Sports medicine in youth athletes.

Annotation: These capsuled thoughts from Richard Gross, MD, a long-standing devotee of and writer about youth sports and youth sports injuries, points up the increasing attention to and the importance of the physical and psychosocial problems of the youth athlete.

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When one thinks about the current interest among parents about youth sports injuries, it is hard to believe that this topic was of essentially no interest until the current generation. It was not that long ago that the major health concerns of children were related to child labor or deaths from infectious disease. Youth sports did not have their onset until the early 20th century; and youth sports programs were quite modest until the 1970s. Even since that time, change has occurred. A recent newspaper article related that parents of today's youngsters started playing organized sports at about age 12. Today's children start at about age 6.

Parents of youth sports participants often inquire about the risk of injury. There are a few helpful principles to consider when responding, and I will spend the rest of this paper addressing what has been useful for me when responding.

The musculoskeletal system undergoes continuous change throughout childhood, affecting the risk and character of injuries sustained at different ages. The young child's epiphysis is largely cartilaginous, with progressive ossification of the secondary growth center. The growth plate becomes the weakest portion of the bone in later childhood, and physeal fractures occur with greater frequency. The younger bone is more elastic, so greater amounts of elastic deformation can occur before the young bone fails mechanically. When failure does occur, greenstick fractures, which do not occur in adults, are common. Muscular and ligamentous insertions into these immature bones are also elastic, thus strains and sprains in younger children are almost nonexistent.

Children in the United States are now entering organized sports programs before age 6, and most continue in programs through mid-childhood. Participation then drops off around age 12. At that time, less talented and/or less interested players often choose other activities.

Children under age 12 have a relatively low injury rate in sports. Permanent sequelae of injury are rare. The musculoskeletal system is still somewhat elastic. The pace of play is less than that of the high school or junior high school level.

The rise in the sports injury rate after age 12 parallels the injury rate for children in general; a very steep rise in injury rate for boys and a less steep rise for girls. Girls have a higher rate of knee ligament injuries in basketball and soccer. The difference in boys' and girls' high school injury rates is largely due to the number of football and wrestling injuries among boys. Anatomic factors include:

* Final closure of the growth plates, with injury stresses then concentrated on the joint.

* Greater muscular strength and velocity.

* Generating greater speed and power while playing.

Play is also more aggressive at this age than in younger children. One has only to compare 9 to 10 year olds with 14 to 18 year olds in a soccer match or a football game.

The literature of youth sports injuries is voluminous. Reports are accessible on any specific sport, from bicycling to skateboarding to wrestling. Further information is available based on sex, age, and rural or urban settings.

Injuries sustained by younger players are generally contusions or falls, with the distal radius being the most common site of fracture. Treatment is usually straightforward. As players mature, the range of injuries becomes more complex. Overuse injuries are more and more prevalent in the newly active or totally committed athlete. The care of school age athletes is uneven, with more affluent urban areas better served than rural or inner city schools.

The opportunity is there for interested primary care physicians to care for the youth athlete. It is not possible in a short paper to provide any more than the general principles mentioned above, but organizations such as the Southern Medical Association and the American Academy of Pediatrics regularly have postgraduate programs on caring for the young athlete. Those of us who do care for young athletes find it to be a rewarding part of our practice.

Accepted May 21, 2004.

Richard H. Gross, MD

From the Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, SC.

Reprint requests to Richard H. Gross, MD, Department of Orthopaedic Surgery, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29425. Email: [e-mail]