Curbside Consult

A Healthy Medium in Children's Sports

Bert R. Mandelbaum, MD, DHL (Hon)


August 09, 2017

As summer turns to fall, I'm bracing myself for the annual parade of injured children. It's the time of year when practices for school sports resume. Often young athletes have lost their conditioning. Their overused muscles and tendons tear, their bones break, and they end up in my office. But I worry just as much about the ones I don't see.

In the United States, we divide into two extremes. Most people are getting too little exercise. The resultant epidemics of diabetes,[1] cardiovascular disease[2] and sarcopenia[3] shorten lives, cost us billions of dollars, and cause immeasurable misery. Meanwhile, another proportion of the population, particularly youngsters, train too hard, pushing to the breaking point.

As sports physicians, we must take a lead role in helping our patients and their families find a path between these poles.

I often begin that conversation with the perspective of evolution. What attracts us to sport? In prehistoric times, we evolved from being prey to hunter. Those of our ancestors who developed the strength and stamina to hunt for 3 hours at a time could feed themselves and their families. They could pass their genes and epigenetic messages to the next generation as Darwinian fittest survivors.

Our bodies adapted to a life of movement, and every system within them—musculoskeletal, cardiovascular, nervous—all benefit from exercise. And we feel it. Exercise stimulates the production of neurotransmitters such as endorphins that improve our moods.

Children who exercise develop stronger bones and are less likely to become obese or suffer from diabetes and heart disease later in life.[4] They perform better in school.[5,6] They feel less depression[7] and have higher self-esteem[5,7] and lower risk for attention-deficit disorder.[8]

Competing at Top levels

But too often children and their parents fixate on external tokens of success. They see sports in terms of success or failure rather than as a process involving struggle, challenge, and adaptation. Often these are the children who play soccer or baseball year-round. These are the young swimmers and gymnasts who practice their sports more than 24 hours a week. Play has become difficult and grueling work for them.

As sports physicians, we can help young athletes and their parents achieve balance and control. I'm not saying that no athlete should pursue competitive sports; helping these elite athletes is a big part of what I do.

We know that if you take children with great potential and match them with high-level coaches at an early age, they can become facile at the highest level. But it takes a professional coach and sports medicine team to understand the component parts necessary for that young athlete in each respective sport.

I'm not just thinking of the problem of the 5'6", 125-pound football player, or the 6'2" 250-pound gymnast. In the game of soccer, foot speed is critical. It takes a trained eye to recognize that quality. Basketball players have to show a combination of speed, jumping ability, and eye-hand coordination. Football players need both strength and power.

For young athletes with the capacity to compete at the top levels, the sports medicine physician can help bring together the professionals who understand the nuances of preparation at all phases. Gymnasts whose gyms don't have the highest level of competition can still succeed if they work with professional coaches and trainers who understand the aspects of nutrition, exercise physiology, and strength and neuromuscular training specific to gymnastics.

This support team must also understand the athlete's stage of puberty. The risk for injury is especially high when the growth plates are open. The pain that athletes experience at this stage may not be a symptom of pathology but rather a warning from the physes that the athlete is overusing the joint.

The Young Athlete's Aspirations

Even those youngsters with all of the requisite physical gifts will not become elite athletes if they don't feel passionate about reaching that goal. They'll need tremendous drive to persevere through the pain and setbacks ahead.

Ask yourself whether the children in your care are the types whose biggest dreams are to become the next LeBron James or Venus Williams. Do they fall asleep thinking of that? Do they wake up asking, "What's next? When's the next camp? Who's the best coach?" Or is all of this someone else's plan for them? Often it's the parent whose unrealistic expectations push the child too far, causing frustration, anxiety, and stress. On the Westside of Los Angeles we joke that there are only two kinds of kids: geniuses and the learning disabled. That dichotomy pervades sports as well. Some children will exaggerate injuries simply to get off a ship that's not leading in a direction they want to go.

Once they realize that they're not going to make the national team, too many kids give up altogether. Here the sports medicine doctor must intervene as a teacher, coach, and adviser. Our job is not just to fix fractures and tears, but to inspire our patient to a long life of fitness and wellness. We can guide our patients to the discovery that exercise can be fun and can make them healthier, stronger, and happier, and that these benefits can last a lifetime.

Our highest calling is to inspire.


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