Are We Losing Talented Young Athletes?

Picture by Richard Seow from Flickr

I came across a really interesting article (Abbott et al, 2020) this week measuring adolescent maturation with respect to sports. 

Our Singapore national school sports competitions use chronological age to categorize adolescent athletes. Australia does the same when it comes to their age group swimming competitions.

The researchers in the paper use a handful of physiological measurements to come up with an estimate of an adolescent's relative age. So, for two 13 year olds born exactly on the same day, one of them can be an early maturer with a relative age of say 13 years and 7 months. The other adolescent can be a late maturer with a relative age of 12 years and one month. They both have the same birthdate, however, in practice one has a 18 months maturity advantage over the other.

The table in the picture above shows the researchers' maturation measure applied to age group swimmers in Australia competing in the 100 m freestyle. You can see that all the swimmers at the top end of this Australian age group are those in the "early" or "early-normal" categories. They are the faster swimmers.

Look at the "late" maturers column, it's a whole long line of zeros. If you look at it from another perspective, it also means that Australia is losing 50 percent of their talent pool. These swimmers probably started swimming with the rest of their age cohort, but by age 13, they probably all became disillusioned and dropped out. So where did all these slowly maturing kids go? Did they all decide to play computer games instead? Hopefully, they found another sport to participate in.

To find their next generation of elite swimmers, Australia is using a high stakes, winner takes all competitive swim competitions. The effect of those competitions was to chase away half the cohort of young swimmers away from swimming.

Now, if we relate this to Singapore's own school sports scene, does this mean that the Singapore Sports School and other schools' Direct School Admission (DSA) selection criteria is also slightly flawed? Perhaps that can explain why many of these 'talented' kids who are early maturers (at 13 years old when they go to Secondary school) don't carry on competing and drop out. 

If you read my earlier post, it it reasonable to say that some of these early maturing athletes in the Sports School or DSA programs would have exceled in any physical screening tests. Just like my classmate in that post who reached puberty and had his growth spurt earlier than us in Primary school. He was physically superior to everyone else. That's how he won all his track events earlier. When the rest of us "caught up" when we hit puberty, he didn't have that advantage anymore.

Having been raised on victories from young, they may not comprehend or accept defeat. Early victories may have paved the way for defeat and giving up eventually.

Please take note that I am not criticising the Singapore Sports School or the DSA programs currently in place. I am just suggesting that our local childhood talent selection programs, on closer examination, are not as meritocratic as they may seem.

A child/ adolescent who is a late maturer may not necessarily be not talented in sports. It may be a lack of motivation. No child or adolescent will persist or strive in an athletic activity if they do not feel they are competitive with their peers.

My wishes for these national schools competitions are that that they can provide opportunities for students to experience joy (and of course heart break) from exercise and competition. To lay down life-long habits of physical activity. And finally to provide those with ability for futher higher level competiton to represent their country. 

Reference

Abbott S, Hogan C, Castiglioni MT et al (2020). Maturity- related Developmental Inequalities In Age-group Swimming: The Testing of 'Mat-CAPs' For Their Removal. J Sci Med Sp. 24(4): 397-404. DOI: 10.1016/jsams.2020.10.003

OCD

Kindly drawn by my older son

In case you're wondering about the title, it's not obsessive compulsive disorder, I definitely can't write a post on that. But I do know about osteochondritis dissecans (OCD). In fact when I kept having recurrent knee pain back in 2002 (which subsequently led to 3 knee operations), I initially thought I had OCD myself, before MRI scans suggested otherwise.

OCD occurs when part of a bone within a joint dies due to lack of blood flow and partially or fully separates from the joint. This separated bone piece can cause pain and subsequently restrict movement in that joint. Meaning you cannot fully straighten or bend that joint.

The cause of OCD is unknown. It is suggested that reduced blood flow to the bone may occur from repetitive trauma like excessive running and jumping. Or small, multiple episodes of minor unknown injury that damage the bone over time. Some studies suggest that there may be a genetic component involved too.

OCD occurs most frequently in children and adolescents, most commonly in the knee, but can also occur in the elbow and ankle. 

Doctors stage OCD according to how big the bone fragment is, whether the bone fragment is totally or partially separated or whether it stays in place. If that loosened piece of bone is not detached, then there may be few or no symptoms. For younger children whose bones are still growing and developing, there is a chance that it can heal.

So it was a total surprise to me when my adult patient was diagnosed with OCD 2 days ago. 

She was in the process of sitting down on her sofa and slightly twisted her knee. She could not extend or bend her knee fully nor put weight on her foot after that. She went to the hospital and was told it might be a meniscus tear and may need surgery. The surgeon suggested an MRI to confirm his hypothesis.

Hence, when the MRI results came out it was a big surprise that there was a bone fragment dislodged. That's the reason why she could not straighten or bend her knee fully.

The only incident my patient could think of was during gymnastics, when she was 12, that her knee started to hurt (possibly from the impact of repeated running and landing). Her knee would 'lock' occasionally for a few days at a time. It gradually resolved and she would occasionally have some knee pain on that same left knee while she competed in triathlons. Otherwise, there was no other clue that she would have OCD.

Now my patient has to decide how she would like to proceed to get the bone fragment out after discussion with her surgeon.

Reference

Kocher MS, Tucker R, Ganley TJ et al (2006). Management Of Osteochondritis Dissecans Of The Knee: Current Concepts Review. AJSM. 34(7): 1181-1191. DOI: 10.177/0363546506290127.

Picture from RadioGraphics