In the end, a custom orthotic is a big investment and shouldn’t be taken lightly by the practitioner responsible for getting you properly fit. I’ve seen way too many patients limp into my clinic carrying a bag of orthotics they have been “prescribed” through weight bearing scans, crush boxes, and treadmill video recordings. You can imagine the disgust they feel when I show them the reasons their $1000+ investment in foot care is really just a scam that has been played over and over to them by some of the best sales teams in the industry. I’m forced to try to use foam padding and tape to post and position their foot better with the orthotic they bring in, but this never serves as a long-term solution. They’re just a number to these sales teams, and no attention has been paid to their individual foot needs based off of their hobbies and work demands.

That’s why at Catalyst we’re expanding our foot care department to provide the best orthotic prescription in San Diego. We’ve partnered with Northwest Podiatric Laboratory and Smartcast Systems to get rid of the outdated plaster casting. This allows us to use 3d technology in printing and scanning in our orthotic prescriptions. We can now scan a patient’s foot to get an exact 3-D replica model. Taking it one step further, we use a foot positioning system at Catalyst that includes a laser alignment device to ensure each foot is positioned optimally when scanning and prescribing the perfect orthotic. With no time wasted, our patients will be back in action with the proper fit in a little over a week and their feet will send us “Thank You” cards.


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Physical therapy can work wonders for helping us get back to sports, hobbies, or even simple tasks we once took for granted, but did you know that physical therapy can help kids of all ages, too? Catalyst is excited to announce that we are now accepting pediatric patients! Here’s a little more about what we […]

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