By Robert Donatelli

Youth sports are becoming increasingly popular in the United States. Children and adolescents are not small adults in their response to exercise and stress. Intensive exercise and training may be associated with acute and chronic illness and injury. Children train harder and participate in sports year-round. We are seeing an increased number of children with fatigue and overuse injuries.

An estimated 45 million children engage in scholastic and organized sports in the United States annually. Approximately 750,000 sports-related injuries requiring hospital-based emergency treatment occur each year. Overuse injuries are the most common. Overuse can be defined as when training demands exceed physiologic ability. Sometimes overuse injuries occur in poorly trained athletes who are pushed too hard and too quickly by their coaches, their parents or themselves. However, overuse can occur in the elite athlete as well.

It is evident that children grow and mature at variable rates. Maturation results in physiologic changes, which affect athletic performance and skill. These changes include increased size, strength and power of the musculoskeletal system. Young athletes perform less efficiently than do adults. Less efficient performance results in a higher metabolic cost and energy than adults. For example, it is well known that the technique of pitching and the overhead serve in tennis are not perfected until later in adolescence. In addition, the efficiency of muscles to fire synchronously in young athletes is poor. Injuries such as “little league elbow” in overhead throwing activities, or tennis elbow in tennis, are at epidemic proportions.

Furthermore, the pediatric athlete produces more metabolic heat in response to exercise and is less efficient in dissipation of the heat. Therefore, children are more susceptible to fatigue due to heat and water loss than adults. Such factors indicate that training programs designed for adults should not be applied to children. Oftentimes I am treating injuries in young athletes directly related to their participation in training programs geared for the adult athlete. It seems that coaches, parents and young athletes who are motivated toward success favor training programs that are more physically challenging. This type of training is not necessary to improve performance at any age.

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