Abstract
Sports-related injuries are the leading cause of all injuries in adolescents, as well as the primary reason for visits to health care providers. As children begin to specialize in a single sport at earlier ages, overtraining and overuse injuries are becoming increasingly prevalent. Well-designed and supervised training programs have shown significant value and safety for youth athletes. In addition, skeletal growth, physiologic development, and the psychological changes of puberty can influence which sports a child chooses and how well they perform. Primary care providers are responsible to encourage age and developmentally appropriate physical activities for their young patients and should provide anticipatory guidance to parents.
Key Concepts
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More than 60 million American young people of all ages participate in organized sports today.
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Youth sports are now more competitive than previously. Many children play at competitive levels at younger ages, often specializing in a single sport at a younger age. These athletes may even follow a year-round cycle of practice, private training, and events for that sport.
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Sports-related injuries have been increasing among young people, becoming the leading cause of all injuries in adolescents, as well as the leading reason for adolescents to visit health care providers. Many of these injuries present because of overtraining and overuse.
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Skeletal growth, physiologic development, and the psychological changes of puberty can influence which sports activities adolescent athletes choose and how well they perform.
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There is growing interest in training and conditioning programs for young athletes. Well-designed and supervised training programs have shown significant value and are safe for all youth athletes, including prepubertal children.
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Primary care providers should encourage age- and developmentally appropriate physical activities for their young patients and should provide anticipatory guidance to parents, with the goal of choosing activities that are fun, safe, and rewarding.
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Providers should be able to assess young people’s “sports readiness,” via their cognitive, social, and motor development, to determine if they can meet the demands of the specific sport and level of competition that they desire.
Trends in American Youth Sports
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Over the past several decades, the numbers of children and adolescents involved in formal youth sports have nearly tripled ( Table 7.1 ). The increase in female participants has been greater than that of male participants, although males still outnumber females in absolute numbers.
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The increase in female participation is associated with Title IX, a 1972 federal law that mandated equal athletic facilities and programs for females and males.
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This has led to a greater acceptance of girls and women in competitive sports and the ascension of female sports figures as role models.
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The athletic focus has shifted away from the recreational component of sports to that of increased competition resulting in participation earlier in life, single-sport specialization, and an increase in frequency and intensity of training at younger ages.
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Traditionally, coaches and (less so) parents are the driving forces behind single-sport specialization.
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Specialization can limit development of various physical and mental athletic skill sets.
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The most frequently cited reasons for younger children’s participation in organized sports are to have fun, learn new skills, test abilities, and experience excitement.
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Receiving individual awards, winning games, and pleasing others are ranked lower.
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TABLE 7.1
Numbers of High School–Age American Boys and Girls Involved in Organized Sports
Group
1971
1996
2006
2016
Boys
3,670,000
3,700,000
4,321,000
4,560,000
Girls
294,000
2,500,000
3,022,000
3,400,000
Total
3,960,000
6,200,000
7,342,000
7,960,000
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Sports Injuries
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Sports injuries are the most common type of injury in adolescents, and sports-related injury is the leading reason for adolescent visits to primary care providers.
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The highest incidence of sports-related pediatric injuries occurs in the 5- to 14-year-old age range.
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These children are less coordinated, have slower reaction times, and are less proficient than older children and adults in assessing and avoiding the risks of sports.
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Most sports-related overuse injuries in young athletes are related to musculoskeletal and physiologic immaturity due to underdeveloped muscles, ligaments, and bones.
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In other words, immature epiphyses are weaker than the surrounding soft tissue (muscles and ligaments), allowing significant stress to cause a traumatic epiphyseal fracture.
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Injury risk is greatest during times of poor physical condition, usually at the beginning of sports seasons. Other factors increasing the risk of injury include rapid increases in activity over short periods of time, athletes playing above their skill/age level, improper rest, and poor adaptation to the increased demands of their sport.
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Most, if not all, of these risk factors can be observed in the increased specialization, intensity, and year-round athletic activity of the pediatric athletic population.
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Recent analyses revealed (1) elite athletes specialized in their respective sports at a later age than the nonelite population and (2) professional baseball players surveyed did not feel sport specialization was required prior to high school to master their skills (as indicated in an early sport specialization article [Wilhelm et al., 2017]).
Growth and Maturation
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Preparedness for particular sports, capabilities for training, and skills development are all directly related to age-specific maturation in children’s neuromuscular, cardiovascular, and cognitive systems.
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By age 6 years, most children have acquired sufficient physical skills to participate in some organized sports.
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Gaining experience in a variety of sports is important for the young athlete to enable them to acquire a mix of skill sets and to keep physical activity interesting and fun.
Developmental Levels and Readiness for Sports at Various Prepubertal Ages
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Selection of appropriate athletic activities for children should be guided by knowledge of the developmental skills and limitations of specific age groups.
Ages 3 to 5 Years
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Focus on learning basic skills such as running, swimming, tumbling, throwing, and catching.
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It is recommended that direct competition should be avoided; fun play should be emphasized.
Ages 6 to 9 Years
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Focus on developing fundamental sports skills with limited emphasis on direct competition.
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To learn additional fundamental skills and work toward a transition to direct competition, sports like swimming, running, and gymnastics can be tried.
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Note: Children have a short attention span, limited memory development, and do not easily make rapid decisions; they need simple, flexible rules and short instruction times.
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Ages 10 to 12 Years (Prepubertal Years)
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With the mastery of basic skills, children can now compete in activities and are able to learn more complex motor skill patterns.
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Children begin to develop their sense of confidence, esteem, and self-awareness. At these ages, body image and popularity are distinguished, and successful mastery of new skills become closely linked to child’s self-esteem.
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They have the cognitive, social, and emotional maturity to handle modest competitive pressure and complex skill sports such as football, basketball, soccer, and field hockey.
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Can accept increasing emphasis on game tactics and strategy
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Many changes occurring during puberty can affect children’s athletic performance. The exact timing of these changes can be affected by genetics, endocrine function, nutritional status, and amounts and types of exercise.
Athletic and Sports Issues of Puberty
Co-Ed Youth Teams
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Muscle strength, speed, and skills are usually nearly equal in boys and girls until age 10 to 11 years, and sports activities can still be coeducational due to these similarities.
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Girls generally begin their pubertal changes at approximately 10 years of age, approximately 2 years before boys.
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By age 12 to 13 years, pubertal differences start to affect the skill and strength involved in sports, and depending on the sport, these differences may affect whether girls and boys should continue to play and compete together.
Physiologic Changes of Puberty
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Capacities for both aerobic and anaerobic exercise are beginning to increase, which allow longer and more intense periods of exercise to be tolerated.
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Aerobic capacity: Greater maximum oxygen uptake (V o 2max )
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Due to increases in pulmonary ventilation and cardiac output and to more efficient extraction and use of oxygen by muscle
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Anaerobic capacity: allows for short, intense bursts of activity
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Note: The downside of these physiologic changes is that although pubertal children are less limited by body fatigue and can thus exercise longer, they are also more capable of overexercising, which can lead to overuse injuries.
Musculoskeletal Changes of Puberty
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Changing body contours during early puberty can lead to physical awkwardness, which may be associated with increased chances of injury, especially in early adolescence when new skills have not caught up with new capacities and new growth.
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Flexibility and joint hypermobility are increased, which increases the risk of glenohumeral and patellar subluxation and dislocation.
Bone Density and Calcium Needs
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During early puberty, bone mineral density begins to increase in both boys and girls.
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The calcium needs of all adolescents are great during puberty, due to the deposition of calcium into rapidly growing bone.
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Adolescents accrue 40% of their eventual adult bone mass during puberty.
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Recommended calcium intake for adolescents is 1300 mg/day (amenorrheic females may need up to 1500 mg/day).
Linear Growth
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Linear growth begins first in the long bones of the extremities and can contribute to a temporary clumsiness that can have an impact on the athletic performance of younger adolescents ( Table 7.2 ). The child who previously exhibited strong skills may suddenly appear to be less coordinated. Puberty-related increases in height velocity usually begin in girls at approximately 9 years of age and in boys at approximately 11 years of age.
TABLE 7.2Related posts:
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