Cynthia R. LaBella

Sports Drinks and Energy Drinks for Children and Adolescents: Are They Appropriate?

Sports and energy drinks are being marketed to children and adolescents for a wide variety of inappropriate uses. Sports drinks and energy drinks are significantly different products, and the terms should not be used interchangeably. The primary objectives of this clinical report are to define the ingredients of sports and energy drinks, categorize the similarities and differences between the products, and discuss misuses and abuses. Secondary objectives are to encourage screening during annual physical examinations for sports and energy drink use, to understand the reasons why youth consumption is widespread, and to improve education aimed at decreasing or eliminating the inappropriate use of these beverages by children and adolescents. Rigorous review and analysis of the literature reveal that caffeine and other stimulant substances contained in energy drinks have no place in the diet of children and adolescents. Furthermore, frequent or excessive intake of caloric sports drinks can substantially increase the risk for overweight or obesity in children and adolescents. Discussion regarding the appropriate use of sports drinks in the youth athlete who participates regularly in endurance or high-intensity sports and vigorous physical activity is beyond the scope of this report.

Effect of Neuromuscular Warm-up on Injuries in Female Soccer and Basketball Athletes in Urban Public High Schools: Cluster Randomized Controlled Trial

OBJECTIVE To determine the effectiveness of coach-led neuromuscular warm-up on reducing lower extremity (LE) injuries in female athletes in a mixed-ethnicity, predominantly low-income, urban population. DESIGN Cluster randomized controlled trial. SETTING Chicago public high schools. PARTICIPANTS Of 258 coaches invited to participate, 95 (36.8%) enrolled (1558 athletes). Ninety coaches and 1492 athletes completed the study. INTERVENTIONS We randomized schools to intervention and control groups. We trained intervention coaches to implement a 20-minute neuromuscular warm-up. Control coaches used their usual warm-up. MAIN OUTCOME MEASURES Coach compliance was tracked by self-report and direct observation. Coaches reported weekly athlete exposures (AEs) and LE injuries causing a missed practice or game. Research assistants interviewed injured athletes. Injury rates were compared between the control and intervention groups using χ(2) and Fisher exact tests. Significance was set at P < .05. Poisson regression analysis adjusted for clustering and covariates in an athlete subset reporting personal information (n = 855; 57.3%). RESULTS There were 28 023 intervention AEs and 22 925 control AEs. Intervention coaches used prescribed warm-up in 1425 of 1773 practices (80.4%). Intervention athletes had lower rates per 1000 AEs of gradual-onset LE injuries (0.43 vs 1.22, P < .01), acute-onset noncontact LE injuries (0.71 vs 1.61, P < .01), noncontact ankle sprains (0.25 vs 0.74, P = .01), and LE injuries treated surgically (0 vs 0.17, P = .04). Regression analysis showed significant incidence rate ratios for acute-onset noncontact LE injuries (0.33; 95% CI, 0.17-0.61), noncontact ankle sprains (0.38; 95% CI, 0.15-0.98), noncontact knee sprains (0.30; 95% CI, 0.10-0.86), and noncontact anterior cruciate ligament injuries (0.20; 95% CI, 0.04-0.95). CONCLUSION Coach-led neuromuscular warm-up reduces noncontact LE injuries in female high school soccer and basketball athletes from a mixed-ethnicity, predominantly low-income, urban population. TRIAL REGISTRATION CLINICALTRIALS.ORG IDENTIFIER: NCT01092286.

Sports specialization in young athletes: evidence-based recommendations.

Context: Sports specialization is intense training in 1 sport while excluding others. Sports specialization in early to middle childhood has become increasingly common. While most experts agree that some degree of sports specialization is necessary to achieve elite levels, there is some debate as to whether such intense practice time must begin during early childhood and to the exclusion of other sports to maximize potential for success. There is a concern that sports specialization before adolescence may be deleterious to a young athlete. Evidence Acquisition: PubMed and OVID were searched for English-language articles from 1990 to 2011 discussing sports specialization, expert athletes, or elite versus novice athletes, including original research articles, consensus opinions, and position statements. Results: For most sports, there is no evidence that intense training and specialization before puberty are necessary to achieve elite status. Risks of early sports specialization include higher rates of injury, increased psychological stress, and quitting sports at a young age. Sports specialization occurs along a continuum. Survey tools are being developed to identify where athletes fall along the spectrum of specialization. Conclusion: Some degree of sports specialization is necessary to develop elite-level skill development. However, for most sports, such intense training in a single sport to the exclusion of others should be delayed until late adolescence to optimize success while minimizing injury, psychological stress, and burnout.

Sports-Specialized Intensive Training and the Risk of Injury in Young Athletes A Clinical Case-Control Study

Background: Data are lacking regarding the independent risk of injury related to intense single-sport training or growth rate in young athletes. Purpose: To determine whether sports specialization, weekly training volumes, and growth rates are associated with increased risk for injury and serious overuse injury in young athletes. Study Design: Case-control study; Level of evidence, 3. Methods: Injured athletes aged 7 to 18 years were recruited from 2 hospital-based sports medicine clinics and compared with healthy controls from affiliated primary care clinics undergoing sports physicals (2010-2013). Participants completed surveys reporting hours per week spent in organized sports, physical education class, and free play, as well as degree of sports specialization and Tanner stage. Heights and weights were measured. Injury details were obtained from athlete surveys and electronic medical records. Results: Of 1214 athletes enrolled, 1190 (50.7% male) had data satisfactory for analysis. There were 822 injured participants (49.5% male; unique injuries, n = 846) and 368 uninjured participants (55% male). Injured athletes were older than uninjured athletes (14.1 ± 2.1 vs 12.9 ± 2.6 years; P < .001) and reported more total hours of physical activity (19.6 ± 9.2 vs 17.6 ± 8.9 h/wk; P < .001) and organized sports activity (11.2 ± 2.6 vs 9.1 ± 6.3 h/wk; P < .01). After accounting for age and hours in sports activity spent per week, sports-specialized training was an independent risk for injury (odds ratio [OR], 1.27; 95% CI, 1.07-1.52; P < .01) and serious overuse injury (OR, 1.36; 95% CI, 1.08-1.72; P < .01). Young athletes participating in more hours of sports per week than number of age in years (OR, 2.07; 95% CI, 1.40-3.05; P < .001) or whose ratio of organized sports to free play time was >2:1 hours/week had increased odds of having a serious overuse injury (OR, 1.87; 95% CI, 1.26-2.76; P < .01). Growth rates were similar between injured and uninjured athletes (4.8 cm/y for both groups; P = .96). Conclusion: Injured young athletes were older and spent more hours per week in organized sports. There is an independent risk of injury and serious overuse injury in young athletes who specialize in a single sport. Growth rate was not related to injury risk. The study data provide guidance for clinicians counseling young athletes and their parents regarding injury risks associated with sports specialization.

Anterior Cruciate Ligament Injuries: Diagnosis, Treatment, and Prevention

The number of anterior cruciate ligament (ACL) injuries reported in athletes younger than 18 years has increased over the past 2 decades. Reasons for the increasing ACL injury rate include the growing number of children and adolescents participating in organized sports, intensive sports training at an earlier age, and greater rate of diagnosis because of increased awareness and greater use of advanced medical imaging. ACL injury rates are low in young children and increase sharply during puberty, especially for girls, who have higher rates of noncontact ACL injuries than boys do in similar sports. Intrinsic risk factors for ACL injury include higher BMI, subtalar joint overpronation, generalized ligamentous laxity, and decreased neuromuscular control of knee motion. ACL injuries often require surgery and/or many months of rehabilitation and substantial time lost from school and sports participation. Unfortunately, regardless of treatment, athletes with ACL injuries are up to 10 times more likely to develop degenerative arthritis of the knee. Safe and effective surgical techniques for children and adolescents continue to evolve. Neuromuscular training can reduce risk of ACL injury in adolescent girls. This report outlines the current state of knowledge on epidemiology, diagnosis, treatment, and prevention of ACL injuries in children and adolescents.

Athletic Participation by Children and Adolescents Who Have Systemic Hypertension

Children and adolescents who have hypertension may be at risk for complications when exercise causes their blood pressure to rise even higher. The purpose of this statement is to update recommendations concerning the athletic participation of individuals with hypertension, including special populations such as those with spinal cord injuries or obesity, by using the guidelines from “The 36th Bethesda Conference: Eligibility Recommendations for Competitive Athletes with Cardiovascular Abnormalities”; “The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents”; and “The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.”

Policy statement - Climatic heat stress and exercising children and adolescents

Results of new research indicate that, contrary to previous thinking, youth do not have less effective thermoregulatory ability, insufficient cardiovascular capacity, or lower physical exertion tolerance compared with adults during exercise in the heat when adequate hydration is maintained. Accordingly, besides poor hydration status, the primary determinants of reduced performance and exertional heat-illness risk in youth during sports and other physical activities in a hot environment include undue physical exertion, insufficient recovery between repeated exercise bouts or closely scheduled same-day training sessions or rounds of sports competition, and inappropriately wearing clothing, uniforms, and protective equipment that play a role in excessive heat retention. Because these known contributing risk factors are modifiable, exertional heat illness is usually preventable. With appropriate preparation, modifications, and monitoring, most healthy children and adolescents can safely participate in outdoor sports and other physical activities through a wide range of challenging warm to hot climatic conditions.

Policy statement—Boxing participation by children and adolescents.

Thousands of boys and girls younger than 19 years participate in boxing in North America. Although boxing provides benefits for participants, including exercise, self-discipline, and self-confidence, the sport of boxing encourages and rewards deliberate blows to the head and face. Participants in boxing are at risk of head, face, and neck injuries, including chronic and even fatal neurologic injuries. Concussions are one of the most common injuries that occur with boxing. Because of the risk of head and facial injuries, the American Academy of Pediatrics and the Canadian Paediatric Society oppose boxing as a sport for children and adolescents. These organizations recommend that physicians vigorously oppose boxing in youth and encourage patients to participate in alternative sports in which intentional head blows are not central to the sport.

The American Academy of Orthopaedic Surgeons Evidence-Based Guideline on Management of Anterior Cruciate Ligament Injuries

This article was updated on June 30, 2015, because of a previous error. The name of one of the authors, which had previously read “Gregory D. Meyer, PhD,” has been corrected to read “Gregory D. Myer, PhD.” An erratum has been published: J Bone Joint Surg Am. 2015 Aug 5;97(15):e57. The AAOS Evidence-Based Guideline on Management of Anterior Cruciate Ligament Injuries includes both diagnosis and treatment. This clinical practice guideline has been endorsed by the National Academy of Sports Medicine (NASM), the American Orthopaedic Society for Sports Medicine (AOSSM), the National Athletic Trainers’ Association (NATA), and the American Academy of Physical Medicine and Rehabilitation (AAPM&R). This brief summary of the AAOS Clinical Practice Guideline contains a list of the recommendations and the rating of strength based on the quality of the supporting evidence. Discussion of how each recommendation was developed and the complete evidence report are contained in the full guideline at www.aaos.org/guidelines. ### ACL HISTORY AND PHYSICAL Strong evidence supports that the practitioner should obtain a relevant history and perform a musculoskeletal exam of the lower extremities, because these are effective diagnostic tools for ACL injury. Strength of Recommendation: Strong ★★★★ ### ACL RADIOGRAPHS In the absence of reliable evidence, it is the opinion of …

Preseason Neuromuscular Exercise Program Reduces Sports-Related Knee Pain in Female Adolescent Athletes

Sports-related knee pain is a common complaint among female adolescent athletes and frequently limits sports participation. Intrinsic neuromuscular risk factors for sports-related knee pain in these athletes include hip muscle weakness and poor explosive poweronvertical jump test. Neuromuscular training for these athletes can improve hip strength, lowerextremity explosive power, and objective measures of athletic performance, such as vertical jump height, squat strength, balance, and sprint speed. Hewett et al and Mandelbaum et al showed that neuromuscular training reduces knee ligament injuries in female adolescent athletes; however, no data demonstrate that neuromuscular training reduces sports-related knee pain. We tested the hypothesis that preseason neuromuscular training would reduce sports-related knee pain and improve self-rated athletic performance.