Kids are starting to come back to sports. They’ve had a lot of time off after spring sports ended abruptly because of COVID-19 and some summer sports never launched.

Whether your child is currently back on the field or is preparing to get back there, doctors worry that the months of less activity will make kids prone to injury.

"This is an unprecedented time," says Dr. Kelly Cline, a sports medicine specialist with Texas Orthopedics. "We don’t have a protocol. ... It is uncharted territory from that standpoint. We’re going to learn a lot in a year or two."

A similar time Cline points to is the National Football League’s 2011 player lockout that lasted 132 days. When those athletes came back, they did not have the same level of training and there were significant increases in Achilles tendon injuries, she says.

While the NFL players didn’t have access to their trainers, they did have access to gyms, which hasn’t always been the case during this pandemic.

When you’re an athlete and you go through "deconditioning" or "detraining," you lose neuromuscular functions — the way your nerves talk to your muscles, the way everything is coordinated, Cline says.

It’s a bit of muscle memory, the way your brain is coordinating everything, the way you jump and land in a safe way, Cline says.

It doesn’t take long to become detrained or deconditioned, says Dr. Kate Labiner, a pediatric neurologist at Child Neurology Consultants. Think about the runner who goes on vacation for a week and then returns to running when they come home. They feel out of breath; they are slower. "It didn’t take very long to get to that point," she says.

If you are detrained or deconditioned, you might land unsafely, creating an injury.

"Our reaction times aren’t as quick as they were before," Labiner says. "Our body isn’t responding the way we can expect."

Those slower reaction times can lead to falls or head and spine injuries.

"If your reaction times are not as good, the chances you move out of the way or respond to someone coming at you quicker are not as good," Labiner says.

She has begun to see concussions coming into her office after the start of football practice.

For kids who had head injuries last school year, Labiner also worries that they didn’t get the physical activity they needed to support the brain healing.

"They didn’t have the trainers to walk them through the protocols," Labiner says.

Kids or athletes of any age cannot just jump right back into play. They need to work up to their previous abilities, flexibility, strength and muscle memory.

They also should get a well-check physical from their doctor if possible even though it is not required this year. Also, if they did have COVID-19, a follow-up visit can help make sure there are no lasting effects, especially to the heart and lungs.

Cline suggests it could be three to five weeks of building up both aerobic training and weight training. For cross-country runners, it’s about slowly building up their endurance.

"Do this slowly and appropriately to avoid injury," she says.

That doesn’t mean going back to a gym while waiting for the season to start, Labiner says. Instead, it could be running outside, doing exercises using your body weight, doing endurance activities such as Zumba and stretching through online videos. A lot of school coaches are doing training over Zoom with kids.

This year another important training exercise is getting kids used to playing in a mask as well as the normal reminders to stay hydrated and stretched, particularly when playing outside.

"It seems safer to me to take three to four weeks to work an athlete on the front end than to blow out an ACL, which is season-ending, and be sidelined for nine months," Cline says.

She also cautions against the mentality of "no pain, no gain."

If your body is hurting beyond normal muscle soreness, that’s a warning sign of a potential impending injury, she says. Particularly listen to pain around joints or if your body is moving differently than it normally does. Bodies will naturally move in a way to avoid pain. That’s another warning sign.

For middle school and high school kids, she worries about inflammation around the growth plates in their bones and growth plate injuries.

"Kids haven’t been doing anything, and then they have a sudden increase in activity. The growth plate gets overloaded," Cline says.

She believes that within a couple of weeks after the start of each sports season, she’ll start seeing a lot of injuries coming into her office.

She also worries that kids will load up on sports because they have been missing them or leagues trying to fit more games into a compressed period of time.

She notes that even the National Basketball Association didn’t go from no games to playing games. They had practice first to get back into condition before returning to the season this year.

"We want our athletes to get back to their sports, but we want them to do it in a healthy way," Cline says.