By Sally S. Harris, M.D., MPH

Over the past several decades, an increasing number of children and adolescents have become involved in individual and organized team sports. While moderate physical activity is healthy for a child’s mind and body, excessive or inappropriate levels of activity can result in serious injuries, some with lasting effects.

Nationwide, an estimated 7 million boys and girls participate in high school sports, and 20 million children ages 8 to 16 participate in community-sponsored sports programs. Another 20 million children are involved in non-structured recreational sports activities.

In addition, we’ve witnessed the emergence of the elite child athlete in sports such as gymnastics, figure skating, swimming and tennis. More children are specializing at younger ages and training exclusively for one sport year-round. In addition, training programs are becoming increasingly rigorous, and it’s not unusual for children to train intensively several hours each day.

The trend toward children’s increased participation in organized sports and their involvement in intensive training has raised a number of concerns about the appropriateness and health consequences of these activities. The rise of organized youth sports has brought about a dramatic increase in musculoskeletal injuries that were previously seen almost exclusively in adults.

The fact that children’s and adolescents’ bodies are still growing makes them vulnerable to unique kinds of injuries. The bones, muscles, tendons, ligaments and joints are not fully developed until the end of puberty (typically age 15 for girls and age 17 for boys). Because injury or pain in these "growth sites" can lead to permanent injury, persistent pain around joints should never be ignored or dismissed as "growing pains."

Young athletes are at greatest risk for injury to these growth centers during their adolescent growth spurts. As adolescents grow taller, the bones lengthen faster than the surrounding muscles, tendons and ligaments -- resulting in a decrease in flexibility. This decrease in flexibility results in increased risk of muscle strains and ligament sprains, as well as increased stress where these structures attach to bone. To prevent injury, young athletes should perform appropriate warm-up exercises, with an emphasis on stretching muscles of the lower back and legs.

The growth plates located at the ends of bones are often the weakest link in an adolescent’s system. An injury that would cause a ligament sprain or muscle strain in adults will often result in a fracture or other injury to the bone growth plate in adolescents. These injuries need to be carefully evaluated and treated to minimize the risk of permanent injury.

Finally, the "no pain, no gain" training philosophy should never be applied to children or adolescents. Activity that consistently causes pain or discomfort during or after exercise should be modified or eliminated until it can be done in a pain-free fashion.

Sally Harris specializes in sports medicine at the Palo Alto Medical Foundation and has specific expertise in the care of child and adolescent athletes. This article was originally published in the Los Altos Town Crier.

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