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Children and adolescents

Regular training of children and adolescents is becoming more common in sport, and competitive sports are indulged in with ever-increasing intensity at ever-decreasing ages. In certain sports, such as figure skating,swimming and gymnastics, children start regular training when they are 5–6 years old, and even in contact sports, such as soccer, training and competition they are beginning to train at earlier ages. In certain sports training for 2–4 hours, 5 or 6 days a week, is not unusual.

Are there any long-term advantages in allowing children to start regular training and competitive activity at such an early age? Children’s play has always included running and jumping, which form a natural basis for sporting activity, but the increased demands and increased intensity of regular training can have a negative effect on an adolescent, and caution is needed. In some sports, swimming and tennis for example, studies have shown that very few winners of junior competitions become successful seniors—in other words, it is difficult to predict future development. Many young people give up their sporting activities too early because they are no longer enjoying themselves. Children and adolescents should be given the opportunity to try different sports rather than concentrating exclusively on one.

In principle, sports for children and adolescents should be fun and should not mean painfully hard training. The principles adults use in training cannot be directly applied to youngsters but must be adapted to their development. The risks of allowing adolescents to train and compete regularly can be looked at from different angles—physiological, psychological, and orthopedic—and the effects of sport on the latter can be divided into three groups:

– effects on the development of the musculoskeletal system;
– injuries due to accidents (traumatic injuries);
– injuries due to overuse.

Effects on development
The development of the musculoskeletal system in adolescents is governed by their ability to adapt in response to a changed or recurrent load, during training or following injury. Adaptation as a result of prolonged one-sided training can cause permanent changes, exemplified by the tennis player who, at an early stage, begins asymmetrical training and loading of the racket arm. This can result in development of a ‘tennis shoulder’, with an increase in the size of bones and muscles and increased laxity of the joint capsule, ligaments, and tendons around the shoulder of the racket arm. This causes dropping of the shoulder and a relative lengthening of the arm. In extreme cases an S-shaped curve (scoliosis) can develop in the thoracic spine.

Another example of the effects of training can be seen in young gymnasts. Long training increases the range of movement in the vertebral column, bringing about permanent changes in vertebral bodies and in the pelvis with increased mobility between the bones that form the pelvic girdle. We do not yet know with certainty what these changes will lead to in the long run, so it is essential that intensive regular training in children and adolescents takes place under medical supervision. At the same time, one-sided and repetitive training must be avoided and rules that reward abnormal mobility, as in scoring gymnastic competitions, should be changed.

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