Sunday, April 25, 2021

Should Youths Run Long Distances?

Picture by Richseow from Flickr

I had a friend ask me on Thursday if his friend's kids should come in to our clinic for physiotherapy or sports massage as they were complaining of feeing 'tight' in their muscles. This year, some of the National School Games are allowed to proceed (after being called off because of Covid-19 last year), so many school athletes are competing again.

I do not recall having such privileges during my time. Perhaps we were hardier or maybe ignorant about recovery and whatever help you can get from sports medicine/ physiotherapy. Besides, I was never into running high mileage during my school days. There were other teenage runners who mentioned that they clocked 100 km a week, while I seldom got above 30 km. We did a lot of quality intervals rather than quantity. Definitely no junk miles. Preparing for the GCE 'A' levels did not leave us much time to run that much either.

There have been studies of youth athletes (not specific to runners) that show sport specialization makes them more prone to injury. Especially those who played their primary sports for more than eight months in a year. These youth athletes had more overuse injuries in the upper and lower limbs compared to those who spent less time in their primary sport.

Youth athletes who participated in their primary sport more hours each week than their age in years had more injuries of any type. They were also more likely to have a history of overuse injuries if time spent training exceeded recommendations for their age. Hence it is important to do different sports for youths. And not to push them.

A running specific study on track and cross country events (989 girls and 1022 boys between 12-18 years) found that youth athletes who specialized had more overuse and previous injuries of any kind compared to those who did not specialize (Post et al, 2017)

Another study (of 126 female cross country and distance track and field athletes) found an increased risk in those runners who specialized compared to those who did not (Rauh et al, 2018).

In order to reduce the risk of running related injuries in the youth runner, we must take into account the complex interaction of various factors, including growth related changes unique to this population. A summary of the risk factors are in the table below taken from Krabak et al (2021).


In addition, the following recommendations are based on expert opinions in the study by Krabak et al (2021). A musculoskeletal screening on your youth athletes for previous injuries, menstrual dysfunction (girls) biomechanical concerns and training errors.

Youth runners should take part in high impact and multidirectional activities focusing on control of the backhip and lower extremities through puberty to reduce injury and promote bone health.

Make sure your youth runners have at least one rest day a week, 1-2 weeks off every 3 months and limit participation to less than 9 months each year. Single sport specialization should be discouraged until they pass puberty.

Self motivated youths can be allowed to take part in long distance events if they follow an acceptable supervised training program, maintain normal growth in height and weight and are healthy with good nutritional intake.  

So all physical education teachers, coaches and parents, if your youth athlete has BMI < 17.5kg/m2 or body weight below 85 percent of normal for their age, bone density scores of Z > 1.0, untreated eating disorders, high risk stress fractures (in femoral neck, proximal tibial or navicular bone) and female runners without menarche by 16 years old or less than 6 menstrual cycles in the past 12 months then they will require further medical evaluation.


References

Krabak BJ, Roberts WO, Tenforde AS et al (2021).Youth Running Consensus Statement: Minimising Risk Of Injury And Illness In Youth. BJSM. 55: 305-318. DOI: 10.1136/bjsports-2020-102518.

Post EG, Trigsted SM, Riekena JW et al (2017). The Association Of Sport Specialization And Training Volume With Injury History In Youth Athletes. AJSM. 45: 1405-1412. DOI: 10.1177/0363546517690848.

Rauh MJ, Tenforde AS, Barrack MT et al (2018). Associations Between Sport Specialization, Running-Related Injury, And Menstrual Dysfunction Among High School Distance Runners. Athl Trg Sp Health care. 10: 260-269. DOI: 10.3928/19425864-20180918.

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