Is it Safe for Children to Do Strength Training?

There is substantial interest and lingering concern from parents, coaches, and the medical community about the safety and appropriateness of strength training for children.   Are these concerns based on solid research or are they misconceptions which need to be put to rest?

What is Resistance Training?

Before discussing the evidence, clear definitions of the terms children and resistance (or strength) training are helpful. Resistance training is a specialized form of conditioning whereby an individual is working against a wide range of resistive loads to enhance health, fitness, and performance. Forms of resistance training include the use of body weight, weight machines, free weights (barbells and dumbbells), elastic bands and medicine balls. Resistance training should be distinguished from terms such as weightlifting and bodybuilding. The term children refers to girls and boys (generally up to the age of 11 and 13 years, respectively) prior to puberty and have not developed secondary sex characteristics.

Injury Rates in Children

With qualified supervision, the risk of injury from resistance training for children is very low. Faigenbaum and Myer (2010) summarized over 30 studies conducted on youth resistance training and found reports of only three injuries when properly supervised. The three injuries reported were short-term non-serious injuries such as muscle strains and low back pain. In fact, the estimated risk for injury from youth resistance training has been estimated to be 0.05 to 0.17 for every 100 hours of training. These injuries rates are far lower than those for children engaging in sports such as soccer, football, baseball, gymnastics, lacrosse, and running. Youth injury rates from resistance training are also believed to be no different than those of adults.

Growth Plate Injuries


The most often cited concern associated with youth resistance training is the potential for injury to the growth plate and “stunted growth”. There have been a few retrospective case reports describing injuries to the growth plates in children.  However, most of these injuries were caused by improper lifting technique, poorly chosen loads, or a lack of qualified adult supervision. For example, in one case report a 13-year-old boy sustained elbow growth plate fractures when he lost control of a 65-pound barbell he attempted to press overhead exercising alone at home.

Injury to growth plates has not been reported in any prospective youth resistance training study that provided professional supervision and instruction. There is also no evidence that resistance training can negatively impact growth in height during childhood. The risk of growth plate injury is likely greater when children perform jumping and landing activities during competitive sports or even free play.

Conclusion

Many of the forces that youth are exposed to in sports and recreation (e.g., soccer, basketball, football, and running) are greater both in duration and magnitude than properly performed resistance training. However, problems can, and often do arise, when children are introduced to resistance training with inappropriate instruction or supervision. With the increasing volume and intensity of youth sports, it is more important than ever that children are properly instructed, supervised, and progressed by qualified personnel. Therefore, parents and coaches should seek out qualified professionals who are knowledgeable and up to date with the most current evidence about youth resistance training. When appropriately performed, youth resistance training is safe and extremely beneficial for improving health, fitness, and performance.

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References

  1. Faigenbaum, A., Kraemer, W., Blimkie, C., Jeffreys, I., Micheli, L., Nitka, M., & Rowland, T. (2009). Youth resistance training: Updated position statement paper from the National Strength and Conditioning Association. Journal of Strength and Conditioning Research, 23(5), S60–S79.
  2. Faigenbaum, A. D., & Myer, G. D. (2010). Resistance training among young athletes: safety, efficacy and injury prevention effects. British Journal of Sports Medicine, 44, 56–63. http://doi.org/10.1136/bjsm.2009.068098
  3. Lloyd, R. S., Faigenbaum, A. D., Stone, M. H., Oliver, J. L., Jeffreys, I., Moody, J. A., … Myer, G. D. (2014). Position statement on youth resistance training: The 2014 international consensus. British Journal of Sports Medicine, 48, 498–505. http://doi.org/10.1136/bjsports-2013-092952

Early Sports Specialization in Young Athletes

In the United States, it is estimated that 72% of school-aged youth (8 to 17 years old) participate in at least one organized sport. Sports participation has many benefits, including living a healthy lifestyle, having a positive self-image, and building social relationships. It is also estimated that nearly 30% of school-aged athletes specialize in a single sport year-round6. Sports specialization has been defined as intensive year-round training in a single sport at the exclusion of other sports4. This may include athletes who:

  1. Choose one main sport,
  2. Participate for greater than eight months per year in one main sport, and
  3. Quit all other sports to focus on one sport.

Young athletes who engage in year-round intense training programs in a single sport are prone to overuse injuries, burnout, and dropping out of sports. Sports believed to be most susceptible to these negative consequences are baseball (pitchers especially), cheerleading, gymnastics, soccer, swimming, tennis, and volleyball.

Injury, Burnout, and Dropping out of Sports

Evidence is emerging which shows specialized young athletes are at more risk for injury compared to those who engage in multiple sports. One study of 7 to 18 year old athletes, showed that those who specialized in a single sport were 2.25 more likely to sustain a serious overuse injury compared to unspecialized young athletes4. Another study of 546 high school athletes found a relationship between the development of knee injuries and single- sport training in those engaged in basketball, soccer, and volleyball3. It appears that female high school athletes who specialize in a single sport are particularly vulnerable to hip and knee overuse injuries1,3. A possible explanation for these injury trends is the lack of diversified activity which may not allow young athletes to develop the appropriate neuromuscular skills that are effective in injury prevention. Year-round training in a single sport also does not allow for the necessary rest from repetitive use of the same muscles and segments of the body. The positive transfer of skill with diversification of sport participation is important in the successful development of any young athlete2.

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Young athletes are under a tremendous amount of pressure brought about by adult-driven specialized training programs, weekend tournaments, showcases, and competitions. The psychological risk of burnout, depression, and increased risk of injury is believed to result in withdrawal from sport. In the physical therapy clinic, we are faced with many young athletes who lose their desire to return to sport following injury. It is my belief that these young athletes view their injury as a means to escape from the increased pressures of youth sports. Research has indicated that adolescents need to enjoy their sport, and that intrinsic motivators are keys to maintaining participation and goal achievement in sports. Unfortunately, this is often not the case as the temptation of collegiate scholarships and stardom causes thousands of adolescent athletes to specialize in single sports. While this may result in more highly skilled, sport-mature athletes at a younger age, it is isolating the child and has the potential to lead to increased stress and pressure. Consequently the child loses a sense of control or decision-making power over their lives. These consequences may be far-reaching with the adolescents overall maturation and development5.

Conclusion

Parents and coaches should be cautious with encouraging young athletes to engage in intense year-round training specialized in any single sport. Adults involved in instruction of youth sports should be on the alert for signs of burnout, and physical symptoms in highly specialized athletes and be prepared to take corrective action such as backing off training. A more proactive approach is the better option. Encouraging multiple sports participation has the benefits of reducing injury risk, decreasing the chance of burnout, and the promotion of basic motor skills which will enhance the young athletes overall development throughout their lifespan.

References

  1. Bell DR, Post EG, Trigsted SM, Hetzel S, Mcguine TA, Brooks MA. Prevalence of sport specialization in high school athletics: A 1-year observational study. Am J Sports Med. 2016;44(6):1469-1474. doi:10.1177/0363546516629943.
  2. Fransen J, Pion J, Vandendriessche J, et al. Differences in physical fitness and gross motor coordination in boys aged 6 – 12 years specializing in one versus sampling more than one sport. J Sports Sci. 2012;30(4):379-386.
  3. Hall R, Foss KB, Hewett TE, Myer GD. Sport specialization’s association with an increased risk of developing anterior knee pain in adolescent female athletes. J Sport Rehabil. 2015;24:31-35.
  4. Jayanthi NA, Labella CR, Fischer D, Pasulka J, Dugas LR. Sports-specialized intensive training and the risk of injury in young athletes: A clinical case-control study. Am J Sports Med. 2015;43(4):794-801. doi:10.1177/0363546514567298.
  5. Myer GD, Jayanthi N, Difiori J p, et al. Sport specialization, part I: Does early sports specialization increase negative outcomes and reduce the opportunity for success in young athletes? Sport Heal A Multidiscip Approach. 2015;7(5):437-442. doi:10.1177/1941738115598747.
  6. Myer GD, Jayanthi N, Difiori JP, et al. Sports specialization, part II: Alternative solutions to early sport specialization in youth athletes. Sport Heal A Multidiscip Approach. 2016;8(1):65-73. doi:10.1177/1941738115614811.
  7. Bell DR, Post EG, Trigsted SM, Hetzel S, Mcguine TA, Brooks MA. Prevalence of sport specialization in high school athletics: A 1-year observational study. Am J Sports Med. 2016;44(6):1469-1474. doi:10.1177/0363546516629943.