Youth sports are becoming increasingly popular in the United States. Children and adolescents are not small adults in their response to exercise and stress.
Intensive exercise and training may be associated with acute and chronic illness and injury. Children train harder and participate in sports year round. We are seeing an increased number of children with fatigue and overuse injuries.
An estimated 45 million children engage in scholastic and organized sports in the United States annually. Approximately 750,000 sports related injuries occur each year requiring hospital-based emergency treatment. Overuse injuries are the most common. Overuse can be defined as when training demands exceed physiologic ability. Sometimes overuse injuries occur in poorly trained athletes who are pushed too hard and too quickly by their coaches, their parents, or themselves. However, overuse can occur in the elite athlete as well.
It is evident that children grow and mature at variable rates. Maturation results in physiologic changes, which affect athletic performance and skill. These changes include increase size, strength, and power of the musculoskeletal system. Young athletes perform less efficiently than do adults. Less efficient performance results in a higher metabolic cost and energy than do adults. For example, in overhead throwing activities little leaguers elbow and tennis elbow are at epidemic proportions. It is well know that the technique of pitching and overhead serve in tennis is not perfected until later in adolescences. In addition, the efficiency of muscles to firing synchronously in young athlete is poor.
Furthermore, the pediatric athlete produces more metabolic heat in response to exercise and is less efficient in dissipation of the heat. Therefore, children are more susceptible to fatigue due to heat and water loss than adults. Such factors indicate that training programs designed for adults should not be directly applied to children. Often times I am treating injuries in young athletes directed related to their participation in training programs geared for the adult athlete. It seems that coaches, parents, and young athletes that are motivated toward success, seem to favour training programs that are more physically challenging. This type of training is not necessary to improve performance at any age.
Musculoskeletal system of the growing child is clearly unique, compared to the adult. The long bones grow from growth plates that are basically in the opposite ends of the bones. The soft tissues that include muscles, tendons, and ligaments may lag behind the growth of the long bones, especially during periods of accelerated growth, i.e., during puberty. Because of this lag time of the soft tissue growth muscles, tendons, and ligaments may be inflexible and weak making the young athlete more susceptible to injury. In addition, the growth plates themselves maybe weak areas of the bone in growing children. Furthermore, the bones themselves maybe under mineralised which could lead to stress fractures or stress reactions.
Finally, structural malalignments of the skeleton are not uncommon in the young growing athlete. Excessive tibial torsion (rotation of the bone below the knee-tibia), femoral antiversion (rotation of the bone above the knee-femur, genu valgum (knock knees) or varum (bow legs), and hyperpronation of the feet (flatfeet) may make the young athlete susceptible overuse injuries.
Clearly there is an increasing stress currently being placed on children to perform. Many of my young athletes do not even have an off-season to rest and recuperate. In my own practice I have 12-15 year olds that play soccer on five different teams, all year round. In addition, they have a personal trainer or someone pushing them to do exercises that they presume will improve their performance. The level of competition is so strong that the young athlete is afraid to sit out of a game, match, or season because of the fear of someone else taking their position, ranking, or scholarship.
Many pediatric athletes are now experimenting with anabolic steroids and other performance enhancing drugs in an effort to excel in their sport. In one study it was reported that almost 3% of children aged 9-13 years had taken anabolic steroids. Interestingly, only 50% of the children in this study who used the steroids thought the steroids were bad for them. Obviously, education of our young athletes is of paramount importance.
As parents, coaches, and health care practitioners our goal should be the safety and health of our children. Several rules to follow include:
1-Never ever allow a young athlete to play a sport while in PAIN. (Read article on Playing Through Pain).
2-No pain, No gain is dangerous.
3-Injuries that cause pain and swelling should be considered serious and the athlete needs to be seen by a physician.
4-Exercises are beneficial in improving your performance only if they are specific to the sporting activity or to the muscle deficits in the athlete.