ASK A PHYSIO..How much is too much?

Dear SquareOne,

 
My 15 year old son is currently participating in 4 rugby teams including; school, club, rep and a school representative team. I am concerned this is too much and that he will end up injured. What is your advice regarding how much is too much for a child this age, and how we can prevent any injuries? Karen 45
 
Thanks Karen. A common scenario for talented kids in sport. 
It is reported in the literature that high game and training exposure at a time when the child’s skeleton is immature and still developing can result in severe consequences for the younger athlete. Appropriate management of a child’s training hours is very important in order to prevent serious injuries, which can potentially result in long term disability and affect the chances of an athlete performing at a higher or professional level of sport later in life. It has been reported that at times, adolescent training loads sometimes exceed those typically prescribed to elite athletes. Finch and Cassell, 2006 reported
Dear SquareOne,
 
My 15 year old son is currently participating in 4 rugby teams including; school, club, rep and a school representative team. I am concerned this is too much and that he will end up injured. What is your advice regarding how much is too much for a child this age, and how we can prevent any injuries? Karen 45
 
Thanks Karen. A common scenario for talented kids in sport. 
 
It is reported in the literature that high game and training exposure at a time when the child’s skeleton is immature and still developing can result in severe consequences for the younger athlete. Appropriate management of a child’s training hours is very important in order to prevent serious injuries, which can potentially result in long term disability and affect the chances of an athlete performing at a higher or professional level of sport later in life. It has been reported that at times, adolescent training loads sometimes exceed those typically prescribed to elite athletes. Finch and Cassell, 2006 reported that the 15-39 year age group had the highest percentage of injuries resulting from sport, closely followed by the 5-14 year old age group in a study of the public health impact of injury in sport. 
 
In a study on adolescent rugby players, it was reported that player exposure time was the strongest predictor of injury occurrence. Over training often occurs when young athletes are participating in multiple sports or representing multiple teams in the same sport including school, club and representative or development squads. At times, levels of activity exceed what these maturing athletes musculoskeletal system is capable of supporting and this is when we start to see progressive soft tissue injuries and chronic overload injuries in our young athletes.
 
The most common chronic overload injuries in children include
Pars defects (stress reactions) in the lumbar spine
Chronic groin pain and muscle strains
Repetitive hamstring injuries
Injuries around the growth plates in the knee and heel including; Osgood Schlatters, Sinding-Larsen-Johansson and Severs
 
Things you can do to help prevent an overuse injury include; ensuring good communication between coaches and managers of school sport, weekend or club teams and development squads to maximise performance outcomes and minimise adverse effects such as fatigue, injury and over training. The coaches between teams may be able to discuss if there is any crossover in training during the week (e.g. two teams both running a fitness session) and therefore the child may just participate in one of these sessions rather than both.
 
Brukner and Khan 2012 estimate that up to 50% of sports injuries in children are preventable and suggest some basic guidelines which may help to minimise the number of injuries sustained by our young athletes.
Ensure all coaches have accreditation by attending coaching courses
Training programs should be individually tailored to the child and consider each childs level of physical maturation, size, weight and skill level
Someone from the club/association should have basic first aid knowledge
Any child complaining of ongoing pain, tenderness or limitation of movement should be referred to a Physio immediately
Warm-ups and cool-downs should be completed at each training session and game
The frequency, duration and intensity of both training and competition should be monitored and discussed with all coaches involved to ensure over training does not occur
Children prior to puberty should be exposed to a wide variety of sporting activities so that general skills can be developed. Early specialisation should be discouraged at a young age to prevent overuse injuries or muscular imbalances.
 
The possible outcomes of high-volume, high-intensity training in children are not confined to physical injury and can include overtraining syndromes, sports burnouts, increased susceptibility to illness, psychological disturbances and performance decrements. As children don’t often understand some of the severe adverse effects of over training, it is important that parents and coaches are well informed in this area. If you would like to know more, or are concerned about your child, please bring them in to see us, or call one of our Physiotherapists to discuss your concerns.