More than ever, children and adolescents are enjoying the health and social benefits of participating in organized sport. Yet many observers have noted problems related to over-competitiveness and unrealistic expectations, while sport medicine physicians have seen alarming increases in sport-related injuries in young athletes. The November/December issue of the Clinical Journal of Sport Medicine is a special Thematic Issue providing expert viewpoints on injuries to children in sport.
Although many commentators have voiced concerns about the pressures placed on young athletes by parents, coaches, and other adults, "no one seems to be backing down," according to Drs. Thomas M. Best, Willem van Mechelen, and Evert Verhagen, Guest Editors of the Thematic Issue. Even more disturbing is the trend toward increased overuse injuries in young athletes, which reflects a wide range of causative factors and may contribute to the growing number of children who drop out of sport by the eighth grade. "Although the scope of the injury problem and drop-out rate in the pediatric athlete is broad, we have tried to bring together expert views on what we feel to be some of the most important current problems and issues regarding injuries in the pediatric athlete," the Editors write.
Several articles in the Thematic Issue highlight the challenges of sport-related injuries in young athletes. For example, disruption of the anterior cruciate ligament (ACL) of the knee is a severe injury that is increasingly common in children and teens. A review draws attention to the lack of scientific data regarding the management of ACL injuries in young athletes: while nonsurgical treatment may lead to knee instability and further injuries, surgery may damage the still-growing skeleton. Injuries to the joint cartilage pose similar questions, although studies have reported promising results with a procedure called autologous chondrocyte implantation.
One paper lends insight into the factors involved in shoulder injuries in "overhead" athletes, such as baseball and tennis players. Another reports that, with proper supervision, weightlifting and strength training are safe and improve performance in children and teens. However, questions remain about the safe "dose-response range"óthat is, what training intensity produces good results without undue risk of injury.
A comprehensive review finds good evidence on the risk factors for injuries in some sports, such as soccer, football, and basketball, but less so for other sports. Another article points out the high incidence and severity of injuries in certain sports: notably including ice hockey and rugby in boys, basketball and gymnastics in girls, and soccer in both sexes. The authors emphasize the need for further studies of incidence and risk factors to help develop effective strategies to prevent injuries.
One study analyzes various approaches to reducing the risk of sport-related injuries, including personal countermeasures, behavioral interventions, and environmental modifications. The authors propose a "responsibility hierarchy" for injury prevention, with government and sport organizations taking the lead role, supported by coaches, teachers, and parents.
The final paper is a study of support versus pressure placed on young soccer players by parents and coaches. The results suggest that a "supportive, mastery-oriented" approach by coaches helps young athletes derive the greatest social benefit from sport participation. The benefits are fewer when athletes feel "pressure to excel" from coaches and parents.
The eight papers in the special issue "clearly illustrate that the pediatric athlete is at risk for injury, that the etiology and treatment of pediatric injuries differs from adult athletes, and that there are black holes within our knowledge of how to deal with these problems," the Editors conclude. However, "the benefits of sport and physical activity still outweigh the vast majority of these challenges we face today," the Editors conclude. Nevertheless, we hope this special issue is food for thought and may be an initiation for future studies leading to safer participation in sports from childhood through adult life."