Drugs and the adolescent athlete

The pediatrician performing a preparticipation physical examination on an adolescent athlete should discuss the use of ergogenic aids. This could be with all of the athletes present in the case of the mass screening examination, or in private during the preferred office-based physical examination, whether preparticipation or health maintenance. Knowing which sport the youth is active in can lead to the drugs most likely being misused being emphasized by the physician; ie, androgens in the case of weightlifting and football, and amphetamines in competitive events like swimming, football, and track. Not only should the risks be discussed (an unsuccessful way to influence adolescents' behavior), but the drugs' degree of ineffectiveness should be stressed. Finally, and possibly at least as importantly, the moral question of a competitor attempting to gain an "illegal edge" should be addressed.     

Anemia in the adolescent athlete.

Anemia is a common disorder among adolescents regardless of level of physical activity. The major cause of anemia in adolescents is nutritional iron deficiency. Iron metabolism may be altered in some athletes training and competing in endurance sports. The dilutional "sports anemia" that can occur in the more elite adolescent athlete may be an adaptation to aerobic conditioning. Screening for anemia in adolescent athletes is warranted because anemia may contribute to morbidity and diminished exercise performance. Current concepts and controversies regarding anemia in adolescent athletes are addressed, and application of this information to preparticipation physical examinations is examined.     

Stress fractures in the adolescent athlete

Consider stress fracture as a diagnosis in adolescent athletes complaining of worsening vague pain without a clear mechanism of injury. Remember that initial radiographs may be normal, especially early in the clinical course. If the fracture is of low risk for delayed or non-union, conservative management is indicated, with repeat radiographs 2 weeks after initiation of treatment. If a high-risk fracture is suspected, early diagnosis with MRI, bone scan, and, in some cases, CT is important for surgical decision making.     

Low back pain in the adolescent athlete

There are several other entities such as infection, tumors, and fractures that I have not covered in this article. These entities are not common in adolescent athletes but must always be considered when athletes do no respond to typical treatment protocols for the problems I have discussed. The most important theme to take from this article is that low back pain in adolescent athletes is a problem that should not be ignored but instead fully evaluated because structural problems are quite common in this patient population.     

The young athlete

Youth sports are becoming increasingly popular in America. Previous studies have shown that children and adolescents are not small adults in their response to exercise and stress. Intensive competition and training may be associated with acute and chronic illness and injury. In addition, we comment on the injury risks that are generated by pressures to perform, injuries from urbanized non-team sports, and legislation underway to minimize these injuries. We also provide insight into psychological and sociological trends in the pediatric athlete and discuss the roles of the pediatrician, coach, trainer, and parent and the ways in which these roles impact upon injury and prevention in this population.     

The college athlete

Participation in sports is important to many college students. Student athletes come from different levels of previous sport experience as they enter collegiate athletics. The primary source of student medical care is the campus student health center. The health care providers at student health centers attend to many of the sports-related concerns of student athletes. Preparticipation evaluation provides an opportunity to assess the general health of the student athlete and to identify conditions that might increase the risk of further injury. Sudden cardiac death and sports-associated concussions have generated much interest and are reviewed in this article. Other areas reviewed here include use of drugs and supplements, ankle sprains, acute knee ligament injuries, back pain, and shoulder impingement syndrome.     

Traumatic shoulder dislocation in the adolescent athlete: advances in surgical treatment

PURPOSE OF REVIEW: The shoulder joint has the greatest range of motion of any joint in the body and as a result is particularly susceptible to dislocation and subluxation. Recurrent instability is a common complication after traumatic shoulder dislocation in young people, with rates as high as 100% in skeletally immature patients and 96% in for adolescents. Treatment for shoulder dislocation has traditionally involved immobilization followed by a rehabilitation program. Recent studies have reported decreased rates of recurrent instability and improved outcomes in patients treated with surgical stabilization of acute, traumatic shoulder dislocation. The purpose of this review is to review recent publications concerning the treatment of traumatic shoulder dislocations in adolescents. RECENT FINDINGS: Lawton et al. retrospectively reviewed 70 shoulders in 66 patients 16 years old or younger treated for shoulder instability with follow-up more than 2 years. Forty-two shoulders were successfully treated with physical therapy, whereas 28 eventually required surgery. Subsequently, Deitch et al. retrospectively identified 32 patients between 11 and 18 years of age with radiographically documented traumatic anterior shoulder dislocation. Instability recurred in 75% of patients and 50% eventually required surgical stabilization. Bottoni et al. reported results of a prospective randomized trial comparing arthroscopic stabilization to nonoperative treatment of acute, traumatic shoulder dislocations in patients aged 18 to 26 years. Recurrent instability developed in 75% of patients treated conservatively versus 11% in those treated with surgery. DeBerardino et al. prospectively evaluated arthroscopic stabilization of acute shoulder dislocations in 48 young athletes with an average follow-up of 37 months and reported a 12% rate of recurrent instability. All patients with stable shoulders were able to return to their previous levels of activity. SUMMARY: Conservative management of traumatic shoulder dislocations in young patients is associated with high rates of recurrent instability. Recent studies have demonstrated improved results and significant reduction in recurrent instability in patients treated with surgical stabilization when compared with nonoperative treatment.     

Sports doping in the adolescent athlete the hope,hype, and hyperbole

A well-balanced diet with appropriate training is the key to maximizing athletic performance. Nutritional counseling should be an essential part of anticipatory guidance, especially for certain teens, such as those who are vegetarians or those with low-calorie intakes. Other considerations for anticipatory guidance are listed in Box 8. Adequate hydration before, during, and after practice or a game is important to maintain hemodynamic balance, prevent heat disorders, and optimize performance. Cool water is adequate for short-duration activities, while carbohydrate-electrolyte fluids are more desirable for long-term activities, especially those lasting more than an hour. Such drinks are also more palatable and the athlete is more likely to consume them. Carbohydrates (meaning hydrates of carbon) are an important part of the athlete's diet; carbohydrates are rapidly broken down and their energy is quickly supplied to the body. The body stores only a small amount of carbohydrates in the form of glycogen in the liver, while muscle glycogen is an immediate source of energy. Thus, carbohydrate loading has been used to increase glycogen stores and aid the athlete involved in endurance events.     

The pediatric athlete with disabilities

There have been increased opportunities and sports participation by athletes with disabilities during the past decades. Research on pediatric athletes with disabilities remains limited. Appropriate classification of athletes on the basis of their functional abilities is key to fair participation. Preparticipation evaluation of these athletes is based on similar principles as for able-bodied athletes. The prevalence, nature, evaluation, differential diagnosis, and treatment principles for injuries are similar for athletes with disability and for those without. There are few disability-specific medical and orthopedic issues to be considered in working with these athletes. Sport participation recommendations are based on the specific disability and demands of the sport. The vast majority of athletes with disabilities can participate safely in a number of sports if appropriately matched; such participation should be encouraged and facilitated at all levels because of well-recognized psychological and medical benefits. Significant progress has been made in increasing sports participation opportunities for persons with disabilities; this is especially true for adults and, to a lesser extent, for children and adolescents. Many barriers remain, however: inadequate facilities, exclusion of children with disabilities, medical professional overprotection, lack of trained personnel and volunteers to work with children with disabilities, lack of public knowledge about disabilities, and lack of financial support for sport and physical education in schools [9,12].     

Preparticipation sports examination of the child and adolescent athlete: changing views of an old ritual

The role of the pediatrician in the management of the child athlete has expanded in accord with the burgeoning number of children involved in sports competition. Growing information regarding physiologic responses to exercise in the pediatric age group has added to the importance and utility of this involvement. The scope of the preparticipation evaluation has enlarged in response to these changes; newer issues such as injury prevention, body composition assessment, and athlete education become important in not only assuring safe participation but also optimizing athletic performance. At the same time, the low yield of important findings during these examinations has prompted a reassessment of when, where, and by whom they might be most efficiently conducted.