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Introduction

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He [died] doing what he loved and had his “go fast” face on as he pulled onto the track … 45 is on another road we can only hope to reach. Miss you kiddo.

Posting signed “Dad” on Peter Lenz’ Facebook page after the 13-year old, riding motorbike 45, was killed in an accident at Indianapolis Motor Speedway (August 29, 2010)

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Participation in youth (i.e. child and adolescent) sports is increasingly popular and widespread in Western culture. Many of these youngsters initiate year-round training and specialization in their sports in childhood, and during adolescence some may reach peak performance and compete nationally or internationally. It is not uncommon today for preteens to train 20 or more hours each week at regional training centers in tennis or gymnastics, to compete in triathlons, or for youngsters as young as six to eight years of age to play organized hockey or soccer and travel with select teams to compete against other teams of similar caliber. Thus, knowledge about specific physiologic characteristics, management of orthopedic conditions, injury prevention guidelines, and information regarding non-orthopedic concerns is imperative for all individuals involved in the medical care of young sportspeople.

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The uniqueness of the young athlete

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Engaging in sports activities at a young age has numerous health benefits, but also involves risk of injury. Indeed, the young athlete may be particularly vulnerable to sport injury due to the physical and physiological processes of growth. Injury risk factors that are unique to the young athlete include nonlinearity of growth, maturity-associated variation, the adolescent growth spurt, and unique response to skeletal injury.1 They might also be at increased risk because of immature or underdeveloped coordination, skills, and perception.2 Although problems do not ordinarily arise at normal levels of activity, the more frequent and intense training and competition of young sportspeople today may create conditions under which this susceptibility exerts itself.

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Nonlinearity of growth

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The normal growth pattern is nonlinear; that is, differential growth of the body segments (head, trunk, and lower extremities) occurs throughout growth and influences body proportions accordingly.3 At birth, the relative contribution of head and trunk to total stature is highest and this declines through childhood into adolescence. Thus, the child is characterized by a proportionately larger head and trunk, and shorter legs compared with an adult. In some events, for example rodeo “mutton busting,” one can anticipate that a young “top-heavy” child would be at increased risk of falling off a sheep compared with an older child with proportional longer legs.

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It could also be argued that, under a given physical load, for example over a distance run, a child’s locomotor apparatus would be exposed to greater stress—hence to a higher risk of overuse injury than that of an adult. Yet, often these child athletes progress rapidly to training regimens, skills, and stunts that ...

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