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Managing Growing Injuries in Young Athletes
Many of the young athletes I train are extremely active and play multiple organised sports throughout the week. I believe that this motivation and enthusiasm shown by many young athletes to play sport should certainly be encouraged, however, there needs to be more education around the potentially harmful effects too much high impact sport may have on a growing body. Growing injuries such as “Severs” and “Osgood-Schlatter's” are bone-related injuries that commonly occur (presenting as heel pain or knee pain) in young, active athletes where the repetitive impact of too much sport can play havoc on bones that have not completely calcified yet. Injuries like these may often be prevented by following three simple steps. 1. Understand when the athlete will be going through their growth spurt. 2. Manage the athlete’s training load 3. Start some form of strength and conditioning to improve functional movement patterns and strength capacity. The following blog post aims to help you understand the theory behind these three steps.
WHAT IS MATURATION?
Maturation is quite simply the process of becoming mature. Typically it is the process of maturing from childhood to adolescence and then to full adult stature. At the onset of puberty, the stage of adolescence begins. This stage is coincided by a rapid change in hormones and considerable physical changes, including increases in height, weight and stature. The adolescent stage usually begins sooner in girls than in boys, however boys tend to grow more during this period. Additionally, it is important to note that each child has a different maturation development in terms of timing and tempo. Meaning the beginning of maturation and the rate at which it progresses will vary for each individual.
WHEN AND HOW FAST WILL YOU GROW?
When an athlete is growing at their fastest rate this is called their Peak Height Velocity (PHV) and how long away it is till this occurs is called their Maturity Offset. These two calculations have been researched by Mirwald (et al) and using simple calculations of height, weight and leg length, factored for age and gender it can be understood by a practitioner or coach where an athlete is at in their maturation phase and how this may affect their training (7,4).
During the adolescent growth spurt (i.e. peak height velocity), the average male typically achieves a PHV of approximately 8.3cm, and females approximately 7.8cm (3). Before, during, and after PHV there appears to be certain periods in time in which young athletes are more sensitive to particular types of training (e.g. strength, speed, hypertrophy) (2). Therefore, it is believed that calculating a child’s onset of PHV can enable the strength and conditioning coach or sports scientist to tailor the training programme in synchronisation with the athlete’s biological age as opposed to their chronological age – this may result in a better suited and more effective training programme (1).
KNOWING THE RED FLAGS
Every child will experience the often tumultuous and challenging transition through puberty, however with a little extra TLC it is not often a problem, unless this period is combined with high training loads. Overuse injuries are a major problem for young athletes who are experiencing periods of rapid growth and who are also being exposed to tremendous training loads. This can be brought about unintentionally by both sport coaches and practitioners who fail to recognise these important red flags (ie rapid growth and high training loads).
MANAGING THE YOUNG ATHLETE’S TRAINING LOAD
It is important to think about the number of high impact training sessions an athlete, going through adolescence, is completing throughout the week. Therefore, when planning a training week it is important to find a balance between high intensity/ impact training; running, football, soccer, netball, athletics, basketball, tennis, with low intensity/ impact training; swimming, walking, cycling, strength training.
Ideally when planning a training schedule for your child if they are likely to be growing try to alternate high intensity with low intensity training during the week. They even do this at the elite level. No athlete can train at high volumes and intensities every day for long periods of time. Bodies would just breakdown. It takes careful planning, and smart monitoring to ensure that an athlete is getting adequate training to ensure performance increases married with adequate rest and recovery to ensure the body doesn’t breakdown.
Alongside training it is also important to be mindful of getting enough sleep (8-10 hours min), appropriate amounts of downtime and managing stress levels from school or relationships. If these factors aren’t managed this can also increase injury risk.
STRENGTH TRAINING FOR INJURY PREVENTION
By now, many sport coaches understand that developing strength in fundamental athletic motor skills training can have a positive effect on the health and performance of children and adolescents. Participation in sport involves some inherent risk of injury, and although the total elimination of sport-related and physical activity-related injuries is an unrealistic goal, it appears that an all-round programme which focuses on increasing muscle strength, enhancing movement mechanics and improving functional abilities may be the most effective strategy for reducing sports-related injuries in young athletes (7).
The strengthening of muscles and connective tissues through strength training makes young athletes capable of sustaining higher external forces, which therefore makes them less susceptible to soft-tissue injury (5). Additionally, the effectiveness of these injury prevention programmes is greater if implemented in younger age groups prior to the commencement of neuromuscular deficits and biomechanical alterations seen during growth spurts (5). In female athletes, for example, early engagement in neuromuscular training is likely to result in a reduced risk of anterior cruciate ligament injury later in life. Furthermore, specific resistance training exercises can help to prevent the development of bone injuries (e.g. Sever’s disease) (6).
CONCLUSION
Young athletes are at an increased risk of growing related injuries when they are in their fastest growth spurt, also known as their peak height velocity, and they are completing large amounts of high impact training or activity. However, with the correct management of training load, an understanding of the athlete’s peak height velocity and an age- appropriate strength training program, the risk of these injuries can be significantly reduced.
HOW I CAN HELP ?
As this is a topic I am passionate about I have several programs and services available to help support young athletes through their sporting journeys, with the aim to keep them healthy, happy and injury free. My Junior Athlete Development Program (JADP) is designed for athletes going through puberty (9-16year olds) and will help to develop the fundamental movement patterns and strength capacity needed for injury prevention and sport performance. In addition to this program I offer an individualised assessment where each athlete in the program can choose to undergo a PHV assessment to ensure it is understood where they are at in their maturation phase, as well as a functional movement screen and musculoskeletal analysis. This assessment allows me to understand any additional injury risks and will allow me to further individualise the athletes strength program.
Further Reading:
1. Lloyd, R.S., and Oliver, J.L. (2012). The Youth Physical Development Model: A New Approach to Long-Term Athletic Development. Strength and Conditioning Journal, 34(3), pp.61-72. [Link]
2. Growth Charts – Data Table of Stature-for-age Charts. 2001. Growth Charts – Data Table of Stature-for-age Charts. [ONLINE] Available at: [Link]. [Accessed 07 February 2016].
3. Ford, P., De Ste Croix, M., Lloyd, R., Meyers, R., Moosavi, M., Oliver, J., Till, K., & Williams, C. (2011). ‘The Long-Term Athlete Development model: Physiological evidence and application’, Journal of Sports Sciences, 29(4), pp.389-402.
4. Mirwald, R.L., Baxter-Jones, A.D.G., Bailey, D.A., & Beunen, G.P. (2002). An assessment of maturity from anthropometric measurements. Medicine and Science Sports Exercise, 34(4), pp. 689–69
5. Lloyd, R. S., Faigenbaum, A. D., Stone, M. H., Oliver, J. L., Jeffreys, I., Moody, J. A., . . . Myer, G. D. (2014). Position statement on youth resistance training: the 2014 International Consensus. Br J Sports Med, 48(7), 498-505. https://www.ncbi.nlm.nih.gov/pubmed/24055781
6. Lloyd RS, Cronin JB, Faigenbaum AD, Haff GG, Howard R, Kraemer WJ, Micheli LJ, Myer GD, Oliver JL. (2016) National Strength and Conditioning Association Position Statement on Long-Term Athletic Development. J Strength Cond Res. 2016 Jun;30(6):1491-509. https://www.nsca.com/education/articles/NSCA_Position_Statement_on_LTAD/