Sports injuries in children: should we be concerned?

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Abstract
During the growth spurt, adolescents are particularly vulnerable to injuries.9 Studies in the early 1980s suggest that between 3 and 11% of school age children were injured each year while taking part in some form of sports activity,11 12 with more recent studies suggesting a higher figure of 22%.13 14 As might be expected boys are more commonly affected than girls.12 14 Physical characteristics may play a part, for example joint laxity is associated with ligamentous injury while tightness of ligaments is more correlated with meniscal injuries and ankle, shoulder, and wrist sprains.15 In adolescence, transient loading to joints may also result in so called exertion injuries which usually resolve over a period of six months without any specific treatment.16 Other so called intrinsic risk factors have been identified including age, sex, and personality. Extrinsic factors that have been identified include type of sport, level of competition, playing surfaces, weather conditions, and provision of protective clothing or equipment.17Matching of opponents is also an important factor. Viewed largely in terms of chronological age, youth sport is often banded by the child’s birth date. However, this does not take biological age differences into account. The potential competitive inequality and increased risk of injury associated with such mismatches are especially evident in contact and collision sports.18 Although minor soft tissue injuries and cuts and abrasions make up the majority of injuries, more serious injuries including acute fractures and stress fractures do occur. It has been suggested that a uniquely vulnerable time for fractures occurs at the age of peak height increase when there may be an imbalance between muscle strength and relative bone strength.19 20 Several studies have reported the occurrence of bone fractures in children involved in a range of sports. The huge variation from 1% in weight training21 to nearly 70% in wrestlers22 highlights one of the problems in identifying the true prevalence of sports injury. These problems include different definitions of injury, whether the study was retrospective or prospective, the intensity of exposure to exercise, and the ability and skill of the individual. The latter issue is of considerable significance as it has been suggested that the reported low injury rates in elite young athletes may be attributed to this factor.23 The immature musculoskeletal system of the growing child results in different patterns of injury from those found in mature adults. Particularly vulnerable sites include the growth plate, the joint surfaces, and sites of musculotendinous insertion.24

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