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SPORTS TRAINING IN CHILDREN: FROM RUNNING TO WEIGHTS

DAN CUSHMAN, MD

MARCH 3, 2018

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DISCLOSURES

Nothing to disclose

DC

THE PEDIATRIC RUNNER

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MY VIEW

• Sports provide:– Good health– Friends, identity– Life lessons– Ability to achieve goals– Almost never, $$

• Thus, the goal should be long-term health

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CROSS-COUNTRY AND TRACK & FIELD

• Increasing in popularity• Most common activity for girls• 2nd most common activity for boys• Over a million high school track & field

athletes per year• Half a million cross-country runners

• Krabak BJ, Snitily B, Milani CJE. Running Injuries During Adolescence and Childhood. Phys Med Rehabil Clin N Am. 2016;27(1):179-202. doi:10.1016/j.pmr.2015.08.010.

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TRAINING REGIMENS

• Varied training programs• Varied coaching

experience• Varied medical assistance• Varied parental

“guidance”

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OLD SCHOOL

• High mileage• Then, high mileage• Then, high mileage• Then, high mileage• Then, FAST high mileage• Then, high mileage• Then easy (just kidding, more high mileage)

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BY THE WAY…

• The most common sport for stress fractures is cross-country– Girls 10.6 out of 100,000 athlete-exposures– Boys 5.42 out of 100,000 athlete-exposures

• Girls affected by all injuries more often than boys

• Changstrom BG, Brou L, Khodaee M, Braund C, Comstock RD. Epidemiology of Stress Fracture Injuries Among US High School Athletes, 2005-2006 Through 2012-2013. Am J Sport Med. 2015;43(1):26-33. doi:10.1177/0363546514562739.

• Rauh MJ, Margherita AJ, Rice SG, Koepsell TD, Rivara FP. High school cross country running injuries: a longitudinal study. Clin J Sport Med. 2000;10(2):110-116.

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CONSISTENT RUNNING IS… NOT IDEAL

• High school runners who don’t vary their mileage over the summer are more likely to get an early-season stress fracture

• Rauh MJ. Summer Training Factors and Risk of Musculoskeletal Injury Among High School Cross-country Runners. J Orthop Sport Phys Ther. 2014;44(10):793-804. doi:10.2519/jospt.2014.5378.

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MILEAGE

• No right answer• Most subscribe to the

10% rule

• Can’t run fast all the time

• Take extended breaks after season

Mileage à

Risk of in

jury

Race time

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OLD SCHOOL METHOD

• Focus is on performance/mileage, not form

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• Few studies examining injury prevention or pathophysiology in this cohort

• Luedke LE, Heiderscheit BC, Williams DSB, Rauh MJ. Association of Isometric Strength of Hip and Knee Muscles With Injury Risk in High School Cross Country Runners. Int J Sports Phys Ther. 2015;10(6):868-876. http://www.ncbi.nlm.nih.gov/pubmed/26618066.

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WHAT TO WORK ON

• Minimize impact• Usually more glute activation• Strong core support• Scapulae stabilized

• Form before mileage!

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GUESS WHAT?

• University of Utah has a runner’s clinic!

DC

STRENGTH TRAINING IN CHILDREN

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STRENGTH TRAINING BENEFITS

• Cardiovascular fitness• Body composition• Bone mineral density• Mental health• Increased strength• Improved overall function

• Faigenbaum AD, Kraemer WJ, Blimkie CJR, et al. Youth resistance training: updated position statement paper from the national strength and conditioning association. J strength Cond Res. 2009;23(5 Suppl):S60-79. doi:10.1519/JSC.0b013e31819df407.

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STRENGTH TRAINING RISKS

• Muscle strains• More common to have injuries

– Home equipment– Unsupervised

• When supervised, risks lower than that at recess

• Catastrophic injuries possible!• American Academy of Pediatrics Council on Sports Medicine and Fitness, McCambridge TM, Stricker PR. Strength training by children and adolescents. Pediatrics. 2008;121(4):835-840.

doi:10.1542/peds.2007-3790.• Faigenbaum AD, Myer GD. Resistance training among young athletes: Safety, efficacy and injury prevention effects. Br J Sports Med. 2010;44(1):56-63. doi:10.1136/bjsm.2009.068098.

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EFFECTS ON GROWING

• Numerous studies have shown no effect on– Linear growth– Physeal injuries

• With improper load– Acute physeal injuries – case reports

• American Academy of Pediatrics Council on Sports Medicine and Fitness, McCambridge TM, Stricker PR. Strength training by children and adolescents. Pediatrics. 2008;121(4):835-840. doi:10.1542/peds.2007-3790.

• Faigenbaum AD, Myer GD. Resistance training among young athletes: Safety, efficacy and injury prevention effects. Br J Sports Med. 2010;44(1):56-63. doi:10.1136/bjsm.2009.068098.

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SPECIAL POPULATIONS

• Cerebral palsy – increased strength, overall function, improved mental well-being

• Spinal Muscular Atrophy – safe• Down Syndrome – well-tolerated, safe

• Lewelt A, Krosschell KJ, Stoddard GJ, et al. Resistance strength training exercise in children with spinal muscular atrophy. Muscle Nerve. 2015;52(4):559-567. doi:10.1002/mus.24568.• American Academy of Pediatrics Council on Sports Medicine and Fitness, McCambridge TM, Stricker PR. Strength training by children and adolescents. Pediatrics. 2008;121(4):835-840..• Gupta S, Rao BK, Sd K. Effect of strength and balance training in children with Down’s syndrome: A randomized controlled trial. Clin Rehabil. 2011;25(5):425-432. doi:10.1177/0269215510382929.• Verschuren O, Ada L, Maltais DB, Gorter JW, Scianni A, Ketelaar M. Muscle strengthening in children and adolescents with spastic cerebral palsy: considerations for future resistance training

protocols. Phys Ther. 2011;91(7):1130-1139. doi:10.2522/ptj.20100356.

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STRENGTH TRAINING – PEDIATRIC POPULATIONS TO BE AWARE OF• Hypertension • Pulmonary hypertension• Previous cardiotoxic chemotherapy• Cardiomyopathy• Marfan syndrome with dilated aortic root• Seizure disorders• Ehlers-Danlos• Muscular dystrophy

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ADOLESCENTS VS. PRE-ADOLESCENTS• ↑ Strength• ↑ Motor unit

recruitment• ↑ Hypertrophy

• ↑ Strength• ↑ Motor unit

recruitment• No hypertrophy

• American Academy of Pediatrics Council on Sports Medicine and Fitness, McCambridge TM, Stricker PR. Strength training by children and adolescents. Pediatrics. 2008;121(4):835-840. doi:10.1542/peds.2007-3790.

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STRENGTH TRAINING IN OVERWEIGHT CHILDREN• Avoids high impact (e.g. running)• Larger children can often outperform peers• Increased metabolic rate• Decrease in body fat percentage• Increase in strength

• Schranz N, Tomkinson G, Olds T. What is the effect of resistance training on the strength, body composition and psychosocial status of overweight and obese children and adolescents? a systematic review and meta-analysis. Sport Med. 2013;43(9):893-907. doi:10.1007/s40279-013-0062-9.

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STRENGTH TRAINING IN OVERWEIGHT CHILDREN

• Schranz N, Tomkinson G, Olds T. What is the effect of resistance training on the strength, body composition and psychosocial status of overweight and obese children and adolescents? a systematic review and meta-analysis. Sport Med. 2013;43(9):893-907. doi:10.1007/s40279-013-0062-9.

DC

HOW DANGEROUS IS IT?

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STUDIES ALL MENTION APPROPRIATE SUPERVISION

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INJURY STUDIES

• “In the vast majority of resistance training intervention studies…, the injury occurrence in children and adolescents was either very low or nil.”

• 0.53 – 1.76 injuries per 1,000 participant-hours

• No evidence of ↑ CPK levels• Faigenbaum AD, Myer GD. Resistance training among young athletes: Safety, efficacy and injury prevention effects. Br J Sports Med. 2010;44(1):56-63. doi:10.1136/bjsm.2009.068098.

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INJURY STUDIES

• Studies examining lifting maximal load (e.g. 1-repetition maximum) in 6-12 year-olds– No injuries when protocols followed

• Comparative studies often show weightlifting to be safer than other sports

• Faigenbaum AD, Myer GD. Resistance training among young athletes: Safety, efficacy and injury prevention effects. Br J Sports Med. 2010;44(1):56-63. doi:10.1136/bjsm.2009.068098.

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• A little biased

LOCATIONS OF INJURIES – ER VISITS

• Faigenbaum AD, Myer GD. Resistance training among young athletes: Safety, efficacy and injury prevention effects. Br J Sports Med. 2010;44(1):56-63. doi:10.1136/bjsm.2009.068098.

DC

SO YOUR KID WANTS TO LIFT…

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HOW YOUNG IS TOO YOUNG?

• Balance and postural maturity– These mature to adult levels by 7-8 years of age

• Emotional maturity– Ability to accept and follow directions

(technique)– Ability to focus

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OLDER = MORE STRENGTH GAINS

• Behringer M, vom Heede A, Yue Z, Mester J. Effects of Resistance Training in Children and Adolescents: A Meta-analysis. Pediatrics. 2010;126(5):e1199-e1210. doi:10.1542/peds.2010-0445.

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TYPES OF WEIGHTLIFTING

• Most gym equipment is made for adults• Free weights require more balance and

control• Explosive (e.g. Olympic) weightlifting and

maximal lifting (e.g. 1-rep max)– Controversial if not at physical/skeletal maturity– Form is key for anyone

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STARTING OUT

• Position statements

• American Academy of Pediatrics Council on Sports Medicine and Fitness, McCambridge TM, Stricker PR. Strength training by children and adolescents. Pediatrics. 2008;121(4):835-840. • Faigenbaum AD, Kraemer WJ, Blimkie CJR, et al. Youth resistance training: updated position statement paper from the national strength and conditioning association. J strength Cond Res.

2009;23(5 Suppl):S60-79. doi:10.1519/JSC.0b013e31819df407.

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FULL GUIDELINES - NSCA

• Faigenbaum AD, Kraemer WJ, Blimkie CJR, et al. Youth resistance training: updated position statement paper from the national strength and conditioning association. J strength Cond Res. 2009;23(5 Suppl):S60-79. doi:10.1519/JSC.0b013e31819df407.

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STARTING OUT

• Safety first – EVERY study talks about appropriate supervision

• Medical evaluation• Part of comprehensive exercise plan

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BASICS

• Warm up and cool down (10 mins)• Initial exercises should be performed

without load until perfected• Then, 2-3 sets of higher (8-15) repetitions• 2-3 times per week• Addressing all major muscle groups

through complete range of motion• American Academy of Pediatrics Council on Sports Medicine and Fitness, McCambridge TM, Stricker PR. Strength training by children and adolescents. Pediatrics. 2008;121(4):835-840.

doi:10.1542/peds.2007-3790.

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MORE ADVANCED

• Varying exercises• Periodization• Sports-specific training?

• Faigenbaum AD, Kraemer WJ, Blimkie CJR, et al. Youth resistance training: updated position statement paper from the national strength and conditioning association. J strength Cond Res. 2009;23(5 Suppl):S60-79. doi:10.1519/JSC.0b013e31819df407.

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FULL GUIDELINES - NSCA

• Faigenbaum AD, Kraemer WJ, Blimkie CJR, et al. Youth resistance training: updated position statement paper from the national strength and conditioning association. J strength Cond Res. 2009;23(5 Suppl):S60-79. doi:10.1519/JSC.0b013e31819df407.

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PEDIATRIC STRENGTH COACHES

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CERTIFICATIONS

• ACSM Health Fitness Instructor (different than ACSM Certified personal trainer)– Associates or bachelor’s in health-related field,

CPR certification

• NSCS-CSCS (not personal trainer): – Requires BA/BS, CPR certification, significant

examination

• Others – the certification isn’t everything!

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AN ARGUMENT FOR PEDIATRIC WEIGHTLIFTING

• Backpacks

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ANABOLIC STEROIDS

• Easy to purchase online• Unknown use prevalence in children and

adolescents

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QUESTIONS?