CHILDREN IN SPORTS

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CHILDREN IN SPORTS

• PANOS THOMAS

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OBJECTIVES

• - GROWTH AND MATURATION
• - PHYSIOLOGICAL DIFFERENCES
• - NUTRITIONAL CONSIDERATIONS
• - PSYCHOLOGICAL CONSIDERATIONS
• - THE IMMATURE MUSCULOSKELETAL SYSTEM

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OBJECTIVES

• - ACUTE SPORTING INJURIES
• - OVERUSE INJURIES
• - CHRONIC CHILDHOOD ILLNESS
• - ACUTE ILLNESS AND SPORTS PARTICIPATION
• - PRE-PARTICIPATION HEALTH EVALUATION
• - INJURY PREVENTION

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GROWTH AND MATURATION

• 1) VARIABILITY IN THE PHYSICAL GROWTH OF 6 YEARS
• 2) PEAK HEIGHT VELOCITY ( PHV )
• 3) 12 YEAR OLD SIGNIFICANT DIFFERENT HEIGHT,
  MUSCULAR STRENGTH, CARDIOVASCULAR FITNESS LEVELS
• 4) NO REASON TO SEGREGATE SEXES UP TO 14 YEARS OLD

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PHYSIOLOGICAL DIFFERENCES

• 1) AEROBIC POWER
• - MAX.AEROBIC POWER THE SAME WITH ADULTS (
  ENDURANCE )
• - METABOLIC COST OF WALKING AND RUNNING HIGHER (
  TRAINING )

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PHYSIOLOGICAL DIFFERENCES

• 2) ANAEROBIC POWER
• - SIGNIFICANT LOWER IN CHILDREN
• ( SHORT TERM POWER OUTPUT )
• - IMPROVING WITH GROWTH
• - IN GIRLS LITTLE CHANGE AFTER 12 YEARS OLD
• - CHILDREN LESS USE OF GLYCOGEN, LESS ABLE TO
  REDUCE PH

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PHYSIOLOGICAL DIFFERENCES

• 3) CARDIOVASCULAR SYSTEM
• - CHILDREN HIGHER MAXIMAL HEART RATE
• - LOWER STROKE VOLUME
• - LOWER SYSTOLIC BLOOD PRESSURE
• - BETTER PERIFERAL BLOOD FLOW ADJUSTMENT TO SPORT

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PHYSIOLOGICAL DIFFERENCES

• 4) RESPIRATORY SYSTEM
• - CHILDREN SHALLOW BREATHING PATTERN RESULTING
  IN LOWER ABSORPTION OF OXYGEN FROM INSPIRATION
• HIGHER RESPIRATORY FREQUENCY RESULTING IN GREATER
  OXYGEN COST IN RESPIRATION

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PHYSIOLOGICAL DIFFERENCES

• 5) EXERCISE IN HOT AND COLD ENVIRONMENTS
• CHILDREN VUNERABLE RATIO OF SURFACE AREA TO
  VOLUME 30-40 HIGHER THAN ADULTS RESULTING IN
  FASTER INCREASE OR LOOSING BODY HEAT SWEATING
  MECHANISM IS FULLY OPERATIVE AFTER ADOLESCENT
  GROWTH SPURT - DEHYDRATION

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NUTRITIONAL CONSIDERATIONS

• 1) ADOLESCENT GROWTH SPURT
• 2) IRREGULAR EATING HABITS ( SNACKS,MISSING LUNCH
  ETC )
• 3) CALCIUM, FOLIC ACID, ZINC, IRON,VITAMINS
  A,B6,C
• 4) DIETARY MANIPULATION, EATING DISORDERS

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PSYCHOLOGICAL CONSIDERATIONS

• 1) CHILDHOOD PLAY IMPORTANT FOR SPORT ( FIRST 7
  YEARS OF LIFE)
• - BALANCE AND CO-ORDINATION
• - PROPREOCEPTION ( POSITION SENSE )
• - PRAXIS ( SPATIAL AWARENESS )

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PSYCHOLOGICAL CONSIDERATIONS

• 2) REWARDS OF PHYSICAL ACTIVITY
• SELF ESTEEM AND ADMIRATION
• 3) SPORTS VERSUS PLAY ( AFTER 6 YEARS OLD ) GROUP
  GAMES, RULES OF GAMES, GOAL GAMES
• PREPARATION AND FEELINGS OF GAME SPORTS

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PSYCHOLOGICAL CONSIDERATIONS

• 4) PSYCHOLOGICAL COSTS OF SPORTS
• EFFORT OVER OUTCOME
• MODELLING EFFECT

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THE IMMATURE MUSCULOSKELETAL SYSTEM

• 1) PRESENCE OF GROWTH CARTILAGE IN SKELETON
• A) ARTICULAR SURFACES
• B) EPIPHYSEAL PLATES, APOPHYSEAL INSERTIONS

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THE IMMATURE MUSCULOSKELETAL SYSTEM

• 2) EFFECTS OF EXERCISE
• INTENSIVE PROGRAMMES LEAD TO BONY DEFORMATION
• HEAVY PHYSICAL TRAINING LEADS TO LONGER
  PREPUBERTAL STATE IN GIRLS
• SPECIAL INTENSIVE TRAINING LEADS TO STRENGTH
  IMBALANCE SHOULDER

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THE IMMATURE MUSCULOSKELETAL SYSTEM

• 3) FACTORS ASSOCIATED WITH INCIDENCE OF SPORT
  INJURIES
• EPIDEMIOLOGY 3 INJURIES PER 100 CHILDREN PER
  YEAR
• 0.69 SERIOUS INJURIES PER YEAR
• PEAK FOR BOYS 14 YEARS OLD
• GIRLS 15 YEARS OLD

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THE IMMATURE MUSCULOSKELETAL SYSTEM

• - INCOMPLETE RECOVERY FROM INJURY 30
• FOUL OR ILLEGAL PLAY 13
• OVERUSE INJURIES 50
• - COMPETITION 35 OF INJURIES
• - RUGBY LEAGUE 32,SOCCER, RUGBY UNION 11,
  MARTIAL ARTS, HORSE RIDING 2 SAFEST
• SPRAIN ANKLE 45. 30 MEDICAL ATTENTION, 11
  HOSPITALIZED, 12 LONG TERM DYSFUNCTION

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ACUTE SPORTING INJURIES

• 1) HEAD AND NECK VERY RARE BELOW 11 YRS
• 1-5 OF ALL SPORT INJURIES SERIOUS CNS DAMAGE
• 2) DIAPHYSEAL FRACTURES
• 3) GROWTH PLATE INJURY SALTER-HARRIS
  CLASSIFICATION
• 4) AVULSION FRACTURE OF ACL
• 5) AVULSION FRACTURE MUSCLE GROUPS
• 6) SUFE 30 SUDDENLY, 70 GRADUAL

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OVERUSE INJURIES

• 1) OSTEOCHONDROSES
• 2) STRESS FRACTURES SUDDEN INCREASE IN TRAINING
  INTENSITY
• X-RAYS OR BONE SCANS
• NAVICULAR, PARS-INTERARTICULARIS, FEMORAL NECK
• 3) MALALIGNMENT SYNDROMES
• TARSAL COALITIONS ( PERONEI TENDINITIS )

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OVERUSE INJURIES

• 1) OSTEOCHONDROSES
• SELF-LIMITED,IDIOPATHIC, DEVELOPEMENTAL
  DISORDERS OF PRIMARY OR SECONDARY OSSIFICATION
  CENTRES
• - TRACTION OSTEOCHONDRITIS (APOPHYSITIS )
  OSGOOD-SCHLATTERS, SINDING-LARSEN-JOHANSSON,
  SEVERS

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OVERUSE INJURIES

• 1) OSTEOCHONDROSES
• - ARTICULAR SUBCHONDRAL ( CRUSHING )
• PERTHES DISEASE (FEMORAL HEAD)
• KIEBOCKS DISEASE ( LUNATE )
• KOHLERS DISEASE ( NAVICULAR )
• FREIBERGS DISEASE ( 2ND METAT.)

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OVERUSE INJURIES

• ARTICULAR CHONDRAL (SPLITTING)
• OSTEOCHONDRITIS DISSECANS ( FEMUR,CAPITELUM,TALAR)
  
• PHYSEAL SCHEURMANNS (THORACIC SPINE )
• BLOUNTS ( TIBIA )

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CHRONIC CHILDHOOD ILLNESS

• 1) ASTHMA EXERCISE INDUCED BRONCHSPASM ( EIB)
• EXERCISE INDUCED ASTHMA ( EIA )
• 2) DIABETES INCREASED FATIGUE, ABNORMAL THIRST,
  FREQ.URINARY,WEIGHT LOSS
• 3) EPILEPSY ( PETIT MAL, TEMPORAL LOBE, GRAND MAL
  )

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CHRONIC CHILDHOOD ILLNESS

• 4) CYSTIC FIBROSIS ( GENERAL EXOCRCINE GLAND
  DYSFUNCTION )
• CHRONIC RECURRENT SINUS AND RESPIRATORY TRACT
  INFECTIONS
• DIGESTIVE TRACT DISORDERS AND MALNUTRITION
• SWIMMING OF PARTICULAR BENEFIT IN BRONCHOSPASM
  HYGIENE

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CHRONIC CHILDHOOD ILLNESS

• 5) HYPERTENSION
• (?) CAUSES, PRIMARY OR SECONDARY
• SPORTS BENEFICIAL FOR PRIMARY HYPERTENSION
• AVOIDANCE IN PRIMARY ISOMETRIC ACTIVITIES WEIGHT
  LIFTING, WRESTLING, ICE-SKATING

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CHRONIC CHILDHOOD ILLNESS

• 6) HEART DISEASE CONGENITAL HEART DISEASE IN
  5/1000 SCHOOL AGED CHILDREN. RHEUMATIC HEART
  DISEASE 1/1000, VALVULAR DAMAGE
• CARDIOMYOPATHY, MYOPATHY, HEREDITARY SYNDROME
  0.8/1000
• RHYTHM SIGNIFICANT DISORDER 0.7/1000
• CONGENITAL CORONARY ANOMALIES 2/100.000 CHILDREN

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CHRONIC CHILDHOOD ILLNESS

• 6) HEART DISEASE
• - CARDIAC CONDITIONS ASSOCIATED COMMONLY WITH
  SUDDEN DEATH IN SPORT ACTIVITIES
• AORTIC STENOSIS, TETRALOGY OF FALLOT,
  HYPERTROPHIC CARDIOMYOPATHY, PULMONARY
  HYPERTENSION, MYOCARDITIS

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CHRONIC CHILDHOOD ILLNESS

• - CARDIAC CONDITIONS ASSOCIATED WITH SUDDEN DEATH
  IN YOUNG ATHLETES
• HYPERTROPHIC CARDIOMYOPATHY, ABERRANT LEFT
  CORONARY ARTERY, AORTIC DISSECTION ( MARFANS
  SYNDROME ) CORONARY ARTERY DISEASE

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ACUTE ILLNESS AND SPORT PARTICIPATION

• 1) INFECTIONS MONONUCLEOSIS
• ( GLANDULAR FEVER )
• - SELF-LIMITED ACUTE VIRAL ILLNESS
• - 90 INFECTED BY 30 YEAR OLDS
• - PEAK IS 15-25 YEARS OLD
• - EPSTEIN-BARR VIRUS (EBV)
• - DIAGNOSIS FROM POSITIVE HETEROPHILE ANTIBODY
  TEST (MONOSPOT)

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ACUTE ILLNESS AND SPORT PARTICIPATION

• - ENLARGED SPLEEN 40-60, RUPTURE 0.1 0.2
• - 4 WEEKS ABSENCE, SYMPTOMS CAN LAST UP TO 6
  MONTHS
• 2) OTHER ACUTE ILLNESSES HAEM.STREPTOCOCCUS,
  MYCOPLASMA PNEUMONIA, SIMPLE HERPES, TINEA PEDIS

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PRE-PARTICIPATION HEALTH EVALUATION

• HISTORY TAKING, PHYSICAL EXAMINATION,
  INVESTIGATIONS, ANTHROPOMETRIC MEASUREMENT
• - CONDITIONS REQUIRING FURTHER EVALUATION AND
  POSSIBLE DISQUALIFICATION FROM SPORT
• 1) UNRESOLVED ORGANIC HEART DISEASE
• 2) SUSTAINED HYPERTENSION WITH EXERCISE

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PRE-PARTICIPATION HEALTH EVALUATION

• 3) LOSS OF CONCIOUSNESS WITH EXERCISE
• 4) SERIOUS CNS TRAUMA OR SURGERY
• 5) HISTORY OF RECURRENT CNS SYMPTOMS ( SEIZURE
  ETC )
• 6) PERSISTENT HEAT INTOLERANCE
• 7) INTRACTABLE ORTHOPAEDIC PROBLEMS

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PRE-PARTICIPATION HEALTH EVALUATION

• 8) SINGLE ORGAN
• 9) HAEMORRHAGIC DISSORDERS
• 10) CHRONIC INFECTIONS
• 11) CHRONIC DEBILITATING ILLNESS
• 12) ENLARGED ABDOMINAL VISCERA
• 13) OBVIOUS PHYSICAL IMMATURITY

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INJURY PREVENTION

• 1) FACTORS CONTRIBUTING TO SPORT INJURIES
• - LACK OF COACHING EDUCATION
• - INADEQUATE PREPARTICIPATION PHYSICAL EXAMS
• - HAZARDOUS PLAYING FIELDS
• - CONDITIONING AND TRAINING ERRORS
• - EQUIPMENT LACK, IMPROPER, POORLY FITTED

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INJURY PREVENTION

• - PLAYING WHILE INJURED OR OVERTIRED
• - GROUPING TEAMS BY AGE NOT SIZE
• - POOR NUTRITION
• - RULES AND OFFICIALS
• - IMPROPER TECHNIQUE
• - INADEQUATE SUPERVISION
• - PSYCHOLOGICAL STRESS
• - WEATHER CONDITIONS

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INJURY PREVENTION

• PREVENTION STRATEGIES
• - GENERAL FITNESS TRAINING
• - RANGE OF SPORT ACTIVITIES
• - TRAINING WELL BEFORE SEASON
• - ALLOW CHILDREN TO CONTROL INTENSITY OF
  ACTIVITIES
• - MODIFY RULES OF ADULT GAMES
• - LESS EMPHASIS ON WINNING

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INJURY PREVENTION

• - OPPONENTS TO BE MATCHED IN AGE, HEIGHT, WEIGHT,
  MATURITY
• - STRICT SUPERVISION
• - NO MORE THAN A 10 INCREASE PER WEEK IN
  TRAINING
• - WARM-UP AND COOL-DOWN TIME
• - PRE-PARTICIPATION EXAMS.