Overuse growth plate injuries. Kids Tri too hard?

So we are all agreed that exercise is good for our kids and competition is a great motivator. It’s good for us parents too!

But compared to the recent past, streets are deserted during the Summer holidays, as are many local playgrounds and playing fields. Childhood obesity is still rising. 2014 figures show 31.2% of 2-15 year olds are obese or overweight. Even childhood Type 2 diabetes is now a statistic, unrecorded before 2000 in the UK. Computer game sales continue to grow.

Kids’ lives have certainly changed since the 60’s and 70’s and part of this change is a move away from ‘free play’ and activity in the street or playground, to more formal sport, training and competition. Has this transformation split the younger generation, creating the ‘Haves’ and ‘Have-nots’ or more accurately the ‘Doers’ and the ‘Do-nots’?

Often kids with active parents have a weekly ‘sports social’ diary that would exhaust the average adult, with many hours each week dedicated to their chosen sport. From results presented in the ‘Copenhagen Consensus Conference 2016’ this group is also more likely to succeed academically too.

On the flip-side, with free play and outside activity falling out of favour, kids are more likely to do virtually no exercise in a typical week, if their parents don’t exercise. Changes to school curriculums and the rise of ‘non-competitive’ school policies won’t help. One extreme to the other, so which is right? Neither! Like most things, balance has to be the key.

An unhelpful but influential perspective in the matter can come from the Media and its collective schizophrenia on whats right or wrong for kids. Their attention grabbing, emotion provoking approach can discourage families from being more active. Whilst sport and activity is generally promoted, with plenty of ‘Legacy’ initiatives during the Olympics, when it comes to kids the media has a habit of focusing on potential risks rather than benefits – citing overuse injuries as a risk to kids.

One of the overuse injuries seen are Growth Plate fractures. These involve the softer bone areas at the ends of limbs where there is ongoing growth (long bones grow from their ends, not from the centre). These fractures at the ends of ‘long bones’ (bones longer than they are wide) are most common in the fingers, legs and arms. Fractures are classified as 5 common types. While recognising there are potential risks, shouldn’t we take a more balanced approach to prevent discouraging inactive families?

Accurate figures for overuse injuries are difficult to come by. We can’t find any published figures. If you can, let us know!

In an attempt to quantify the risk, we can look at some very basic figures. Various research data in the UK and the US shows that approximately 15% to 30% of all childhood fractures, are growth plate fractures. These figures show a big spread, indicating more work is needed in this area!

The 2011 Census records approximately 7.2m 4-14 year olds. With a population fracture incidence of 14% for that age group means 1m fractures annually in children, wow! So taking 22.5% (mid-point of 15-30%) for an estimate of Growth Fractures gives approx. 225,000. However, these are NOT all sports related. A trip on a kerb walking to school and a child can fracture a Growth Plate.

Looking at the sport of cycling, a figure of 20% has been estimated in US studies for recreational sports such as ‘biking, sledding, skiing, or skateboarding’, but we don’t know the individual breakdown for each sport. So taking a proportional split of 5% for cycling, that’s 11,250 fractures. Finally, what percentage of this figure has been caused by actual overuse, and not an accident whilst cycling?

Even if it was half of this number (in reality, it may actually be just 10%!) at 5,625, the incidence of injury is a significantly lower number than the 2.3m overweight or obese children!

However, we believe its far more plausible that the actual figure for cycling sports related overuse injuries is likely to be in the hundreds, not thousands – is it even possible to fracture bones without a crash of collision on a bike? The more common injuries to prevent would be muscular, as is the case with adults over-training. Common cycling injuries and their prevention are well documented.

Other sports also risk overuse injuries. Gymnastics and Football are listed as the highest risk. Gymnastics is understandable, Football is probably high being the most common youth sport with collisions causing fracture.

So if the reality of the risk may be as small as several hundred incidents annually, should this be used as a stick by the media to deter millions of kids and parents? Of course not. However, hundreds of incidents a year is still too many and its the responsibility of parents and coaches to ensure it doesn’t happen. Kids on their own will very rarely hurt themselves, but parents and coaches can push too hard.

How can we reduce the risk to a minimum? Balance is key again. The move away from ‘free play’ towards more dedicated, repetitive training means overuse injuries are reportedly on the increase.

During a Growth Spurt children are more vulnerable to injury, so observing behaviour can help. Are they sleeping longer, eating more or suffering mood swings? Outside of the obvious “trousers look shorter” these are all common changes whilst growing. ‘Growing Pains’ is another, although it is most likely muscle growth spasms that can be felt, not bone pain!

So whilst it’s good for all parents and coaches to understand the risks and recognise the signs, sweeping rules to limit or stop kids who love what they are doing is also counter-productive. We are happy to let our kids challenge themselves, as long as the risks is sensibly managed. So far our kids have sustained no injuries!

From our own research and practice with our kids, this is our own preventative action list;

• Warming up and stretching before training.
• Reduced or no training during / shortly after illness.
• If anything hurts, stop. (don’t let them know this beforehand, they may keep it quiet!)
• If they don’t actually want to do it (desire must come from them) – stop.
• Parents always be prepared – enough water, food and clothing for the event.
• Minimum of one total rest day each week.
• At least one purely for fun session each week – less intense family walk / jog / ride or swim.
• Keep it fun. Don’t add pressure. Every event is not the 100m Sprint final at the Olympics!
• Cross-train / alternate sports – multi-sport athletes tend to suffer less from overuse injuries.

We feel the last point is a crucial one and another convincing case for Kids Triathlon. Triathlon provides a variety of activities that reduces the risk of overuse injury to a minimum, whilst continuing to provide stimulus for the child, avoiding physical and psychological burnout. It is recognised that specialising in one sport too soon, is the real problem.

Overuse injury aside, too much anecdotal evidence points to kids who start too serious, too early, dropping out of that sport by their early/mid-teens. Browse the CV’s of the average TeamGB medal winners, to see how many only took up their chosen sport in the mid to late teens. Vicky Holland didn’t compete on her first Triathlon until the age of 19!

As for the group of ‘do-not’s’ the future looks a lot less bright. More needs to be done by government and through schools to raise the profile of sport and exercise in schools and elsewhere. Childhood Obesity, diabetes and associated long-term health effects are still on the increase, albeit recent increases are slowing. However, levels are still significantly higher than 30 years ago, so where will this put the NHS in 30 years time?

Compared to the huge health risks of obesity and diabetes, we think the fear of overuse injury is over-played in the media. Minimising the risk is about applying common sense – involving young kids in Multi-sport, avoiding specialising too soon. Keeping it low pressure but lots of fun is the key.

More useful sources of information;
The Dangers of Overtraining Youth
Overuse Injuries, Overtraining, and Burnout in Child and Adolescent Athletes