CHILDREN IN SPORTS

1. CHILDREN IN SPORTS

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: - SIGNIFICANTLY LOWER IN CHILDREN ( SHORT TERM POWER OUTPUT ) - IMPROVES 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 IN 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 ARE MORE VUNERABLE: RATIO OF SURFACE AREA TO VOLUME 30-40% HIGHER THAN ADULTS RESULTING IN FASTER INCREASE OR LOSS OF BODY HEAT FOR CHILDREN. SWEATING MECHANISM IS FULLY OPERATIVE AFTER ADOLESCENT GROWTH SPURT - DEHYDRATION

10. NUTRITIONAL CONSIDERATIONS 1) ADOLESCENT GROWTH SPURT ( Because of the massive physical changes happening in puberty, teenagers have bigger nutrition needs compared both to adults and young people who’ve finished their growth spurts.) 2) IRREGULAR EATING HABITS ( Snacks, Missing Lunch, etc ) 3) ESSENTIAL: CALCIUM, FOLIC ACID, ZINC, IRON, VITAMINS A,B6,C 4) DIETARY MANIPULATION (Eating Disorders)

11. PSYCHOLOGICAL CONSIDERATIONS 1) CHILDHOOD PLAY IS IMPORTANT FOR SPORT. ( FIRST 7 YEARS OF LIFE ESPECIALLY) IT ENHANCES: • 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 FOR GAME SPORTS

13. PSYCHOLOGICAL CONSIDERATIONS 4) PSYCHOLOGICAL COSTS OF SPORTS: - EFFORT OVER OUTCOME; praising effort over outcome is best for children. - MODELLING EFFECT; also called observational learning or imitation. Involves the use of live or symbolic models to demonstrate a particular behaviour, thought, or attitude.

14. THE IMMATURE MUSCULOSKELETAL SYSTEM • PRESENCE OF GROWTH CARTILAGE IN SKELETON; cartilage at ends of long bones consists of the epiphyseal, physeal, and articular cartilage components. • ARTICULAR SURFACES (joint surfaces some of which are cushioned by malleable cartilage) B) EPIPHYSEAL PLATES, APOPHYSEAL INSERTIONS; are susceptible to injury during adolescent growth spurts due to muscle tightening across joints.

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; - 3 INJURIES PER 100 CHILDREN PER YEAR - 0.69 SERIOUS INJURIES PER YEAR PEAK FOR BOYS: 14 YEARS OLD AND GIRLS: 15 YEARS OLD

17. THE IMMATURE MUSCULOSKELETAL SYSTEM - INCOMPLETE RECOVERY FROM INJURY: 30% - FOUL OR ILLEGAL PLAY: 13% - OVERUSE INJURIES: 50% STATISTICALLY, ORGANISED COMPETITION ACCOUNTS FOR 35% OF TOTAL SPORTING INJURIES . OF THAT FIGURE:- RUGBY LEAGUE 32%,SOCCER, RUGBY UNION 11% ( MARTIAL ARTS, HORSE RIDING AT 2% WAS RATED THE SAFEST), 30% REQUIRED MEDICAL ATTENTION, 11% REQUIRED HOSPITALIZATION, 12% RESULTED IN LONG TERM DYSFUNCTION.

18. ACUTE SPORTING INJURIES 1) HEAD AND NECK : VERY RARE BELOW 11 YRS. 1-5% OF ALL SPORT INJURIES SERIOUS Central Nervous System DAMAGE 2) DIAPHYSEAL FRACTURES 3) GROWTH PLATE INJURY: SALTER-HARRIS CLASSIFICATION 4) AVULSION FRACTURE OF ACL (knee ligament) 5) AVULSION FRACTURE MUSCLE GROUPS 6) Slipped Upper Femoral Epiphysis: 30% SUDDENLY, 70% GRADUAL

19. OVERUSE INJURIES • OSTEOCHONDROSIS; a condition where a fragment of bone and cartilage detaches from the joint surface. 2) STRESS FRACTURES: Can be caused by sudden increases in training intensity. Confirmed via x-rays or bone scans. 3) MALALIGNMENT SYNDROMES: TARSAL COALITIONS - Tarsal coalition is a congenital abnormality that results in a partial or complete fusion between two bones of the foot. PERONEAL TENDONITIS - lnflammation or crowding of the peroneal tendons. Usual cause is repetitive trauma. Direct trauma (i.e., ankle fracture) or chronic lateral ankle instability.

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

21. OVERUSE INJURIES • OSTEOCHONDROSIS: - ARTICULAR SUBCHONDRAL ( bone / cartilage) - PERTHES DISEASE ( femur) - KIENBOCKS DISEASE ( wrist ) - KOHLERS DISEASE ( mid-foot ) - FREIBERGS DISEASE ( 2ND Toe)

22. OVERUSE INJURIES - ARTICULAR CHONDRAL (splitting of the bone) - OSTEOCHONDRITIS DISSECANS ( femur, capitelum, talar) - PHYSEAL: SCHEURMANNS (thoracic spine) - BLOUNTS ( tibia )

23. CHRONIC CHILDHOOD ILLNESS • 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 SPORT IS CONSIDERED TO BE BENEFICIAL FOR PRIMARY HYPERTENSION BUT AVOID PRIMARY ISOMETRIC ACTIVITIES SUCH AS WEIGHT LIFTING, WRESTLING, ICE-SKATING

26. CHRONIC CHILDHOOD ILLNESS 6) HEART DISEASE: - CONGENITAL HEART DISEASE IN 5/1000 SCHOOL AGED CHILDREN. - RHEUMATIC HEART DISEASE IN 1/1000. - VALVULAR DAMAGE, CARDIOMYOPATHY, MYOPATHY, HEREDITARY SYNDROME IN 0.8/1000 - RHYTHM SIGNIFICANT DISORDER IN 0.7/1000 - CONGENITAL CORONARY ANOMALIES IN 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 • INFECTIONS MONONUCLEOSIS ( GLANDULAR FEVER ) - SELF-LIMITED ACUTE VIRAL ILLNESS - 90% INFECTED BY 30 YEARS OLD - PEAK INFECTION RATE IS 15-25 YEARS OLD - EPSTEIN-BARR VIRUS (EBV) • DIAGNOSIS FROM POSITIVE HETEROPHILE ANTIBODY TEST (MONOSPOT) - ENLARGED SPLEEN 40-60%, RUPTURE 0.1 –0.2% - 4 WEEKS ABSENCE, SYMPTOMS CAN LAST UP TO 6 MONTHS

30. ACUTE ILLNESS AND SPORT PARTICIPATION 2) OTHER ACUTE ILLNESSES: -HAEM.STREPTOCOCCUS (Scarlet Fever, Tonselitis) -MYCOPLASMA PNEUMONIA (Bacterial Pneumonia) -SIMPLE HERPES (not dangerous but it may be exasperated by picking or scratching) -TINEA PEDIS (Fungal infection of the toes and feet)

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 PRE-PARTICIPATION PHYSICAL EXAMS - HAZARDOUS PLAYING FIELDS - CONDITIONING AND TRAINING ERRORS • EQUIPMENT; LACK, IMPROPER, POORLY FITTED - PLAYING WHILE INJURED OR OVERTIRED - GROUPING TEAMS BY AGE NOT SIZE - POOR NUTRITION - RULES AND OFFICIALS

35. INJURY PREVENTION - 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.