Young Athletes

More young people enjoy sports than ever before. Athletic participation has increased in grade schools, high schools and community programs.

Young athletes have special needs. Because their bodies are growing, they often require different coaching, conditioning, and medical care than more mature athletes. It is important to examine the special requirements of young athletes to better prepare them for the competitive pressures and physical injuries that can come with increased sports activity.

Statistics demonstrate the increased popularity of sports among young people. Fifty percent of boys and 25 percent of girls between the ages of eight and 16 compete in an organized sports program sometime during the year. Three-fourths of junior high schools and middle schools have competitive interscholastic sports programs. At the high school level, there are 32 male and 27 female competitive sports with 7,000,000 high school students participating. Beyond organized sports programs, millions more compete and participate in physical education classes, church and community intramural programs, and other recreational athletic activities.

A host of factors has contributed to the awakening of interest in health, conditioning and sports. The media impact on youth has elevated talented college and professional athletes to heroic levels. The multimedia message on these sports heroes may confuse young athletes by creating unrealistic expectations. The early return to competition by professional athletes following an injury creates the impression that athletes often heal faster than the rest of us. However, peer pressure and the economic and social forces exerted on school coaches to win may lead to decisions that are not truly in the best interests of a child’s health, growth and development.

Young athletes are different

The growing athlete is not merely a smaller version of the adult. There are marked differences in coordination, strength and stamina between a youth and an adult. In young athletes, bone-tendon-muscle units, growth areas within bones, and ligaments experience uneven growth patterns, leaving them susceptible to injury.

Increases in body size may be due to fat and not muscle, causing marked differences in strength. Too often unfair competition occurs between boys of 100 pounds of baby fat and peach fuzz versus 200 pounds of muscle and mustache.

Grade school students are less likely to suffer from severe injury because they are smaller and slower than older athletes; when they collide or fall, the forces on their musculoskeletal system are usually not high enough to cause injury. On the other hand, high school athletes are bigger, faster, stronger and capable of delivering tremendous forces in contact sports.

Coaches bear a prime responsibility in developing their young athletes and watching for early signs of physical problems (such as pain or limp). They often recognize severe injuries because their athletes show signs of pain and can’t continue playing.

Coaches may have more difficulty spotting less severe injuries, however, because the pain is low grade and the athlete often ignores it. Repeat injuries may turn into overuse conditions which can put the athlete on the sidelines for the rest of the season.

Many sports injuries in young athletes, particularly elbow and knee injuries, are caused by excessive, repetitive stress on immature muscle-bone units. Such repetitive overuse can cause fractures, muscle tears or bone deformity Fortunately, such injuries are uncommon, and usually prolonged pain is an early warning sign.

Coaches, parents and players should provide protection for the young athlete through proper conditioning, prompt treatment of injuries and rehabilitation programs. Conditioning programs usually strive to make the young athlete “physically fit” by improving muscle strength, endurance, flexibility, and cardiorespiratory fitness.

The coaches and parents also are responsible for creating a psychological atmosphere that fosters self-reliance, confidence, cooperation, trust and a positive self-image. Young athletes must learn to deal with success and defeat in order to place events in a proper perspective. Some coaches and parents go too far in analyzing player performance. The promotion of the “win at all costs” ethic has both short-term and long-term detrimental effects on impressionable young people.

Soft tissue injuries

Fortunately major sports-related injuries are rare in young people. About 95% of sports injuries are due to minor trauma involving soft tissues-bruises, muscle pulls, sprains (ligaments), strains (muscles and tendons), and cuts or abrasions. Little sports time is lost from these injuries. Moreover, sports injuries occur more frequently in physical education classes and free-play sports than in organized team sports. Minimal safety precautions and supervision can prevent many injuries.

Sprains

Almost one-third of all sports injuries are classified as sprains. A sprain is a partial or complete tear of a ligament, which is a tough band of fibrous connective tissue that connects the ends of bones and stabilizes the joint. Symptoms include the feeling that a joint is “loose” or unstable; an inability to bear weight because of pain; loss of motion; the sound or feeling of a “pop” or “snap” when the injury occurred, and swelling. Not all sprains produce pain, however.

Strains

A strain is a partial or complete tear of a muscle or tendon. Muscle tissue is made up of cells that contract and make the body move. A tendon consists of tough connective tissue that attaches muscles to bones.

Contusions

The most common sports injury contusions (bruises) rarely cause a student athlete to be sidelined. Bruises result when a blunt injury causes underlying bleeding in a muscle or other soft tissues.

Prompt treatment for soft tissue injuries usually consists of rest, applying ice, wrapping with elastic bandages (compression), and elevating the injured arm, hand, leg or foot. This usually limits discomfort and reduces healing time. Proper first aid will minimize swelling and help the physician establish an accurate diagnosis.

Spinal cord injuries

Although spinal cord injuries in sports are rare, ten percent of all spinal injuries occur during sports, primarily diving, surfing and football. They can range from a sprain to paralysis in the arms and legs (quadriplegia) to death. Participants in contact sports can minimize the risk of minor neck spinal injuries-sprains and pinched nerves-by doing exercises to strengthen their neck muscles.

Skeletal injuries

A sudden, violent collision with another player, an accident with sports equipment or a severe fall can cause skeletal injuries in the growing athlete, including fractures.

Fractures constitute a low five to six percent of all sports injuries. Most of these breaks occur in the arms and legs. Rarely are the spine and skull fractured.

More common, however, are stress fractures and ligament-bone disruptions that occur because of continuing overuse of a joint. The main symptom of a stress fracture is pain. Frequently, initial x-rays do not show any signs of a stress fracture so the athlete is permitted to return to the same activity. Unfortunately the pain often returns or continues, but the athlete keeps playing. The most frequent places stress fractures occur are the tibia (the larger leg bone below the knee), fibula (the outer and thinner leg bone below the knee), and foot.

“Little League elbow” can result when a pitcher’s repetitive throwing puts too much pressure on the elbow bone’s growth centers. This painful condition results from overusage of muscles and tendons or from an injury to the cartilage surfaces in the elbow.

In the growing athlete’s musculoskeletal system, pain from repetitive motion may appear somewhere besides the actual site of the injury. For instance, a knee ache in a child or adolescent may actually be pain caused by an injury to the hip.

Diagnosis and treatment

Diagnosis of any sports-related orthopaedic injury should be made promptly by orthopaedic surgeons, physicians who specialize in the care of the musculoskeletal system. The physician usually will ask the young athlete how the injury occurred, then follow with questions about the type of pain-whether it is a stabbing pain, a dull ache or throbbing-the location of the pain, and the sport in which the athlete was involved.

During the physical examination, the orthopaedist will ask the athlete to move the affected area to determine whether the child’s motion has been affected. The orthopaedist will gently touch the area to observe for obvious skeletal abnormalities. X-rays or other radiographic tests may be ordered, depending on the athlete’s condition and the doctor’s need for additional information.

Orthopaedic surgeons have been in the forefront of treating musculoskeletal system injuries and have a long tradition of caring for young athletes. In the last two decades, they have analyzed and clarified young athletes’ psychological needs, conditioning, training, and susceptibility to physical injury. They provide early and comprehensive care of orthopaedic injuries. This can help young athletes heal and return to competition with less chance of repeated injury.

Treatment varies according to the patient’s condition, but it may include bed rest, elevation, compression bandages, crutches, cast immobilization or physical therapy.

Female athletes

Female involvement in sports has increased tremendously at the high school level-by 700% over the last 15 years. Although early studies indicated that female athletes needed to train at lower levels of intensity than male athletes, it appears that this was more a social than a physiological problem. Today’s female athlete is able to train and frequently compete at levels that rival many of the best male athletes. Although there are differences in performance that are sex-related, athletic injuries are related more to the player’s sport than sex.

Risk and benefits

Sports activity by young people is generally safe with low risks and high benefits. The major goal should be enjoyable participation. Exposure to competitive and noncompetitive sports encourages the development of fitness, motor skills, social skills and life-long appreciation for sports.

Your orthopaedist is a medical doctor with extensive training in the diagnosis, and non-surgical and surgical treatment of the musculoskeletal system, including bones, joints, ligaments, tendons, muscles and nerves.


This brochure has been prepared by the American Academy of Orthopaedic Surgeons and is intended to contain current information on the subject from recognized authorities. However, it does not represent official policy of the Academy and its text should not be construed as excluding other acceptable viewpoints.

February 2002

> Child Athlete Overview

> Children’s Responses to Exercise in Cold Climates: Health Implications

> Children’s Responses to Exercise in Hot Climates: Health & Performance Implications

> Child Athlete Nutrition

> Nutritional Needs of Youth in Sport

> Food Guide Pyramid

> Understanding Children’s Physical Abilities

> Play It Safe Sports

> Stretching Exercises for Young Athletes


Important Tips

Isometric stretching is NOT recommended for children and adolescents whose bones are still growing. These people are usually already flexible enough that the strong stretches produced by the isometric contraction have a much higher risk of damaging tendons and connective tissue. (See the Stretching section.)