HIGH-IMPACT SPORTS & ADOLESCENTS…

What we know about the long term detrimental effects of participating in high-impact sports as adolescents…

As with the debate around strength and conditioning for adolescents, there is also debate about ‘how much is too much?’, especially in regards to participation in high impact sports.

Due to these ongoing debates, there has now been research conducted to specifically identify if there is any correlation between playing high impact sports during adolescence and the potential for detrimental long term effects on the body.

So, what does this research tell us…

Most recently, a focus has been placed on soccer players and hip pathology. There is also similar research and evidence detailing a link between basketball players and hip pathology. Together, the results are quite conclusive.

Recent studies have found:

  1. Changes can occur to the bones in the hip joint (femoral head and acetabulum) secondary to increased load (high impact sports). These changes are referred to as a ‘Cam deformity’ (see the picture below).
  2. These changes lead to the early development of osteoarthritis in the hip. Symptomatic hip osteoarthritis is seen in adult populations from the age of 40.
  3. These bony changes (or Cam deformities) at the hip usually occur between the ages of 12 and 13, when adolescents are going through their growth spurts. This is when the bone is highly responsive to load and consequently the body will lay down more bone in areas where there is a higher load, which leads to the development of Cam deformities.
    • 60-90% of the adult athletic population will have a Cam deformity.
    • Adolescents who participate in high impact sport more than four times a week before the age of 12 are 64% more likely to develop a Cam deformity.
    • Adolescents who participate in high impact sport more than four times a week after the age of 12 are 40% more likely to develop a Cam deformity.
    • The presence of ‘flattened’ or ‘prominence’ was minimal in the 12-13 year old group at baseline. This age-group had the most significant change; at baseline, 84.1% had normal appearances of their hips, two years later only 43.2% were normal.
    • Looking at the columns on the far right, open and closed growth plate (GP), it is evident that most changes happen while the growth plate is open.
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These results suggest a dose-response relationship between the frequency of loading (training and games) during growth phases of adolescence and cam deformity in adulthood. This means the more time spent training and playing, the more likely a cam deformity will exist in adulthood.

Research is showing a prevalence of Cam deformities as high as 60%-89% in those who participate in high impact sport more than four times a week before the age of 12. This is compared to a prevalence of 17%-20% in the general population.

The graph below shows the following:

  • Graph A – Baseline (B) and follow-up (FU) data (which was taken a minimum of 2-years later) based on hip classification.
    • Normal – what you would expect and class as a normal hip
    • Flattened – initial/early changes that can develop into a Cam deformity
    • Prominence – notable Cam deformity
    • The presence of ‘flattened’ or ‘prominence’ was minimal in the 12-13 year old group at baseline. This age-group had the most significant change; at baseline, 84.1% had normal appearances of their hips, two years later only 43.2% were normal.
    • Looking at the columns on the far right, open and closed growth plate (GP), it is evident that most changes happen while the growth plate is open.
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  • Graph B – Baseline (B) and follow-up (FU) data (which was taken a minimum of 2-years later) based on radiological presence of a Cam deformity.
    • Normal – a normal x-ray of the hip
    • Cam deformity – changes in the hip that indicate increase loading and bony deposition
    • Pathological Cam deformity – significant changes with a large cam deformity.
    • As you look across the age groups, there is a steady increase of pathological cam deformities. These numbers increase both between baseline and follow up, but also increase between each of the age groups and open vs closed growth plates.
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So, what should we do with this information?

Essentially, this information is telling us that if you play high impact sport more than four times a week before the age of 12 you are more likely to develop changes in your hip. These changes significantly increase the likelihood of developing osteoarthritis of the hip later in life.

The statistics to back this up…

  • 5%-30% of the general population will develop hip osteoarthritis, with an average age of onset being 60 years or older. 11%-60% of the athletic population will develop hip osteoarthritis, with the onset being between the ages of 40 and 55.
  • Looking back to graph B above, those in the ‘cam deformity’ group are four times more likely to develop osteoarthritis of the hip. Those in the ‘pathological cam deformity’ are ten times more likely. Even the ‘normal’ group is 2-3 times more likely to develop hip osteoarthritis when compared to the general population.

This information is based on high impact sports only (basketball and soccer in particular) and is looking at the hip joint specifically. There have been no formal recommendations on changes that should be made to loading based on this research; these decisions have been left up to each individual.

What is also interesting is we are only looking at one joint in the body. So, are there similar changes happening secondary to increased loading during adolescence in other joints in the body? There has been research which links pitching in baseball and changes in the shoulder when there is a high training load in adolescent growth phases. To my knowledge, there is no other convincing evidence linking skeletal changes and high sporting loads, however, this may be because the research is yet to be done!

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