Upload
others
View
4
Download
0
Embed Size (px)
Citation preview
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7DC
SPORTS TRAINING IN CHILDREN: FROM RUNNING TO WEIGHTS
DAN CUSHMAN, MD
MARCH 3, 2018
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7DC
DISCLOSURES
Nothing to disclose
DC
THE PEDIATRIC RUNNER
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7DC
MY VIEW
• Sports provide:– Good health– Friends, identity– Life lessons– Ability to achieve goals– Almost never, $$
• Thus, the goal should be long-term health
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7DC
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.
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7DC
TRAINING REGIMENS
• Varied training programs• Varied coaching
experience• Varied medical assistance• Varied parental
“guidance”
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7DC
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)
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7DC
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.
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7DC
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.
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7DC
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
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7DC
OLD SCHOOL METHOD
• Focus is on performance/mileage, not form
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7DC
• 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.
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7DC
WHAT TO WORK ON
• Minimize impact• Usually more glute activation• Strong core support• Scapulae stabilized
• Form before mileage!
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7DC
GUESS WHAT?
• University of Utah has a runner’s clinic!
DC
STRENGTH TRAINING IN CHILDREN
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7DC
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.
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7DC
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.
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7DC
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.
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7DC
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.
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7DC
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
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7DC
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.
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7DC
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.
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7DC
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?
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7DC
STUDIES ALL MENTION APPROPRIATE SUPERVISION
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7DC
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.
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7DC
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.
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7DC
• 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…
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7DC
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
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7DC
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.
Effe
ct si
ze (s
tren
gth
gain
)
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7DC
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
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7DC
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.
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7DC
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.
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7DC
STARTING OUT
• Safety first – EVERY study talks about appropriate supervision
• Medical evaluation• Part of comprehensive exercise plan
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7DC
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.
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7DC
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.
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7DC
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.
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7DC
PEDIATRIC STRENGTH COACHES
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7DC
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!
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7DC
AN ARGUMENT FOR PEDIATRIC WEIGHTLIFTING
• Backpacks
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7DC
ANABOLIC STEROIDS
• Easy to purchase online• Unknown use prevalence in children and
adolescents
© U N I V E R S I T Y O F U T A H H E A L T H , 2 0 1 7DC
QUESTIONS?