Sports Injuries in Children

Reproduced by kind permission of the Federation of Holistic Therapists

On the whole, sport is good for children. Not only does it tackle the thorny issue of childhood obesity (and related conditions, such as type II diabetes), participating in competitive sport is also said to improve self-esteem, team spirit, self-discipline and motor skills. But although regular exercise is more favourable than sitting in front of a television screen or computer monitor with a packet of salt and vinegar crisps, some children are pushing their small bodies so hard in order to reach their sporting goals, they are causing themselves serious injuries.

If you wanna be the best…

It would seem that if you really want to make it in sport (or your parents really want you to make it in sport), you have to start training at a very early age. Let us take, for instance, four well-known sporting personalities: Tim Henman started playing tennis when he was just two years old, and was part of a training group run by former British tennis star David Lloyd when he was ten; Tiger Woods was hitting golf balls at the age of three, and won his first tournament at the age of eight; Paula Radcliffe started running when she was seven, and joined Bedford Athletics club when she was nine; and David Beckham was practically kicking a football by the time he was able to stand on his feet, and went on to win the TSB Bobby Charlton Soccer Skills Finals when he was eleven.

With today’s sporting stars starting out so young, it is not surprising that more and more children are being introduced to competitive sport at a very early age. As a result, more children are starting to trickle through to sports clinics and therapists. Although a number of injuries presented will be no different to those we would expect to see in an adult, there will be those that relate specifically to the child’s stage of physical development. So what are the ‘common’ sports injuries to be found in children, how are these caused, and how can their occurrence be reduced or prevented?

Down to the bone

In Sports Injuries: Causes, Diagnosis, Treatment and Prevention², the authors suggest that: “a number of sports injuries observed in children are generally related to: (1) their immature skeleton, which can be more vulnerable to injury, and (2) the anatomical imbalances that can occur during the growth spurts” [e.g. when bones lengthen faster than muscle-tendon attachments, resulting in poor flexibility].
Of particular concern is the risk of injury to the ‘growth plates’. A growth plate is an area of developing tissue situated within (or at the end of) a bone. These growth plates are made of cartilage and do not, under normal circumstances, ossify until the child matures and their bones are fully developed. Consequently, childrens’ bones are weaker and more susceptible to fracture and overuse injuries.2 The likelihood of injury can be further enhanced if the child is experiencing a ‘growth spurt’ (growth spurts typically occur between the ages of 10-14 for girls, 12-16 for boys⁴).

Different bones also grow at different rates, and this in turn is influenced by the individual status of the child, such as their age, gender, growth rate, and sexual maturity. Such a range of factors render it almost impossible to judge when a child is ‘less’ likely to incur an injury: a good understanding of physical development and a sensible training plan is therefore essential for those responsible for the care of the child during their training.

Extrinsic risk factors

There are other factors, other than physical ones, that can increase the incidence of injuries in children. These include:

Pushy coaches and/or parents
It is well recorded that Andre Agassi used to have a tennis racket taped to his hand when he was just 2 years old, and that his father suspended a tennis ball above his bed for something to ‘fix his eyes on’ as a baby. Whether or not such behaviour could be considered immoral or exploitive, it is quite common in parents and coaches. Many children will be constantly pushed, and even made to ‘play through’ pain (and injury) because someone else is desperate for them to achieve.

Inappropriate Levels of Training
Children training in competitive sports are often unfairly treated as ‘mini’ adults. This can result in long hours of intense training that their little bodies simply aren’t physically or mentally mature enough to cope with.

Pitching them against bigger players
Children are often pitched against others of the same age who are their superior in terms of size, strength and skill. This could easily result in injury and low self-esteem.

Radically changing training conditions
If a football coach suddenly introduces the child to a different playing surface or piece of equipment, the child should be given adequate time and/or training to adapt.

Ignoring participation in other physical activities
If the child is taking part in other activities (e.g. P.E. lessons) that may affect their performance, this needs to be taken into consideration.

Reducing/ Preventing Injuries

Injuries sustained during childhood can have serious, long-term implications (see the table below). Ideally, the risks posed to children need to be reduced or minimised where possible. Allowances should be made for the fact that they are physically and mentally less able to endure the training loads placed on adults. Some key points to consider:

The physique of some children make them ill-suited to certain sports (e.g. someone who is large and inflexible will not make the ideal candidate for gymnastics)
Ideally, the child should be introduced to a variety of different sports to see which one they are best suited to and enjoy
The child needs to be physically fit before they commence training
Training should be modified when the child is experiencing a growth spurt
Good coaching is essential. The child needs to be taught how to perform (and to fall) correctly
Equipment, circuits, and areas of ‘play’ should be scaled down accordingly
Children need to be supplied with protective gear that fits properly
Warm-ups and warm-downs are just as crucial to children as they are to adults. It also gets them into good training habits at an early age
It is up to those responsible for the child to ensure that they are sufficiently hydrated and protected against sunburn during training sessions as the child may not appreciate the seriousness of such things. Equally, the coach needs to know when it is time to stop training
Again, it is up to the coaches and parents to ensure that competitive events entered are well organised and do not pose any undue risks to the child
The child needs adequate rest in between training sessions and in the event of injury.

References/ Suggested Further Reading

1 DiDiori, John P. (1999) Overuse injuries in children and adolescents. The Physician and Sportsmedicine: Vol 27; No. 1. (www.physsportsmed.com/issues/199/01_99/didiori.htm)
2 Bird, S., Black, N., Newton, P. (1997) Children and sports injuries. Sports Injuries: Causes, Diagnosis, Treatment and Prevention. Stanley Thornes Ltd. ISBN 0 7487 3181 4
3 NIAMS (National Institute of Arthritis and Musculoskeletal and Skin Diseases. USA) (2000) Childhood Sports Injuries and Their Prevention: A Guide for Parents
(www.niams.nih.gov/hi/topics/childsports/child_sports.htm)
4 Briggs, James. (2001) Children in Sport/ Child Abuse in Sport. Sports Therapy: Theoretical and Practical Thoughts and Considerations. Corpus Publishing Ltd ISBN 1 903333 04 0