Canada turned in a solid Gold performance in the 1996 Olympics, the largest games in history. However the physical and emotional cost to some of the participants, particularly the young female athletes cannot go unnoticed. In the women’s 5000 meter heat a 14 year old Nigerian finished last and more than 4 minutes behind the winner. One young female gymnast performed under pressure from her trainer despite a significantly obvious ankle injury. Many of the female gymnasts from all parts of the world were clearly smaller and less well developed than one would expect for their chronological age. In the last few years, two United States female gymnasts at the Olympic level died from medical problems related to their sport. One died from complications of anorexia nervosa and the second from complications of spinal trauma due to a vaulting injury. These few incidents provide a background to many of the worrying trends that have appeared in competitive youth sports.
What are some of the physical injuries that may occur in competitive sports and gymnastics?
Most elite gymnasts do not pass through childhood and adolescence without injury because of the intense repetitive and high impact nature of this sport. Clearly the risk of injury increases with longer practice time, the degree of difficulty of the routines and age related vulnerability of the skeletal system. Reported injuries include stress fractures, growth-plate fractures, wrist and elbow injuries, spinal injuries and reflex sympathetic dystrophy. Training more than 18 hours per week before and during puberty may alter the growth rate and prevent the attainment of full adult height. Hence the appearance of short stature among many gymnasts, one of the nutritional and endocrine consequences of competitive gymnastics.
What is meant by the term “female-athlete triad?
This triad is characterized by disordered eating, menstrual dysfunction and osteoporosis and is associated with substantial morbidity and mortality. The prevalence of eating disorders amongst female athletes is reported to be between 15% and 62% (the prevalence of eating disorders in the general population is 1% for anorexia and 1-3% for bulimia). The pressure for female gymnasts to maintain a thin and muscular body appearance encourages atypical eating behavior. Furthermore disordered eating and intensive exercise may well contribute to primary and secondary amenorrhea. Menstrual dysfunction in turn increases the risk of premature osteoporosis and fractures and may also increase the risk of scoliosis.
What are the psychological risk factors that occur in young female athletes?
Young females who compete at high level sport and gymnastics tend to be extremely obedient and disciplined and strive for adult approval. Their desire to succeed and win ensures that these girls may be driven beyond their physical and emotional limits. The young athlete may perceive her entire identity and self worth as depending on her participation and success in sport. The pressures put on these children by their family and coaches often impede their ability to think or act independently. They may suffer from social isolation and a lack of opportunity for social development. Many of these athletes may leave home before the age of 12 to devote themselves almost exclusively to training for their desired sport.
What are the contributing factors that give rise to these risk factors in competitive sports?
Parents and coaches often attribute a child’s overtraining to the child’s enthusiasm and love for the sport. While some children may have extraordinary abilities and high athletic aptitudes, their parents and coaches must still take responsibility in exercising appropriate control and timely advice to these young athletes. Self deception on the part of the parents as well as the personal and financial sacrifices endured by many of these families may well increase the stress on the child.
Are young male athletes at risk for sports injuries?
Yes. Many of the same factors that affect female athletes affect young pubescent males, however to a much lesser extent partly because they are somewhat less selfconcious about there bodies in the early stages of puberty. In particular, boys should not begin strength training before approximately 16 years of age in order to allow the growth plates an opportunity to close and solidify properly. Adequate supervision must be available by appropriately trained personnel at all times.
What should be done to prevent harm to these young athletes?
Coaches and parents who have the greatest influence over these athletes are best able to monitor the athlete’s behavior. External agencies are needed to establish standards and monitor health and safety requirements for young athletes. Physicians must play a role in ensuring that the injured athlete does not return to competition too soon. All aspects of the young child athlete must be taken into consideration including the close monitoring of nutrition, endocrine and psychoemotional aspects of the growing child
|Consequences of competitive sport include overtraining injuries and psychological damage.|
|The “female-athlete triad” is associated with substantial morbidity and mortality.|
|The triad is characterized by disordered eating, menstrual dysfunction, and osteoporosis.|
|Parents and coaches must take responsibility in preventing harm to young athletes.|
Reference:Tofler I.R. et al, Physical and emotional problems of elite female gymnasts,
NEJM 335; 4: 281-83, 1996.
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