ArticleLiterature Review

Overuse Injuries, Overtraining, and Burnout in Child and Adolescent Athletes

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Abstract

This Clinical Report was revised. See https://doi.org/10.1542/peds.2023-065129 Overuse is one of the most common etiologic factors that lead to injuries in the pediatric and adolescent athlete. As more children are becoming involved in organized and recreational athletics, the incidence of overuse injuries is increasing. Many children are participating in sports year-round and sometimes on multiple teams simultaneously. This overtraining can lead to burnout, which may have a detrimental effect on the child participating in sports as a lifelong healthy activity. One contributing factor to overtraining may be parental pressure to compete and succeed. The purpose of this clinical report is to assist pediatricians in identifying and counseling at-risk children and their families. This report supports the American Academy of Pediatrics policy statement on intensive training and sport specialization.

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... Activity history and clinical examination are important, not only to make the diagnosis, but also to provide an indication of severity on the level of exercise-induced microdamage and the capacity of the apophysis to withstand further loading (stress and strain). A precise understanding of the signs of early symptoms is essential, in order to proactively identify these patients early when tissue changes are reversible and intervention is least invasive [59,96,111]. During the clinical examination, pain or discomfort is often triggered by palpation, passive stretch, and resisted manual muscle testing, with the latter maneuver placing stress on the symptomatic apophysis. ...
... International healthcare providers recognize that education of young athletes and their caregivers is critically important components in the successful management of OSD [109]. It has been speculated that the development of educational opportunities can be extended to the coaching staff and applied to any apophyseal injury management [111]. Advice and education can be achieved by diverse methods (e.g., leaflet, conversations, presentation) and must be adapted to the age and skeletal maturation status of the targeted athletes and patient population. ...
... 13 Symptoms manifestation and suggested management approach for various stages of disease ranging from 0 (most mild) to 4 (most severe) apophysitis. (Adapted from the work of Brenner et al.[111] and Launay[59 ...
Chapter
The apophyses develop through endochondral ossification that occurs at the periphery of the enlarging secondary ossification center. Sever’s and Osgood–Schlatter diseases are the most studied sites for traction apophysitis. Regrettably, apophyseal injuries are frequently underdiagnosed and mistaken for soft tissue injuries. These injuries occur from childhood to late adolescence with some diagnosed in the third decade of life. Most sports-related epidemiological research on apophyseal injuries involve the lower extremity, and male athletes, especially in soccer. These overuse injuries are caused by repetitive submaximal mechanical stress beyond the physeal tolerance-threshold, disrupting the periphyseal vascular supply. Avulsions are the most severe presentation. Currently, clinical examination and management of these injuries relies mainly on clinical research and expert opinion. Clinicians should be familiar with the various sites of vulnerability in the immature skeleton which facilitates early diagnosis and intervention, prior to irreversible damage and growth disturbance. Thus, management has evolved into a more active approach, which involves athlete education, activity, and load modification management. We propose a novel framework for understanding the pathophysiologic mechanisms behind these injuries and a structured hypothetical approach to enhance the management of apophyseal PSIs.
... BACKGROUND Sport-specialised athletes who have chosen to focus on one sport at the expense of other sports are at greater risk for overuse injuries, overtraining and social-emotional imbalances, including early burnout, stress and anxiety. [1][2][3][4] The increased risk for injury may be linked to the increased training volume, drive to succeed, and high competition levels inherent to sports specialisation. [4][5][6][7][8] Furthermore, in a study that did not account for sport specialisation, athletes with increased hours of play, a variable often seen in sportspecialised athletes, were more likely to use legal performance-enhancing substances (PES), independent of demographic characteristics and physical activity level. ...
... [4][5][6][7][8] Furthermore, in a study that did not account for sport specialisation, athletes with increased hours of play, a variable often seen in sportspecialised athletes, were more likely to use legal performance-enhancing substances (PES), independent of demographic characteristics and physical activity level. [1][2][3][4][5][6][7][8][9] The use of legal PES in sports is widespread. [10][11][12][13][14][15] Sixty-five to eighty-nine percent of intercollegiate athletes use some form of legal PES supplement, with similar use patterns occurring at the scholastic level. ...
... The findings of our study are important to consider because sport specialisation for young athletes is often discussed in line with negative ramifications, including serious overuse injury, relative energy deficiency syndrome, burnout, heightened stress levels, depression, and anxiety. [1][2][3][4] In this sense, healthcare providers caring Open access for young athletes may naturally conclude that sports specialisation places them at increased risk for PES use. ...
Article
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Objectives To investigate the association of reported legal performance enhancing substance (PES) use and consideration of banned PES use among sport-specialised and non-sport-specialised young athletes. Methods and design Cross-sectional study of 1049 young athletes enrolled in an injury prevention programme from 2013 to 2020. We used logistic regression modelling to determine the independent association between sports specialisation. We reported (1) legal PES use and (2) consideration of banned PES use after adjusting for the effects of gender, age, having a relative as a coach, unrestricted internet access, use of a weight training regimen, and weeknight hours of sleep. Results The final cohort consisted of 946 athletes with a mean age of 14. 56% were female, and 80% were sport-specialised athletes. 14% reported legal PES use, and 3% reported consideration of banned PES use. No difference was found between sport-specialised athletes who reported legal PES use (OR=1.4; 95% CI 0.81 to 2.43; p=0.23) or consideration of banned PES use (OR=3.2; 95% CI 0.78 to 14.92; p=0.1) compared with non-sport-specialised athletes. Reported legal PES use was more common among athletes who were male, older, used weight training, and slept less. Reported consideration of banned PES use was more common among male and older athletes. Conclusions PES use is not independently associated with sport specialisation in young athletes. Athlete sex, age, training, and sleep patterns are important factors for young athletes to consider in PES use.
... 4,9,21,23,34,35,38 It is generally agreed that the number of hours spent in deliberate training and practice positively correlates with level of achievement in both team sports and individual sports and might confer benefits in terms of securing college scholarships or entry to elite collegiate, national, Olympic, or professional teams. 4,5,13,23 The AOSSM defines sports specialization as engaging in a sport for 8 months per year (approximately 3 seasons per year) at the exclusion of other sports. 34 Currently, there is no evidence to support that specializing leads to success in a sport at an elite level. ...
... 23,31,34,44 It is increasingly suggested that this intense level of practice during early childhood and the exclusion of other sports should be delayed until late adolescence to optimize success while minimizing injury, burnout, and psychological stress. 4,12,13,21,23,31,34,44 While relatively uncommon in the general population, injuries to the anterior cruciate ligament (ACL) of the knee have been shown to be more frequent in adolescents who participate in organized sports. 46 Compared with adolescents who do not play sports, male and female adolescents who participate in organized sports have a 2-to 4fold and 2-to 11-fold increased risk of ACL injury, respectively, depending on the time spent in each sport per week. ...
Article
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Background Anterior cruciate ligament (ACL) injury in youth can lead to expensive treatment, lengthy rehabilitation, and long-term impairment. Injuries to the ACL are more common in adolescents who participate in organized sports. Purpose To examine whether there is an association between age, physical activity patterns, pubertal timing (Tanner stage), or body mass index (obesity/overweight status) and the risk of developing an ACL injury in youth. Study Design Cohort study; Level of evidence, 2. Methods Data from the Growing Up Today Study (GUTS), a prospective cohort study of youth throughout the United States, were used in this study. From 1996 to 2003, questionnaires were sent to GUTS participants every 12 to 18 months to assess a variety of self-reported factors; in a related 2004 questionnaire, ACL tears and other diagnoses among the participants were reported. Cox proportional hazard models were run to determine the sex-specific association of activity patterns and pubertal timing with risk of developing an ACL tear. Results A total of 4519 boys and 5622 girls (age: 9-15 years) were included, with 2.4% and 2.0% sustaining an ACL injury, respectively. Age was found to be a significant risk factor for ACL injury in both sexes (male: hazard ratio [HR] = 1.30 [95% CI, 1.14-1.48]; female: HR = 1.23 [95% CI, 1.10-1.38]). Mean hours per week engaged in vigorous activity was also predictive of a higher risk of ACL injury (male: HR = 1.04 [95% CI, 1.01-1.08]; female: HR = 1.10 [95% CI, 1.07-1.14]). The sports that were the most predictive of injury were running, basketball, soccer, and cheerleading/gymnastics in girls and running, football, and karate/martial arts in boys. Additionally, in boys, overweight/obese status was found to be a significant predictor of ACL injury (HR = 2.61 [95% CI, 1.60-4.26]). Furthermore, among 9- to 13-year-old girls, advanced Tanner stage was a strong predictor of injury risk (HR = 2.43 [95% CI, 1.10-5.36]). Conclusion Age, time engaged in vigorous activity, overweight/obese status, and advanced Tanner stage were associated with an increased risk of ACL injury in young adults and adolescents. Further research with follow-up data will help complement this study and continue to highlight the risk factors associated with ACL reconstruction in adolescents and young adults.
... Sports participation continues to increase among adolescents with an estimated 30 to 45 million youths between the ages of 6 and 18 participating in some form of athletics (Seefeldt et al., 1992). With greater accessibility to sports (Brenner, 2007), recent trends have also shown an increase in the training loads of youth athletes and sport specialization (or Frontiers in Psychology 02 frontiersin.org single-sport participation) over the past decade (Brenner, 2007;Jayanthi et al., 2013). ...
... With greater accessibility to sports (Brenner, 2007), recent trends have also shown an increase in the training loads of youth athletes and sport specialization (or Frontiers in Psychology 02 frontiersin.org single-sport participation) over the past decade (Brenner, 2007;Jayanthi et al., 2013). Youth sports culture has evolved over time and the multi-faceted relationship adolescents form with sports is also adapting. ...
Article
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Introduction The development of identity formation occurs during adolescence through experiences, ideals and principle. With greater accessibility to sports, recent trends have shown increased rates of sports specialization over the past decade in youth athletes. Athletic identity measures the strength an individual is tied to the athlete role and can be formed in conjunction to adolescent identity formation. More specialized youth athletes may have stronger ties to their athletic identity during their adolescent identity formation period. Methods Youth basketball athletes were surveyed on specialization levels and athletic identity via the Athletic Identity Measurement Scale (AIMS), including three submeasures: social identity, exclusivity, and negative affectivity. Results Participants showed stronger identification to social identity items and the weakest identification with exclusivity items. Athletes reporting more time spent playing their primary sport presented higher scores across all measures of athletic identity, and total athletic identity was stronger in athletes reporting specialization at an earlier age. Exclusivity and negative affectivity tended to increase with specialization level which may primarily be driven by specialized athletes choosing to quit non-primary sports. Discussion Athletic identity may be worth noting as a psychological indicator of potential risk of injury. The long-term goal of this work is to provide the research and clinical community a greater understanding of a potential psychosocial risk factor as youth athletes continue specializing and spending more time training in a singular sport.
... Studies have shown that injuries can have a significant psychosocial effect and can negatively impact QOL in athletes; furthermore, some injuries can ultimately result in symptoms consistent with post-traumatic stress disorder [21,49]. In fact, specialized athletes who had physically recovered from recent injuries reported continued lower QOL, which is consistent with prior studies showing that injuries' impact on QOL persists long after physical recovery [6]. ...
... Sport specialization has been associated not only with overuse injuries as previously mentioned but also with increased risk of burnout [6]. Highly sport-specialized athletes have demonstrated worse subjective well-being in terms of fatigue, mood, and soreness compared with multisport athletes, even after controlling for confounding factors including age, sleep, and training load [68]. ...
Article
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The concept of youth sport specialization has evolved over the past decade, from a focus on the risk of overuse injury to a broader awareness of its effects on mental health, social well-being, quality of life, growth and maturation, sport performance, and long-term athletic success. This review article considers a recently revised definition of youth sport specialization, as well as guidelines and consensus statements from various sports medicine organizations, with practical applications for young athletes.
... Role strain theory (RST) has been used to examine the demands placed on adolescent athletes. 52 Research has found that junior athletes competing at an elite level experience role strain associated with their sport 5 and other important life roles, such as schooling and family. 7 Van Rens and colleagues 52 proposed that role strain consists of the following elements: (i) (dual career) overload in sport and between roles, (ii) overload in school, (iii) between-role conflict, (iv) underload, and (v) ambiguity. ...
... Overload is the athlete's perception that the demands placed on them in their various roles outweigh their personal resources. 14 This construct is relevant to wellbeing and burnout in adolescents, both as athletes 5 and students. 37 Between-role conflict is the discrepancy between the performance expected by others in a certain role and an athlete's personal schemas regarding what constitutes appropriate performance or behaviour. ...
... While sports participation provides many benefits, concerns have been raised regarding the overtraining and overuse injuries [1,2] (e.g., 35 injuries/100 students annually requiring medical attention [1]) among adolescents. Thus, some organizations [1,2] have recommended that adolescents take adequate rest for injury prevention. ...
... While sports participation provides many benefits, concerns have been raised regarding the overtraining and overuse injuries [1,2] (e.g., 35 injuries/100 students annually requiring medical attention [1]) among adolescents. Thus, some organizations [1,2] have recommended that adolescents take adequate rest for injury prevention. ...
Article
Purpose We examined whether introduction of national guidelines limiting sports club activities at school was associated with adolescents' exercise and cardiorespiratory fitness. Methods We conducted interrupted time-series analysis to quantify the changes in prefecture-level aggregated data on exercise or sports activities and 20-m shuttle run (indicator of cardiorespiratory fitness) among adolescents in Japan before (2013–2017) and after (2018–2022) the introduction of the guidelines using data from the National Survey of Physical Fitness, Athletic Performance and Exercise Habits. Results The introduction of the guidelines was associated with reductions in exercise and sports activities duration (boys, −4.8 [95% CI −5.9, −3.8] min/day; girls, −5.5 [95% CI −6.2, −4.8] min/day) and performance of 20-m shuttle run (boys, −1.2 [95% CI −1.4, −1.0] laps; girls, −2.3 [95% CI −2.5, −2.2] laps). Discussion After introducing guidelines limiting sports club activities at school, levels of exercise or sports and cardiorespiratory fitness declined among adolescents.
... Ek olarak, ergen sporcularda teknik eksiklikler, yetersiz ısınma ve soğuma süreçleri de yaralanma riskini artıran önemli faktörlerdir. Özellikle bu yaş grubundaki sporcuların biyomekanik yetenekleri ve koordinasyonları hala gelişmekte olduğundan, yanlış hareket kalıpları veya teknik hatalar yaralanmalara zemin hazırlayabilir (Caine et al., 2008;Brenner, 2007). Bu olumsuz durumları önleyebilmek için literatürde theraband, core, kalistenik ve direnç egzersizlerinin öneminden bahsedilmektedir (Kılınç et al., 2018;Bayrakdar & Kılınç, 2020;Bayrakdar, 2020). ...
Book
Spor, bireylerin fiziksel ve zihinsel sağlığını geliştiren, sosyal bağları güçlendiren ve yaşam kalitesini artıran önemli bir aktivite alanıdır. Ancak, sporun dinamik ve rekabetçi doğası, zaman zaman çeşitli yaralanma risklerini de beraberinde getirebilir. Bu yaralanmalar sadece sporcuların fiziksel sağlıklarını değil, aynı zamanda kariyerlerini, psikolojik durumlarını ve yaşam standartlarını da etkileyebilir. Elinizdeki bu çalışma, spor kazalarının tanımından önlenmesine, akut müdahalelerden rehabilitasyon süreçlerine kadar geniş bir çerçevede, bilimsel ve uygulamalı bilgileri bir araya getirme hedefiyle hazırlanmıştır. Amacımız, spor kazalarına dair temel bilgileri aktarmakla birlikte, okuyucuların bu alanda güncel yaklaşımları anlamalarına katkıda bulunmak ve bu bilgileri hem profesyonel hem de akademik çalışmalarda kullanabilmelerine olanak sağlamaktır. Bu kitabın hazırlanmasında çok sayıda kaynaktan faydalanılmış ve multidisipliner bir bakış açısı benimsenmiştir. Spor hekimleri, fizyoterapistler, antrenörler ve sağlık profesyonelleri için bir rehber niteliğinde olan bu eser, aynı zamanda sporcular ve sporla ilgilenen bireyler için de yararlı bir başvuru kaynağı olacaktır. Bu çalışmanın, spor yaralanmalarının önlenmesi ve rehabilitasyon süreçlerinin iyileştirilmesi konusunda farkındalık yaratacağına inanıyorum. Emeği geçen tüm meslektaşlarıma ve desteklerini esirgemeyen herkese teşekkür eder, bu kitabın okuyuculara faydalı olmasını temenni ederim.
... These effects may arise due to differing nutritional requirements compared to adults, which can be either higher or lower, or from the potential for excessive consumption relative to their specific nutrient needs [12,13]. Especially since it is thought that young athletes mirror the attitudes of those more experienced and adopt similar supplementation protocols that are recommended for adults [9,14]. Young athletes who excel in their fields deserve special attention due to the strenuous energy expenditure from intense physical training and the energy demands for growth and development [10,15]. ...
Article
Full-text available
Background/Objectives: The increasing popularity of acute supplementation among young athletes is concerning, given the limited scientific evidence to guide recommendations specific to this group. Therefore, the aim of this systematic review was to synthesize the available scientific evidence on the acute effects of supplementation in young athletes to understand the impact on physical and cognitive performance. Methods: Following pre-registration on INPLASY (INPLASY202310017) and according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, systematic searches of three electronic databases (Web of Science, PubMed, and Scopus) were conducted by independent researchers from inception until July 2024. Only original studies in English that examined the acute effects of supplementation on young athletes’ physical and/or cognitive performance, specifically when taken on the same day as exercise (before or during), were included. The risk of bias was individually assessed for each study using the revised Cochrane risk of bias tool for randomized trials (RoB 2.0). Results: A total of 16 studies were included in the review. A range of ages, participants, sports, and methodological approaches were involved in the studies included in the current review. The studies mainly used carbohydrates, beetroot juice, and sodium citrate, with carbohydrates being the most used acute supplementation. Carbohydrate supplementation enhanced endurance capacity and increased blood glucose, but mixed results were found for anaerobic performance. Mixed results were found for beetroot juice, with one study finding increases in power production. One study used sodium citrate supplementation, with improvements in technical performance observed. Conclusions: Since this review identified only three substances meeting our eligibility criteria, further research is needed to confirm the acute effects of supplements in young athletes and to better understand their benefits and limitations. Carbohydrate supplementation shows strong evidence for enhancing endurance performance, particularly during prolonged activities, while sodium citrate appears to support the preservation of skill performance. In contrast, the effects of beetroot juice are less consistent. Additional research is required to confirm the acute effects of supplements like beetroot juice in young athletes.
... This is in accordance with what Joel expressed Abuse wounds are microtraumatic wounds to bones, muscles, or ligaments that are subjected to tedious push without adequate time to recuperate or experience a characteristic recuperation prepare. Abuse wounds can be separated into four stages:(1) torment within the influenced range after physical activity; (2) pain during activities without limitations; (3) pain on activity that limits performance; and (4) chronic pain that does not go away even after rest (Brenner et al. 2007). ...
Article
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This research used experimental research methods, Running Interval Training (RIT) method which was divided into 2 groups (n=20) athletes, the experimental group (n=10) used a training mask for a 6 month period and the control group (n=10) did not use a training mask, for sampling using purposive sampling technique. BOD POD ® is highly accurate, and can detect even small changes in body fat and lean body mass. the experimental group using the Running Interval Training (RIT) method which uses the Elevation Training Mask is superior to the control group using the Running Interval Training (RIT) method without using the Elevation Training Mask. 17.19% superior to the control group, namely 13.74%, the difference in increase between the two groups was 3.45%, the RIT Method which uses the Training Mask has an effect on increasing the VO₂Max of Kuningan Cycling Athletes. The feedback receive from your BOD POD ® assessment can be used to measure the success of nutrition or exercise program, while the average of the twenty athletes whose body composition was analyzed was 16.9, Meaning they were at the Moderate Lean level, meaning the Fat% numbers were at a very good level. Keywords: Running Interval Training (RIT), Elevation Training Mask, Body Composition.
... 12, 13 The potential disadvantages span a broad spectrum of topic areas. The common themes include overtraining, 14,15 dropout, 16 burnout, 17 and injuries. 18,19 Among the listed categories, injuries can be further broken down into additional subcategories. ...
Article
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Objective Youth athletes are beginning to specialize in a single sport more often. Previous studies in sports medicine and orthopedics have shown an association between intensity of sport specialization and incidence of injuries. This study is the first of its kind to explore the effects of early sport specialization on injury risk through a multicenter framework with a concentration on NCAA athletics. Design Retrospective cohort study. Setting SAFE Consortium. Participants A total of 211 collegiate athletes from the NCAA's 3 levels of competition: Division I, II, and III. Data were collected by the SAFE investigators. Intervention N/A. Main Outcome Measures Participants completed a questionnaire about their demographics, sport participation, specialization status, physical injuries, recovery period, and treatment method. Specialization status was calculated with a previously published 3-point scale: low, moderate, and high. Injuries were categorized as upper extremity injuries (UEIs) and lower extremity injuries (LEIs). Results Highly specialized athletes were more likely to report UEIs and LEIs than low specialized athletes ( P < 0.0001). Moderate specialization, in contrast to low specialization, was associated with a higher likelihood of LEIs ( P = 0.03) but not UEIs ( P = 0.052). Highly specialized athletes were more likely to report an injury of any kind. Conclusions The SAFE investigators found high specialization was associated with a history of UEIs and LEIs. Return to play was longer for highly specialized athletes versus low specialized athletes (112 days and 85 days, respectively). Highly specialized athletes were more likely to be from Division I and to require surgery.
... Physical literacy is not restricted to the development of motor skills in early childhood; rather, it is characterized by a broad variety of forms of PA and is relevant throughout life [19]. Insufficient motor skills from childhood can lead to both avoidance of PA and low ability to avoid injury in adolescence and adulthood [20][21][22][23]. ...
Article
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Many children spend a large proportion of their waking hours in early childhood education and care (ECEC). Movement and physical activity (PA) are crucial for children’s development and sustainable health. The competence to manage and assess risks starts early in life and can be improved through opportunities for challenging PA. The aim of this study was to investigate ECEC educators’ experiences and perceptions of injury risks in ECEC and examine their reasoning about teaching movement and PA, and experiences of any restrictions and prohibitions of movement and PA. Eighteen ECEC educators were interviewed. The qualitative content analysis revealed three themes with adherent sub-themes: Responsibility for the children (Caretaking and Empathy); Fear of being accused (Fear of being exposed and Fear of being irresponsible in the work team); Low competence in movement (Low expectations of children and Perceived poor personal movement skills). The study concluded that educators’ fear of injury risks limits the children’s movement and PA occasions. The educators’ perceived poor personal motor skills and low fitness combined with their perceived low competence to teach movement limit the possibility for the children to develop their motor skills, which in turn might affect the children’s physical literacy for sustainable health.
... Previous research on elite youth track and field athletes has shown that junior athletes often do not transit into elite senior athletes [8], and the main reasons for dropping out of sports in England have been inappropriate training and competition loads with repeated injury and inability to recover to previous levels at a young age [8,23,9,15]. The analysis by Ristolainen et al. [30] has also revealed a significant relationship between forced retirement and having sustained an overuse injury. ...
Article
The aim of the study was to record the extent of lower limb overuse problems in highly trained track and field athletes during the 12 weeks of their preparation for national and international athletics championships. 21 highly trained track and field athletes (10 males: height 188.4 ± 6.8 cm; weight 79.9 ± 5.4 kg; BMI 22.5 ± 0.9; training hours per week 7.78 ± 2.37; 11 females: height 174.1 ± 7.9 cm; weight 61.7 ± 5.8 kg; BMI 20.4 ± 1.4; training hours per week 6.28 ± 2.76) from the national team volunteered to participate. The study was a prospective cohort study during which the Oslo Sports Trauma Research Center Overuse Injury Questionnaire was distributed weekly to all athletes for 12 weeks from May 2015 to August 2015. The two most prevalent overuse problems reported in our study group were hamstring and lower back area problems. On average, 64% of athletes in the present study group suffered from an overuse problem to ankle, hamstring, groin, knee or low back at any given time. The results of the study show that lower limb overuse injuries are too frequent in track and field athletes, and many athletes still train and compete through these injuries. Therefore, it is very important for athletes’ long-term health to regularly monitor their health problems in order to start preventing them.
... The same study by Lemyre et al., (2007) found that, consistent with the integrated model of athlete burnout (Gustaffson et al., 2011), overtraining syndrome is positively associated with predisposing an athlete to ABO. A deontologist may suggest, then, that extremely intense overtraining micro cycles should be strictly avoided, as an understood "sequela of overtraining syndrome" (Brenner, 2007(Brenner, , p.1243. ...
Article
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The cultural importance of sport across the world is well established, with meaningful significance given to policies that promote participation for health and psychosocial reasons, strong narratives, nation-building, and entertainment formed through the consumption, both contemporary and historical, of performance sport. In this commentary, we argue and provide evidence that any examination of sports culture inevitably ties to ideologies of performance, and that oftentimes this results in approaches to the development of athletes and sportspeople that overemphasize profoundly unethical means of achieving a variety of performance ends. Because of this, our position in this commentary uses a philosophical perspective to justify our proposition, one that espouses a more holistic approach for sport coaches, organizers, and architects that, through supporting athletes and focusing on development, actually mirrors scientific principles for sport performance, more so, we believe, than any ‘win at all costs’ approach.
... 47 Multivariate prospective studies investigating potential risk factors for injury in elitelevel adolescents over the physical and psychological domains have shown increases in training load, decreases in sleep volume, and low subjective well-being can potentially increase the risk of injury. 10,68,69 Up to 30% of nonelite adolescent athletes experience nonfunctional overreaching and overtraining, 42 and they may be more prone to injury if psychological factors are present 8,36 or if they experience poor sleep quality and quantity. 30 With only 1 study 72 investigating interactions between training loads, psychosocial stress, sleep and injury risk at the nonelite team sport level, further research is needed to guide coaches and trainers on how best to monitor and address these factors with their adolescent athletes. ...
Article
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OBJECTIVES: The objectives of this scoping review were to map the evidence for promising injury risk factors in adolescents who played team sports at a nonelite level and to identify gaps in knowledge. DESIGN: Scoping review. LITERATURE SEARCH: Online databases (CINAHL, Embase, Medline, ProQuest, PsycINFO, Scopus, and SPORTDiscus) were searched. STUDY SELECTION CRITERIA: Studies were included if participants were adolescents who played nonelite team sports and exposure to at least 1 potential risk factor for sport-related musculoskeletal injury was evaluated. DATA SYNTHESIS: The Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews (PRISMA-ScR) checklist was used. RESULTS: From 12 077 studies, 377 studies were included; 199 were prospective, 109 were retrospective, and 69 were cross-sectional in design. Soccer was the most frequently investigated sport and females represented 30% of total participants. The most promising potential risk factors (highest proportion of studies) for injury were training load (94%), playing in competition (91%) and previous injury (80%). Less research has investigated psychosocial factors with no study investigating factors over the entire biopsychosocial domain. Considerable methodological heterogeneity existed between studies. CONCLUSIONS: The promising potential risk factors identified in this review require further investigation to explore causal relationships. The heterogeneity found within the current research with respect to potential risk factor variable measures, observation period definitions, and injury definitions may provide limitations when trying to formulate conclusions from meta-analyses using pooled studies.
... Međutim, neadekvatan period oporavka može loše da utiče na sposobnost tkiva da se adaptira, što rezultuje oštećenjem tkiva. Zbog toga je neuravnoteženost između opterećenja tokom treninga i oporavka ključan faktor za nastanak sindroma preopterećenja, naročito kod mladih sportista sa nepotpuno razvijenim koštano-mišićnim sistemom (1)(2)(3)(4)(5). ...
Article
Sindrom preopterećenja obuhvata povrede nastale uticajem ponovljene fizičke aktivnosti (do nivoa submaksimalnog opterećenja)na koštano-mišićni sistem, pri čemu oporavak nije adekvatan jer ne rezultuje strukturalnim i funkcionalnim adaptacijama. Potencijalni okidači za nastanak sindroma preopterećenja uključuju povećano opterećenje tokom treninga bez adekvatnog oporavka, monotoniju treninga i preveliki broj takmičenja. Uobičajene manifestacije kod dece sportista uključuju hronični bol u mišićima ili zglobovima, diskretne promene ličnosti, povišeni puls u mirovanju, nedostatak entuzijazma za trening ili takmičenje, kao i česte poteškoće da se uspešno završe uobičajene fizičke aktivnosti. Prilikom savetovanja sa trenerima i roditeljima, treba poći od činjenice da ne postoje naučno određene smernice koje bi definisale koliko je fizičke aktivnosti zdravo i korisno mladim sportistima u poređenju sa onim što ih može dovesti u rizik od nastanka sindroma preopterećenja ili sindroma izgaranja. Većina vodećih strukovnih udruženja preporučuje ograničavanje jedne sportske aktivnosti na maksimum pet dana nedeljno, uz najmanje jedan slobodan dan od bilo kakve organizovane aktivnosti. U današnje vreme izgleda da je fokus većine sportskih programa za decu i adolescente usmeren ka razvoju sport-specifičnih veština, umesto na razvoj bazičnih fitnes komponenti kao što su snaga, izdržljivost, agilnost, ravnoteža i koordinacija. Svetska strukovna udruženja predlažu da ne bi trebalo ohrabrivati sportsku specijalizaciju pre adolescencije. Zbog toga, programirana fizička aktivnost ne bi trebalo da se bazira na jednom sportu, već da se razvija iz raznovrsnih sportskih aktivnosti, koje uključuju fundamentalne veštine kretanja (trčanje, skakanje, okretanje, poskok i preskakanje), i kondicionih priprema koje poboljšavaju i zdravstvene i komponente vezane za fizički fitnes.
... Other labs that can help differentiate OTS from other illnesses are blood work, testosterone: cortisol ratio, overnight urinary cortisol: cortisone ratio, maximal heart rate at lactate threshold, and/or decrease maximal lactate concentration [15]. Recommended treatment involves limiting participation to a maximum of 5 days per week with at least 1 rest day, taking 2-3 months off per year, and participating in one sport per season with just one team [16]. ...
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Purpose of Review This study aimed to provide an overview of some of the medical concerns surrounding the care of the pediatric endurance athletes and add to the limited literature specific to the pediatric endurance athlete. Recent Findings Endurance athletes are at risk for overtraining, relative energy deficiency in sport (RED-S), overuse injuries, nutritional deficiencies, and sleep dysfunction. Youth runners and female endurance athletes are particularly high-risk populations for RED-S; nutritional deficiencies and their care should involve thoughtful mitigation of modifiable risk factors. The growing endurance athlete may experience slightly different cardiac adaptations than the adult endurance athlete with the long-term implications of these changes still unclear. Summary Endurance sports are common among youth athletes. Multidisciplinary care that includes screening and early intervention for high-risk areas is critical to optimize their care and promote, safe lifelong sport participation.
... It is important for the pediatrician to investigate the athlete's motivation in participating in their sport. 56 Athletes with decreased performance despite adequate recovery, nutrition, and hydration may require further evaluation for burnout. 52,57 To accurately diagnose burnout, it is important that the pediatrician rule out other organic causes that can present similarly. ...
Article
Sports participation can have tremendous physical and mental health benefits for children. Properly implemented progressive training programs can yield a broad range of beneficial physiologic adaptations, but imbalances of training load and recovery can have important negative consequences. Overuse injuries, for example, can result from repetitive stress without sufficient recovery that leads to accumulated musculoskeletal damage. In addition, extended periods of increased training loads that exceed the intervening recovery can have systemic consequences such as overtraining syndrome, which results in decreased performance, increased injury and illness risk, and derangement of endocrine, neurologic, cardiovascular, and psychological systems. Burnout represents one of the primary reasons for attrition in youth sports. Broadly defined as physical or mental exhaustion and a reduced sense of accomplishment that leads to devaluation of sport, burnout represents a direct threat to the goal of lifelong physical activity and the wide-ranging health benefits that it provides. This clinical report is intended to provide pediatricians with information regarding the risk factors, diagnosis, management, and prevention of these conditions to assist in the identification of at-risk children, the treatment of young athletes, and the guidance of families in the promotion of safe and healthy sport participation.
... Current HIIT training recommendations advise that HIIT be followed by low-to-moderate intensity training for at least the first 48 h to ensure proper recovery, especially in untrained individuals (13,77). Furthermore, HIIT guidelines also recommend 1-2 recovery days per week and no more than a weekly increase of 10% in training time or intensity (78). Overtraining has been shown on numerous accounts to induce neurotransmitter and enzyme disturbances including disturbances of dopamine and modulation of TH expression (60- 63,79,80). ...
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Background Previous research has outlined the health benefits of exercise including its therapeutic potential for substance use disorders (SUD). These data have already been utilized and it is now common to find exercise as part of SUD treatment and relapse prevention programs. However, we need to better understand different exercise regimens and determine which would be the most beneficial for SUDs. Recently, high intensity interval training (HIIT) has gained attention in comparison with aerobic and resistance exercise. Little is known regarding the neurobiological mechanisms of HIIT, including its effects on dopamine signaling and receptor levels in the brain. The present study examined the effects of chronic HIIT exercise on dopamine signaling as measured by dopamine type 1-like receptor (D1R)-like, dopamine type 2-like receptor (D2R)-like, and tyrosine hydroxylase (TH) quantification in the brains of male and female rats as measured by [³H] SCH 23390 and [³H] spiperone autoradiography, and TH-immunoreactive optical density values. Methods Rats were separated in two groups: sedentary and HIIT exercise. Exercise was on a treadmill for 30 min daily (10 3 min cycles) for six weeks with progressive speed increased up to 0.8 mph (21.5 m/min). Results Results showed for D2R-like binding, a significant effect across the ventral caudate putamen (V CPU) between sexes, such that mean D2R-like binding was 14% greater for males than females. In the nucleus accumbens shell (Nac Shell), the HIIT Exercise rats showed 16% greater D2R-like binding as compared to the sedentary rats. No significant effects of HIIT exercise were found across groups for brain D1R-like binding levels or TH expression. Conclusion These results suggest that HIIT exercise can modulate dopamine signaling by way of increased D2R. These findings support the premise that HIIT exercise plays an important role in dopamine signaling and, may provide a potential mechanism for how HIIT exercise can impact the brain and behavior.
... An appropriate amount of physical activity and sport participation among children and adolescents has been typically associated with improved psychosocial well-being [28]. However, mental health and function could be negatively affected among those youth athletes who specialized early in their career secondary to numerous factors, including social isolation, poor academic performance, increased anxiety, greater stress, inadequate sleep, decreased family time, and burnout [13••, [29][30][31][32][33]. ...
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Purpose of Review The evaluation of a young athlete with an overuse injury to the knee involves a comprehensive approach. There are a number of elements to consider including assessments of skeletal maturity (biologic maturation), workload (training load + competition load), sport specialization status, and biomechanics. The type of injury and treatment, as well as future prognosis, may be influenced by these and other factors. Recent Findings Calculating the percentage of predicted adult height (PPAH) is a valuable tool in assessing overuse injury patterns and diagnoses in youth athletes. Modifiable and non-modifiable overuse injury risk factors require monitoring from clinicians as young athletes mature and develop over time. Training and rehabilitation programs should be adapted to account for these. Summary In this manuscript, we seek to introduce a novel, comprehensive approach: S.P.O.R.R.T. (Skeletal Maturity, Prior Injury Risk, One Sport Specialization, Rehabilitation, Return to Play, Training Recommendations) (Fig. 1). Overuse, non-traumatic injuries to the knee in youth athletes will be presented in a case-based and evidence-based model to provide a framework for a comprehensive approach to the assessment and treatment of youth athletes with overuse injuries.
... However, oxidative stresses such as reactive oxygen species (ROS) increase after a single bout of exercise, and thus exercise is also a stress applied to the body [9]. In other words, excessive exercise or overtraining poses a health risk [10,11]. The threshold for excessive exercise varies among individuals. ...
Article
One of the most important strategies for successful aging is exercise. However, the effect of exercise can differ among individuals, even with exercise of the same type and intensity. Therefore, this study aims to confirm whether endurance training (ETR) has the same health-promoting effects on the musculoskeletal and hematopoietic systems regardless of age. Ten weeks of ETR improved endurance exercise capacity, with increased skeletal muscle mitochondrial enzymes in both young and old mice. In addition, age-related deterioration of muscle fiber size and bone microstructure was improved. The expression levels of myostatin, muscle RING-finger protein-1, and muscle atrophy F-box in skeletal muscle and peroxisome proliferator-activated receptor-γ in the femur increased with age but decreased after ETR. ETR differentially modulated hematopoietic stem cells (HSCs) depending on age; ETR induced HSC quiescence in young mice but caused HSC senescence in old mice. ETR has differential effects on modulation of the musculoskeletal and hematopoietic systems in old mice. In other words, endurance exercise is a double-edged sword for successful aging, and great effort is required to establish exercise strategies for healthy aging.
... [35][36][37] Dependence upon optimal weather and formal supervision to practice ski racing at the highest level often necessitates increased training loads in a shorter amount of time, which is believed to increase an athlete's risk of burnout during their athletic career. 38,39 Although total practice volume has been investigated as an antecedent to burnout, 40 the specific contribution of different types and hours of practice experiences (ie, individual, play, coach-led) has received less scientific scrutiny. External pressures to succeed from parents and coaches on alpine ski racers at elite (and expensive) private developmental academies may also be a particularly salient factor to consider. ...
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Introduction: Previous theoretical frameworks focusing on burnout have identified numerous antecedents and psychosocial risk factors; however, the influence of early sport-specific experiences on burnout in developmental athlete populations remains less understood. Objectives: We explored the associations between burnout and prior sports engagement (ie, milestones, practice time, performance, injury history) in a sample of subelite academy alpine ski racers in the United States (N = 169, M age = 15.82 ± 1.80). Methods: Participants completed retrospective practice history profiles (milestones, practice time, injury), while their respective performance data were collected using an online national ranking registry. Simple and mixed-effect regressions were implemented to assess the associations between these measures and subscales of the Athlete Burnout Questionnaire. Results: The results indicated that greater participation in the coach-led group and individual practice during adolescence mitigated burnout responses (ie, greater sense of accomplishment, less sport devaluation), whereas more play earlier in development was associated with greater devaluation. Furthermore, poorer performance and more injury incidences were associated with increased burnout (ie, reduced sense of accomplishment). Conclusions: The structure of training and past experiences during early career years appear to influence burnout among alpine ski racing during their adolescent years, the implications of which are discussed in relation to sport developmental pipelines.
... According to Weiss and Ebbeck [14] , achieving personal goals, developing skills, and receiving praise for one's efforts can significantly boost self-esteem and confidence. Besides, sports support expects understudies to offset their scholastic obligations by preparing timetables and contests, developing abilities in using time productively, association, and discipline, which are adaptable to different aspects of their lives [15] . Educational institutions can contribute to student's holistic development by encouraging exercise and physical activity. ...
Article
Objectives: The growing diffusion of sports activities is centering attention on the development of diseases correlated with sports performance. The most common diseases reported by sswimmers are dental stains. They are also exposed to the onset of erosive tooth wear and harbor cariogenic bacteria. Considering that the oral cavity of swimmers is in close contact with the swimming pool water in their daily training environment, this study aimed to evaluate whether swimming can change salivary parameters and oral microbiota of amateur athletes. Material and method: This before-after study included 18 amateur athletes between 10 to 18 years old from a Swimming Team who practiced the sport at least three times a week. The swimmers were interviewed by a questionnaire and clinically evaluated. Unstimulated saliva was collected before and immediately after swimming. The salivary flow, pH, and buffer capacity were evaluated. The microbiological analysis included: total microorganisms, mutans streptococci group, Lactobacillus spp., and Candida spp. Wilcoxon test was applied before and after swimming with 5% level of significance. Results: A total of 18 subjects participated in this study. All of the pool parameters were under acceptable limit. There was no statistical difference in the salivary parameters: salivary flow (P = 0.264), pH (P = 0.132); buffer capacity (P = 0.067). Regarding the oral microbiota, no significant differences were found before and after swimming for mutans streptococci group (P = 0.950), Lactobacillus spp. (P = 0.432), Candida spp. (P = 0.386), and total microorganisms (P = 0.332). Conclusion: No change was observed in the salivary parameters and the oral microbiota before and after swimming in the evaluated group.
Article
Objective: To evaluate the role of parental influence on youth SSS and to characterize parental perceptions of SSS. Data sources: Embase.com, Ovid-Medline All, CINAHL Plus, APA PsycInfo, Scopus, Web of Science, and PubMed Central (PMC) since database inception. Study selection: Primary studies that assessed reasons for youth SSS that included parental influence as a factor and/or studies that investigated the nature or extent of parental influence on SSS were included. Data extraction: A single author extracted data, focusing on definitions and measures of SSS and parental influence, findings concerning primary reasons for SSS, any quantitative or qualitative findings on the extent of parental influence on SSS, and findings concerning various associations between parental influence, SSS, and other themes. Data synthesis: 61 articles were assessed in total, with 23 meeting criteria for inclusion. Parental influence plays a limited direct role in SSS, accounting for approximately 10.6% of the overall influence. Athlete self-influence or self-enjoyment of sport was found to be the predominant reason to pursue SSS, accounting for 82.3% of the overall influence. However, parents indirectly influence SSS by modulating athlete motivation and providing financial, practical, and emotional support. Conclusions: Athlete self-motivation primarily drives SSS directly, while parents indirectly influence SSS by modulating athlete self-motivation and offering financial, practical, and emotional support. Misconceptions persist regarding parental perceptions of SSS-related injury risks, scholarship attainment, and athletic development. Communication with parents regarding the risks associated with SSS and their role in monitoring their children's sports participation is crucial for mitigating adverse outcomes in youth athletes.
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Over the past two decades, participation in professional sports among children and adolescents has surged despite the rising inactivity and obesity rates. Approximately 60 million young individuals in the USA are involved in organized sports. This increase has led to a concerning rise in overuse syndromes, which is becoming a primary concern in sports medicine. Our review aims to examine common overuse syndromes in youth athletes and assess risk factors, pathophysiology, and preventive measures. Early sports specialization, societal pressures, and competitive demands lead to repetitive strain injuries. The young musculoskeletal system, though adaptable, is prone to injuries from intense training and insufficient recovery. Prevention advocates against early sports specialization and promotes adequate rest. Diversifying sports, limiting training hours, and a robust support system are recommended to counteract the mental effects of intense specialization. In summary, a holistic approach is needed to address overuse syndromes, emphasizing diversification, education, and a balanced approach to sports.
Chapter
There are many benefits of physical activity and sports participation for children and adolescents across the entire range of functional abilities. Youth with disabilities have some unique considerations when it comes to physical activity, exercise, and sports participation. Clinicians should be familiar with physical activity guidelines for all age groups and have expertise of a breadth of medical conditions to provide customized recommendations to promote physical activity, exercise, and sports participation that also keeps safety in mind. It is also important for clinicians to know and advocate for resources to facilitate equitable access and participation in physical activity and sports opportunities. This chapter focuses on the pediatric athlete with a disability and discusses: the benefits and current status of physical activity and sports participation, the current physical activity guidelines for different age groups, clinical approaches to discuss and prescribe physical activity and sports participation, common medical conditions and important medical considerations pertinent to sports participation and competition, and adaptive sports equipment and prostheses. The end of this chapter provides a list of many valuable resources relevant to pediatric adaptive and Para sports, physical activity, and exercise.
Article
Mindfulness has been around for centuries and a significant amount of research has been published in the past 6 years. Mindfulness has been shown to be helpful to improve overall wellbeing and sports performance. There has been a large increase in anxiety, depression, and overall stress in the pediatric, adolescent, and young adult population. This clinical commentary highlights the importance of using mindfulness as one tool to help young athletes improve their overall wellbeing and athletic performance. It also describes how it can be utilized in the sports medicine world along with noting a novel program at a Children’s Hospital that is utilizing these tools to help young athletes.
Article
Objective To investigate the association between psychosocial factors and physician clearance to return to play (RTP) in youth ice hockey players after sport-related concussion. Design Prospective cohort study, Safe to Play (2013-2018). Setting Youth hockey leagues in Alberta and British Columbia, Canada. Participants Three hundred fifty-three ice hockey players (aged 11-18 years) who sustained a total of 397 physician-diagnosed concussions. Independent Variables Psychosocial variables. Main Outcome Measures Players and parents completed psychosocial questionnaires preinjury. Players with a suspected concussion were referred for a study physician visit, during which they completed the Sport Concussion Assessment Tool (SCAT3/SCAT5) and single question ratings of distress and expectations of recovery. Time to recovery (TTR) was measured as days between concussion and physician clearance to RTP. Accelerated failure time models estimated the association of psychosocial factors with TTR, summarized with time ratios (TRs). Covariates included age, sex, body checking policy, days from concussion to the initial physician visit, and symptom severity at the initial physician visit. Results Self-report of increased peer-related problems on the Strengths and Difficulties Questionnaire (TR, 1.10 [95% CI, 1.02-1.19]), higher ratings of distress about concussion outcomes by participants (TR, 1.06 [95% CI, 1.01-1.11]) and parents (TR, 1.05 [95% CI, 1.01-1.09]), and higher parent ratings of distress about their child's well-being at the time of injury (TR, 1.06 [95% CI, 1.02-1.09]) were associated with longer recovery. Conclusions Greater pre-existing peer-related problems and acute distress about concussion outcomes and youth well-being predicted longer TTR. Treatment targeting these psychosocial factors after concussion may promote recovery.
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Competing predominately in one sport instead of multiple sports has become increasingly prevalent in young athletes. However, there is a lack of data focused on female athletes who compete exclusively in one sport. We hypothesized that female athletes who selectively train in a single sport (SS) have higher rates of injury, body image concerns, and menstrual dysfunction compared to female athletes who play multiple sports (MS). Retrospective data was collected from a pre-physical questionnaire distributed among female athletes from five local high schools (n=611; 13-18 years of age). Odds ratios, 95% confidence intervals (CI), and effect size were calculated to investigate the association between SS training and injuries, irregular menses, and body image concerns (a priori p< 0.05). SS training was not associated with higher rates of injury (p=0.48) and were less likely to have a history of stress fractures compared to MS athletes (p=0.03). There was a decrease in the number of menstrual cycles within the last 12 months among SS athletes (p=0.02, d=0.34). Exclusively competing in a single sport is not associated with higher injury rates in female high school athletes but is associated with dissatisfaction with one’s weight.
Chapter
As sport specialization among young athletes has become increasingly common; the topic has received much attention in the pediatric sports medicine arena over the last decade. The current paradigm shift in youth sports participation is toward participation with greater intensity, at higher competitive levels, and greater focus on singular sports activities to achieve these competitive levels. This chapter aims to discuss sport specialization with a unique focus on mental health, psychosocial well-being, and burnout along with the role of injury risk and the complex interplay between these factors in the young athlete.KeywordsSport specializationOveruse injuryAthlete burnoutAthlete sleepAthlete anxiety and depressionInjury prevention
Chapter
The popularity of youth participation in endurance sports, particularly running, has dramatically increased in the middle school- and high school-aged populations. Youth running provides various benefits in health (musculoskeletal and cardiovascular development) along with social and personal development. As participation in youth running grows, there is a greater need to better understand methods to optimize treatment of health concerns in this population. Identifying the types and patterns of running-related injuries specific to the youth runner can lead to further investigations into injury risk factors. The development of effective screening tools and preventative measures relies on better understanding of the impact of youth running on health and injury. This chapter will review medical and rehabilitation considerations in the youth runner while highlighting expert-guided recommendations for youth participation in running, identifying intrinsic and extrinsic risk factors for injury, and providing recommendations for injury management and injury preventative measures pertaining to training, nutrition, and safe running participation.KeywordsRunningYouthPediatricEndurance athleteInjury
Article
Regelmäßige körperliche Aktivität ist mit einer Vielzahl an präventivmedizinisch erstrebenswerten Begleiterscheinungen verbunden und leistet somit einen bedeutsamen Beitrag zu einer gesunden Lebensführung. In der Welt des Leistungssports befinden sich die Athleten allerdings auf einer ständigen Gratwanderung zwischen Gesundheitsschutz und Gesundheitsgefährdung, bedingt durch kontinuierlich zu erbringende Höchstleistungen in Training und Wettkampf. Schmerzen und Verletzungen sind dabei fortwährende athletische Wegbegleiter und das damit verbundene Competing Hurt gehört zum leistungssportlichen Tagesgeschäft dazu, auch bereits im Nachwuchsbereich. Neben verschiedenen schmerzbedingten Bewältigungsmechanismen spielt die weitverbreitete unkritische Schmerzmitteleinnahme eine besonders gesundheitsgefährdende Rolle. Ein umfassendes Umdenken aller sportlichen Akteure im Umgang mit Schmerzen und speziell hinsichtlich des Schmerzmitteleinsatzes ist dringend erforderlich.
Article
Background: An increase in intra-muscular creatine through supplementation has been proposed as a strategy for improving muscle performance and recovery, with studies showing some benefit for adult athletes who rely on short, explosive movements. We reviewed and summarized the current literature on creatine supplementation in a pediatric and adolescent population. Methods: The databases PubMed and EMBASE were queried to identity articles related to the use of creatine supplementation in a healthy pediatric and adolescent population according to the guidelines established by PRISMA. The abstracts of all articles were reviewed to determine relevancy, with those meeting the pre-defined criteria included in the final review. Results: A combined total of 9393 articles were identified. Following application of filters and review of abstracts, 13 articles were found to meet criteria and were included in the final review. There was a total of 268 subjects across all studies, with mean age ranging from 11.5 to 18.2 years. More than 75% of the studies were randomized-controlled trials, and 85% involved either soccer players or swimmers. The overall quality of the studies was poor, and there were no consistent findings regarding creatine supplementation and improvements in athletic performance. No studies were designed to address the topic of safety. Conclusions: There is a gap in the study of the safety and efficacy of creatine supplementation in adolescents. Additional studies are needed to evaluate the effects of alterations in muscle composition on the growth, development, and performance of the developing athlete. Orthopedic providers should counsel their pediatric and adolescent patients on the current limitations in trying to assess the true risk and benefit of creatine supplementation for the aspiring athlete. Level of evidence: Review, III.
Article
Objective: Artistic swimming is a highly challenging discipline, requiring physical skills and creativity. There are almost no published data on trauma. We aimed to assess the incidence and the nature of injuries in artistic swimmers. Design: An 11-year retrospective single-center cohort study. Setting: Department of Sport Medicine of a University Hospital. Patients: One hundred and twenty-four elite female artistic swimmers aged 12.9 ± 1.6 years. Interventions: The cohort was divided into 3 groups according to the competition categories (from 9 to 12 years old called "future", 12-15 years old called "youth", 15-19 years old called "junior"). Main outcome measures: Injury rate per season and per athlete was assessed. Results: The injury rate was 0.95 injuries/season/athlete and 1.05 injuries/1000 hours of practice. The most frequent injuries were rotator cuff tendinopathy (13.6%), acute low back pain (13.6%), and patellofemoral syndrome (11.9%). Swimmers in the youth and junior categories had significantly more injuries than those in the future category (P = 0.009), possibly because of more training hours (P < 0.001). Twelve major injuries occurred, all in the same group of youth swimmers. Conclusion: This is the first study investigating trauma during artistic swimming practice. A better knowledge of the main injuries is necessary for the physician to provide optimal care for athletes and to develop prevention. Attention should be particularly paid to the swimmers' shoulders and knees.
Article
Due to its multifaceted effects, sport is referred to as a “polypill” and compared with pleiotropic drugs. This article summarises the biopsychosocial effects of sport. Particular attention is given to the psychological and social effects of physical activity on children and adolescents. Firstly, sport is defined according to its various forms of organisation followed by a description of the individual effects on physical, psychological and social resources. These range from motor performance abilities (conditioning and coordinative abilities) as well as from cognitive, emotional and motivational aspects to social skills. Although sport – particularly regular physical exercise – can strengthen physical, psychological and social resources, it is also true that non-physiological stresses, inadequate supervision and normative structures still have the potential to induce harm at an individual level. Furthermore, socialisation and enculturation processes relevant to children and adolescents are integrated in the model. The skills learned through sport, particularly psychological and social skills, can thus become important in other areas of life too. The model proposed here can be used in both university and non-university teaching as well as for planning specific studies and training approaches. Keywords: physical activity, athletes, child, adolescent, sport psychology, sport sociology
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We report overuse injuries in 14 elbows of ten élite young gymnasts. In 12 elbows of eight patients aged 11 to 15 years there was a spectrum of radiological abnormalities including widening of the olecranon physis and fragmentation of the epiphysis. The radiographs were compared with those of normal elbows matched for age and sex. The radiograph appearances were very similar to those of the Osgood-Schlatter lesion of the tibial tuberosity. Two older boys, aged 18 and 19, had stress fractures through the olecranon growth plate. Conservative management was successful in all except one case of stress fracture which required internal fixation.
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Many recreational and elite runners participate in distance races each year. When these events are conducted in hot or cold conditions, the risk of environmental illness increases. However, exertional hyperthermia, hypothermia, dehydration, and other related problems may be minimized with pre-event education and preparation. This position stand provides recommendations for the medical director and other race officials in the following areas: scheduling; organizing personnel, facilities, supplies, equipment, and communication; providing competitor education; measuring environmental stress; providing fluids; and avoiding potential legal liabilities. This document also describes the predisposing conditions, recognition, and treatment of the four most common environmental illnesses: heat exhaustion, heatstroke, hypothermia, and frostbite. The objectives of this position stand are: 1) To educate distance running event officials and participants about the most common forms of environmental illness including predisposing conditions, warning signs, susceptibility, and incidence reduction. 2) To advise race officials of their legal responsibilities and potential liability with regard to event safety and injury prevention. 3) To recommend that race officials consult local weather archives and plan events at times likely to be of low environmental stress to minimize detrimental effects on participants. 4) To encourage race officials to warn participants about environmental stress on race day and its implications for heat and cold illness. 5) To inform race officials of preventive actions that may reduce debilitation and environmental illness. 6) To describe the personnel, equipment, and supplies necessary to reduce and treat cases of collapse and environmental illness.
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To characterize fully all the major and minor carotenoids and their metabolites in human retina and probe for the presence of the oxidative metabolites of lutein and zeaxanthin. Carotenoids of a composite of 58 pairs of human retinas and a monkey retina were elucidated by comparing their high-performance liquid chromatography (HPLC)-ultraviolet/visible absorption spectrophotometry (UV/Vis)-mass spectrometry (MS) profile with those of authentic standards prepared by organic synthesis. In addition to lutein and zeaxanthin, several oxidation products of these compounds were present in the extracts from human retina. A major carotenoid resulting from direct oxidation of lutein was identified as 3-hydroxy-beta, epsilon-caroten-3'-one. Minor carotenoids were identified as: 3'-epilutein, epsilon,epsilon-carotene-3,3'-diol, epsilon,epsilon-carotene-3,3'-dione, 3'-hydroxy-epsilon,epsilon-caroten-3-one, and 2,6-cyclolycopene-1,5-diol. Several of the geometric isomers of lutein and zeaxanthin were also detected at low concentrations. These were as follows: 9-cis-lutein, 9'-cislutein, 13-cis-lutein, 13'-cis-lutein, 9-cis-zeaxanthin, and 13-cis-zeaxanthin. Similar results were also obtained from HPLC analysis of a freshly dissected monkey retina. Lutein, zeaxanthin, 3'-epilutein, and 3-hydroxy-beta,epsilon-caroten-3'-one in human retina may be interconverted through a series of oxidation-reduction reactions similar to our earlier proposed metabolic transformation of these compounds in humans. The presence of the direct oxidation product of lutein and 3'-epilutein (metabolite of lutein and zeaxanthin) in human retina suggests that lutein and zeaxanthin may act as antioxidants to protect the macula against short-wavelength visible light. The proposed oxidative-reductive pathways for lutein and zeaxanthin in human retina, may therefore play an important role in prevention of age-related macular degeneration and cataracts.
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The overtraining syndrome affects mainly endurance athletes. It is a condition of chronic fatigue, underperformance, and an increased vulnerability to infection leading to recurrent infections. It is not yet known exactly how the stress of hard training and competition leads to the observed spectrum of symptoms. Psychological, endocrinogical, physiological, and immunological factors all play a role in the failure to recover from exercise. Careful monitoring of athletes and their response to training may help to prevent the overtraining syndrome. With a very careful exercise regimen and regeneration strategies, symptoms normally resolve in 6-12 weeks but may continue much longer or recur if athletes return to hard training too soon.
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Several studies found a benefit of long-chain polyunsaturated fatty acid (LCP) supplementation for visual or mental development, but others found no benefit. Likely contributors to differences among studies are the amount of LCP supplementation, functional outcomes, and sample size. We evaluated LCP supplementation in amounts typical for human milk (based on local and worldwide surveys) in a large cohort of infants by using sweep visual evoked potential (VEP) acuity as the functional outcome. The study was a double-masked, randomized, controlled clinical trial in 103 term infants. By age 5 d, infants were randomly assigned to receive either formula with no docosahexaenoic acid (DHA) or arachidonic acid (ARA) or formula supplemented with DHA and ARA as 0.36% and 0.72%, respectively, of total fatty acids. Sweep VEP acuity was the primary outcome. Random dot stereoacuity, blood lipid profile, growth, and tolerance were secondary outcomes. VEP acuity in the LCP-supplemented group was significantly better than that in the control group at ages 6, 17, 26, and 52 wk. Stereoacuity in the LCP-supplemented group was significantly better than that in the control group at age 17 wk but not at ages 39 and 52 wk. By ages 17 and 39 wk, the red blood cell DHA concentration in the LCP-supplemented group was more than double and more than triple, respectively, that in the control group. Growth of infants fed LCP-supplemented and control formulas did not differ significantly, and both diets were well tolerated. LCP supplementation of term infant formula during the first year of life yields clear differences in visual function and in total red blood cell lipid composition.
Article
Triathlon is a sport combining swimming, cycling, and running in one continuous event. It is a relatively new sport for children and adolescents, and participation is growing rapidly. The purpose of this statement is to provide pediatricians and others with information on the participation in triathlons by young athletes. A list of triathlon events is given in the 'Resources' section at the end of this statement.
Article
This Policy Statement was revised. See https://doi.org/10.1542/peds.2011-1664 For morphologic and physiologic reasons, exercising children do not adapt as effectively as adults when exposed to a high climatic heat stress. This may affect their performance and well-being, as well as increase the risk for heat-related illness. This policy statement summarizes approaches for the prevention of the detrimental effects of children's activity in hot or humid climates, including the prevention of exercise-induced dehydration.
Article
As sports participation increases so too does the incidence of injuries, both acute and overuse. The growing skeleton is particularly susceptible due to the presence of growth cartilage at 3 locations; the epiphyseal plate, the joint surface and the apophysis. The risk of injury is most pronounced during the rapid growth spurt of adolescence when other factors, such as muscle tightness across joints, also become important in the aetiology of sporting injury. Overuse injuries seen in this age group may reflect the growth characteristics of the immature skeleton or may be of the type seen in adult athletes undergoing rigorous training schedules. Recent developments in organised competitive sport have seen growing individuals undertake prolonged and intensive training programmes when they are particularly at risk of sustaining an overuse injury. The training programme is one of a number of risk factors important in the generation of injury, many of which can be modified or controlled to an extent. Other factors such as growth deformities or malalignments are peculiar to the individual and preparticipation evaluation of the young athlete helps to identify those at risk. Whilst long term disability rarely eventuates, the loss of enjoyment and temporary incapacity resulting from this type of injury is significant. It is apparent that many of these injuries are preventable, and given the information available concerning the factors involved in their aetiology, it is the responsibility of coaches and health professionals alike to become involved in their early diagnosis, treatment and prevention.
Article
The radiographic appearances are reported of chronic stress to the wrist joints of eight adolescent males, seven gymnasts and one roller skater. These consist of bilateral, asymmetrical widening and irregularity of the distal radial growth plates with an ill-defined cystic appearance, sclerosis and flaring of the metaphyses in all eight cases. Similar but less marked changes were present in the distal ulnar growth plates in five cases. The aetiology is thought to be that of a Salter Type I stress fracture of the growth plate due to chronic repetitive shear forces applied to the hyperextended wrist joint. Rapid healing of the stress fracture will occur with cessation of the sporting activity but continued strenuous use of the wrists will result in further widening and irregularity of the growth plate. The differential diagnosis of the radiographic appearances and previous literature are discussed.
Article
In addition to acting as an optical filter, macular (carotenoid) pigment has been hypothesized to function as an antioxidant in the human retina by inhibiting the peroxidation of long-chain polyunsaturated fatty acids. However, at its location of highest density in the inner (prereceptoral) layers of the foveal retina, a specific requirement for antioxidant protection would not be predicted. The purpose of this study was to determine whether lutein and zeaxanthin, the major carotenoids comprising the macular pigment, are present in rod outer segment (ROS) membranes where the concentration of long-chain polyunsaturated fatty acids, and susceptibility to oxidation, is highest. Retinas from human donor eyes were dissected to obtain two regions: an annular ring of 1.5- to 4-mm eccentricity representing the area centralis excluding the fovea (perifoveal retina) and the remaining retina outside this region (peripheral retina). ROS and residual (ROS-depleted) retinal membranes were isolated from these regions by differential centrifugation and their purity checked by polyacrylamide gel electrophoresis and fatty acid analysis. Lutein and zeaxanthin were analyzed by high-performance liquid chromatography and their concentrations expressed relative to membrane protein. Preparation of membranes and analysis of carotenoids were performed in parallel on bovine retinas for comparison to a nonprimate species. Carotenoid concentrations were also determined for retinal pigment epithelium harvested from human eyes. ROS membranes prepared from perifoveal and peripheral regions of human retina were found to be of high purity as indicated by the presence of a dense opsin band on protein gels. Fatty acid analysis of human ROS membranes showed a characteristic enrichment of docosahexaenoic acid relative to residual membranes. Membranes prepared from bovine retinas had protein profiles and fatty acid composition similar to those from human retinas. Carotenoid analysis showed that lutein and zeaxanthin were present in ROS and residual human retinal membranes. The combined concentration of lutein plus zeaxanthin was 70% higher in human ROS than in residual membranes. Lutein plus zeaxanthin in human ROS membranes was 2.7 times more concentrated in the perifoveal than the peripheral retinal region. Lutein and zeaxanthin were consistently detected in human retinal pigment epithelium at relatively low concentrations. The presence of lutein and zeaxanthin in human ROS membranes raises the possibility that they function as antioxidants in this cell compartment. The finding of a higher concentration of these carotenoids in ROS of the perifoveal retina lends support to their proposed protective role in age-related macular degeneration.
Article
Chronic musculoskeletal pain is becoming increasingly common in young athletes. When these athletes do not respond well to standard treatments, for example physical theraphy and anti-inflammatories, other diagnoses must be considered, such as reflex sympathetic dystrophy, fibromyalgia, and/or overtraining syndrome.
Article
In humans, as in plants, the xanthophyll lutein is believed to function in two important ways: first as a filter of high energy blue light, and second as an antioxidant that quenches and scavenges photo induced reactive oxygen species (ROS). Evidence suggests that lutein consumption is inversely related to eye diseases such as age-related macular degeneration (AMD) and cataracts. This is supported by the finding that lutein (and a stereo isomer, zeaxanthin) are deposited in the lens and the macula lutea, an area of the retina responsible for central and high acuity vision. Human intervention studies show that lutein supplementation results in increased macular pigment and improved vision in patients with AMD and other ocular diseases. Lutein may also serve to protect skin from UV-induced damage and may help reduce the risk of cardiovascular disease. Crystalline lutein is readily absorbed from foods and from dietary supplements whereas, to enter the bloodstream, lutein esters require prior de-esterification by intestinal enzymes. Unlike the hydrocarbon carotenoids which are mainly found in the LDL fraction, xanthophylls like lutein and zeaxanthin are incorporated into both HDL and LDL. Today, lutein can be obtained from the diet in several different ways, including via supplements, and most recently in functional foods. Animal toxicology studies have been performed to established lutein's safety as a nutrient. These studies have contributed to the classification of purified crystalline lutein as generally recognized as safe (GRAS). The achievement of GRAS status for purified crystalline lutein allows for the addition of this form into several food and beverage applications. This achievement speaks directly to the quality and safety of purified lutein.
Article
Committee on Sports Medicine and Fitness; International Marathon Medical Directors Association. Children and marathoning: how young is too young?
  • Rice Sg
  • Waniewski
Rice SG, Waniewski S; American Academy of Pediatrics, Committee on Sports Medicine and Fitness; International Marathon Medical Directors Association. Children and marathoning: how young is too young? Clin J Sport Med. 2003;13:369 –373
Available at: www.usatriathlon.org/AthleteFocus/Junior.aspx. Accessed
  • Usa Triathlon
  • Juniors
. USA Triathlon. Juniors. Available at: www.usatriathlon.org/ AthleteFocus/Junior.aspx. Accessed March 30, 2006
Committee of Sports Medicine and Fitness. Intensive training and sports specialization in young athletes
Committee of Sports Medicine and Fitness. Triathlon participation by children and adolescents
Committee on Sports Medicine and Fitness. Risks in distance running for children