Young athletes.

The relationship between children and athletic activities is a critical factor in psychological, physical, and emotional growth. Tremendous benefits can evolve from youth sports participation, during which socialization patterns are being established and musculoskeletal growth and development are occurring. Likewise, bad experiences at these stages can be devastating to vulnerable personalities, leaving scars for a lifetime. The unfortunate episodes often point to a lack of good coaching and mentorship at the entry levels of athletics. A teacher, coach, or parent who can identify strengths and weaknesses in developing personalities can provide mentorship that is invaluable. In today’s world, too often it is the strengths that are emphasized and nurtured at the expense of ignoring the weaknesses.

Many of the traits developed early in life in sports, both good and bad, can be traced into adulthood. Kids who learn early to respect and help their teammates usually develop the foundation for cooperation, trust, and good interpersonal relationships. This is a fundamental aspect of personality development. It goes far beyond the team concept of working together to their attitudes toward everyone around them, including family, friends, and society in general. Unfortunately, poor behavior is often tolerated from those with athletic prowess, which bodes poorly for those athletes later in life.

While team concepts can be helpful in the development of interpersonal relationships, individual sports can also provide many personal benefits to the athlete. Self-reliance, discipline, self-confidence, and self-assessment become ingrained in those who can only depend on themselves in the pool, on the track, or on the mat. There is no one else to blame when the commitment or effort is unsatisfactory. Likewise, individual accomplishments often solidify the factors that generated the positive result.

Both types of athletic endeavors—individual and team—have their advantages and strengths, which leads to the question: Which type of sport participation best prepares children for today’s world? Actually, both offer unique challenges to kids and provide many opportunities for personality development. That is why the best scenario for a young athlete may be participation in both types of sports.

Beyond the psychosocial, the physical benefits of early childhood sports participation can also pay great dividends. Growing healthy bone, tendon, ligament, and articular cartilage structure requires repeated physical stimulation to develop stronger, healthier bodies. As long as the rate of skeletal force transmission is appropriate for the age and increased in a manner to allow adaptation, the results should be positive for growth and development. I pity the child with an orthopaedic injury whose overweight parents did not model daily exercise or emphasize the benefits of sports participation as a component of a healthy lifestyle. If the child is still growing when his or her body mass index (BMI) rises to more than 30, it will be difficult to reverse that trend in body habitus later in life. Unfortunately, some never learn desirable health maintenance lessons and habits until the ill effects of obesity, diabetes, cardiovascular disease, and degenerative disease take their toll. The struggle to implement a healthy exercise lifestyle later in life is much more difficult if a healthy baseline is not developed in early years. This is one of the most important aspects of sports and physical activity in childhood. They are the initial crucial components in the struggle to stay fit and maintain a healthy body weight throughout life. This is why some of the injury risk in athletics, especially contact sports, may be acceptable. If early participation in sports can establish a healthy lifestyle, then maybe the injury risks are justified.

As clinicians, we are tasked with balancing all the positives of sports and exercise with the consequences of injury and overuse. Take the issue of concussion in contact sports, for instance. Head trauma continues to trouble parents, coaches, players, and clinicians as attempts are made to balance the risks and benefits. Hopefully, some positives will result from the protocols and guidelines now in place to protect young athletes. No less concerning than concussions is the reality of posttraumatic osteoarthrosis in shoulders, hips, and knees after joint injury early in life. Accurate diagnosis and prompt appropriate treatment of brain or body trauma, allowing subsequent years of continued physical activity, should be the goal for all children injured on the fields and courts of sports.

Looking back, our ability to provide accurate diagnostic assessments and treatments to injured kids has improved immensely over the past 30 to 40 years. Three articles in this issue of Sports Health highlight how much we’ve progressed. The work by Khormaee et al[2] on patellar instability and the pediatric and adolescent athlete highlights the benefits and concerns for both operative and nonoperative treatment and an evidence-based guide for each treatment approach. This is a lot better than the cast treatment frequently used in the past. Immobilization was often implemented to address the patella stability problem, but it often resulted in loss of muscle mass and knee stiffness while not solving the stability issue. Worse yet were some of the medieval surgical procedures employed when immobilization did not alter the course of the troublesome unstable patella.

Another worthwhile read is the publication by Stracciolini et al[3] on the pediatric anterior cruciate ligament (ACL) dilemma. It is interesting how boys appear to injure more ACLs before puberty while girls catch up later through their teenage years. Why BMI is independently associated with ACL injury is perplexing. Could it be that the immature neuromuscular system is not yet capable of absorbing the added forces produced by an increased BMI?

Last in this threesome of must-reads on kids is the primer by Jawetz et al[1] on physeal imaging. Thirty years ago we had no imaging insight into the severity of injury at the physis. Most radiographs of these injuries were normal except for those produced by major trauma. A bone scan was often used to detect the presence of a hot spot, indicating a likely injury. Unfortunately, a lot of that was guess work, regardless of what the radiologist or nuclear medicine specialist wanted us to believe. Now, with magnetic resonance imaging, accurate diagnosis is the standard of care, allowing appropriate management and rehabilitation of physeal injuries.

In all, the care of children in sports has dramatically improved over the past 30 years. We should be able to keep children more physically active yet prevent or treat the many injuries that are expected to occur. Unfortunately, as some of our understanding of musculoskeletal injury has improved, more apparent are the gaps in our knowledge of growth and development of many musculoskeletal tissues. Great potential exists to make athletic participation even safer and more beneficial in the future.