CHILDREN IN SPORTS

1. CHILDREN IN SPORTS PANOS THOMAS

2. OBJECTIVES - GROWTH AND MATURATION - PHYSIOLOGICAL DIFFERENCES - NUTRITIONAL CONSIDERATIONS - PSYCHOLOGICAL CONSIDERATIONS - THE IMMATURE MUSCULOSKELETAL SYSTEM

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

4. 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

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

6. 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

7. PHYSIOLOGICAL DIFFERENCES 3) CARDIOVASCULAR SYSTEM: - CHILDREN: HIGHER MAXIMAL HEART RATE - LOWER STROKE VOLUME - LOWER SYSTOLIC BLOOD PRESSURE - BETTER PERIFERAL BLOOD FLOW ADJUSTMENT TO SPORT

8. 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

9. 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

10. 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

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

12. 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

13. PSYCHOLOGICAL CONSIDERATIONS 4) PSYCHOLOGICAL COSTS OF SPORTS EFFORT OVER OUTCOME MODELLING EFFECT

14. THE IMMATURE MUSCULOSKELETAL SYSTEM 1) PRESENCE OF GROWTH CARTILAGE IN SKELETON A) ARTICULAR SURFACES B) EPIPHYSEAL PLATES, APOPHYSEAL INSERTIONS

15. 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

16. 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

17. 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

18. 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

19. 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 )

20. OVERUSE INJURIES 1) OSTEOCHONDROSES: “ SELF-LIMITED,IDIOPATHIC, DEVELOPEMENTAL DISORDERS OF PRIMARY OR SECONDARY OSSIFICATION CENTRES” - TRACTION OSTEOCHONDRITIS (APOPHYSITIS ): OSGOOD-SCHLATTERS, SINDING-LARSEN-JOHANSSON, SEVERS

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

22. OVERUSE INJURIES ARTICULAR CHONDRAL (SPLITTING) OSTEOCHONDRITIS DISSECANS ( FEMUR,CAPITELUM,TALAR) PHYSEAL: SCHEURMANNS (THORACIC SPINE ) BLOUNTS ( TIBIA )

23. 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 )

24. 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

25. CHRONIC CHILDHOOD ILLNESS 5) HYPERTENSION: (?) CAUSES, PRIMARY OR SECONDARY SPORTS BENEFICIAL FOR PRIMARY HYPERTENSION AVOIDANCE IN PRIMARY ISOMETRIC ACTIVITIES: WEIGHT LIFTING, WRESTLING, ICE-SKATING

26. 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

27. 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

28. 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

29. 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)

30. 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

31. 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

32. 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

33. 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

34. 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

35. 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

36. 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

37. 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.