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Youth sports increase risk of physeal injury

This is an excerpt from Structure and Function of the Musculoskeletal System - 2E by James Watkins.

Case Study 1 Physeal Injuries in Youth Sports

Caine D, DiFiori J, Maffulli N. 2006. Physeal injuries in children's and youth sports: Reasons for concern? British Journal of Sports Medicine 40:749-760.

Participation in children's and youth sports is widespread in Western culture. Many children start year-round training and specialization by 9 years of age. Preteens training at regional centers or with high school and club teams in sports such as gymnastics may train more than 20 hr per week. There is increasing concern, especially among physicians, that the frequency and intensity of training and competition experienced by many participants in children's and youth sports are putting them at risk of serious physeal injury (epiphyseal and apophyseal), which may result in permanent skeletal abnormalities. Unfortunately, detailed information, based on the use of standardized recording systems applied over a long period, on the epidemiology of injuries (incidence, location, type, diagnosis, severity) sustained by participants in children's and youth sports is not available for any sport. The purpose of this study was to systematically review the literature on the frequency and characteristics of physeal injuries in children's and youth sports.

The review was undertaken using Medline and SPORTdiscus. More than 150 reports were obtained, largely case reports or case series investigations. The authors used the reports to determine the number, location, type, diagnosis, and severity of physeal injuries that occur in different sports, but it was not possible to calculate incidence of injury because information was not provided on the total number of participants and exposure time of participants in the various sports.

The review indicates that acute physeal injuries (sudden widening or fracture along or through an epiphyseal or apophyseal plate accompanied by considerable pain) and chronic physeal injuries (progressive widening of an epiphyseal or apophyseal plate associated with a progressive increase in pain, especially during exercise) occur frequently in some sports, including football, baseball, gymnastics, basketball, volleyball, judo, weightlifting, soccer, rugby, tennis, cricket, and long-distance running. The main regions of physeal injuries are the shoulder, elbow, wrist, and knee. Most of the injuries are chronic, and most resolve without complication. However, there are several reports of premature partial or complete physeal closure.

The authors express a number of concerns with current practice, in particular, the paucity of epidemiological data on the distribution and determinants of physeal injuries in children's and youth sports and the apparent lack of knowledge on the part of many coaches of children's and youth sports regarding musculoskeletal growth and development in children in general and physeal injuries in particular.


Coaches should consider the following strategies to reduce the incidence of physeal injuries in children's and youth sports:

  • Individualize fitness training and practice for athletes experiencing rapid growth. Assess growth rate by monitoring increases in height and limb segment lengths.
  • Use a variety of training and practice drills and avoid excessive volume of training.
  • For collision sports, ensure that competition is based on physical maturity rather than chronological age.
  • Mandate regular medical assessment to ensure early diagnosis and treatment of epiphyseal and apophyseal plate disorders.
More Excerpts From Structure and Function of the Musculoskeletal System 2E