Medscape Orthopaedics & Sports Medicine eJourn. 2001;5(2) 

In This Article


The past decade has witnessed an explosion in the number of children participating in sports as more intense training sessions expose young athletes to a changing pattern of potential injuries. In the United Kingdom, approximately 75% of all healthy children between the ages of 5 and 15 years participate in organized sports.[1,2] Only 11% of them are involved in intensive training, however, and only a fraction will require treatment for sports-related injuries. Still, large numbers of overuse injuries are seen at many clinics.

Children grow and mature at different rates, but they are usually matched in competition by chronological age, which can cause striking differences in size, height, and weight, especially near puberty. These mismatches are a major risk for physical and psychological injuries. Although some sports, such as wrestling and boxing, group athletes according to weight classes, this is uncommon. Several classification schemes, including genital maturity measurements and grip strength, have been proposed to match more evenly these athletes, but none are widely accepted or used, so the risk remains.

The effects of psychological immaturity on injury risk in children have been poorly investigated, and no reliable data exist. However, studying young ice hockey players, Reid and Loseck[3] found that some athletic children may perceive themselves not at risk of injury and may play in a haphazard fashion, possibly not using appropriate protective gear.

Most injuries in children's sports are minor and self-limiting, suggesting that youth sports are safe. However, a child's skeletal system demonstrates pronounced adaptive changes after intensive sports training, and sports injuries, which affect both growing bone and soft tissues, can lead to impairment of growth mechanisms and permanent damage. Physiological loading is beneficial to the young skeleton, but excessive strains may result in serious injury to weight-bearing joint surfaces. In young athletes, given the stiffness characteristics of their bones, sudden overload may cause bones to bow or buckle. Epiphyseal injuries are usually due to shearing and avulsion forces, although compression also plays a significant role. Epiphyseal injuries are obviously unique to this age group, and damage to the growth plate can produce permanent effects, with progressive deformity and degenerative joint disease. On the other hand, in the diaphysis and metaphysis, given the remarkable healing potential of bone in young patients, fractures that initially unite with some deformity can later completely remodel normally. Because the risk of injuries sustained by young athletes can be significant, it is essential that training programs take into account children's physical and psychological immaturity so that growing athletes can adjust to their own body changes.

At the American College of Sports Medicine's 47th annual meeting in Indianapolis, Indiana, David Hawkins, MD, of the University of California, Irvine, chaired a symposium on the biomechanics of musculoskeletal injuries in young athletes. Participants included the following:


  • Deborah Aaron of the University of Pittsburgh, Pittsburgh, Pennsylvania, who discussed the epidemiology of musculoskeletal injuries in young athletes.

  • James Renwick of the University of Virginia, Charlottesville, who spoke on the physiology of musculoskeletal growth and development.

  • Thomas Best of the University of Wisconsin, Madison, who presented data and an overview on the mechanism of muscle tendon injuries healing in young athletes.

  • Jack Andrish of the Cleveland Clinic Foundation, Cleveland, Ohio, who spoke about strategies for treating musculoskeletal injuries in athletes.

  • Lyle Micheli of the Children's Hospital in Boston, Massachusetts, who spoke about overuse injuries in young athletes.



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