We previously discussed the preparticipation physical evaluation (PPE) which should be completed prior to participation in competitive sports. After making sure that our young sportspersons can safely participate in sports, we need to do all we can to ensure that they remain able to practise and compete as much as possible. In order to do this, we have to tackle the most common reasons youth athletes miss practice and competition, including:
· Acute injuries
· Overuse injuries
· Overtraining syndrome (previously called “burnout”)
Acute injuries in youth sports can affect any part of the body and can range from something as simple as a muscle strain to serious injuries such as fractures and concussions. Factors which may contribute to the occurrence of acute injuries in youth athletes include:
· Gender – girls have been found to have higher incidence of knee injuries than boys
· Previous injury
· Rapid growth
· Poor dynamic balance
· Muscle weakness
· Poor flexibility
· Heavier weight or higher body mass index (BMI)
Interventions to reduce the incidence of acute injuries include performing a warm-up before activity, balance training and possibly stretching. Qualified coaches, proper sports technique, safe and well-maintained sporting environments and the use of proper protective sporting equipment during practice and competitions also reduce the incidence of acute injuries in youth athletes. A well-designed preparticipation physical evaluation can identify some risk factors for injury and recommendations can be made to minimize the effects of these factors.
Overuse injuries can occur in all age groups but in the youth athlete overuse leads to unique injury patterns. This occurs as a result of the differences in the structure of growing bone compared to adult bone. Whereas adults get injuries of their tendons, youth athletes get injuries to the apophyses (sites where tendons attach to the bones). This occurs because these sites are weakly attached to the main bone by cartilage. Some overuse injuries also lead to injuries to the physes/growth plates (areas which contribute to the lengthening of bone). Risk factors for overuse injuries are similar to those for acute injuries, as well as poor coaching and technique. These injuries can affect many different areas of the body. The pain from an overuse injury can progress as follows:
1) After physical activity
2) During the activity, with normal performance
3) During the activity with impaired performance
4) Chronic, persistent pain even at rest
Recognition of these injury patterns in different areas of the musculoskeletal system in youth athletes and correlation with specific activities have led to development of guidelines for activity participation in youth sports in several developed countries. These include pitch counts in baseball and directives pertaining to fast bowling in youth cricket. Adherence to these guidelines can prevent the occurrence of overuse injuries in young sportspersons and keep them in the game.
In order to improve sporting performance, training needs to be undertaken and it should get progressively tougher. When training progresses appropriately in a healthy athlete who has an adequate recovery period, there is adaptation to the training stress, resulting in improved performance. Inappropriately rapid or tough training progression and inadequate recovery periods can lead to the development of overtraining syndrome or burnout. The initial symptoms of this disorder are fatigue and impaired sporting performance but multiple systems in the body are affected, leading to symptoms in addition to the overuse injuries that will likely occur as a result of excessive training. Single sport specialization (intensive year-round training in a single sport at the exclusion of all other sports) has become more common in young athletes who demonstrate prowess in a particular sport at an early age. This phenomenon contributes to the overtraining syndrome which may require a prolonged recovery period and can lead to some youth athletes quitting their sports.
The preparticipation physical evaluation provides a good start towards preventing injuries and the overtraining syndrome. In addition to prior injuries, important information that can be elicited includes the amount of time spent in training and competition, parental pressure, athlete happiness and coach involvement. Recommendations can be made to manage any risk factors that can lead to injury and management of injuries can be done in a timely fashion. Recommendations to avoid overuse and the overtraining syndrome can also be made. These include: limiting sport participation to a maximum of five days per week; at least seven hours sleep each night and taking at least 2-3 months off competitive sports to rest; manage injuries; and undergo strength, training and conditioning. If an injury or decreased performance occurs, a consultation with a qualified sports medicine professional should be arranged.
Parents, coaches, athletes and any other persons involved in youth sports should be aware of these issues so that our athletes can continue to perform at their best.
(Dr Shane Drakes is Specialist in Physical Medicine & Rehabilitation and Sports Medicine. He can be contacted at firstname.lastname@example.org)