Perils of Puberty for Young Male Athletes
Helping boys navigate growing pains and dangers of overuse injury as they enter adolescence
In these virtual pages we have devoted a lot of attention and ink (keystrokes?) to the challenges young females face as they reach adolescence and the imperative of early training intervention to provide girls with the boost they require to endure and overcome. It is true that boys are generally more favoured by nature as puberty comes later and brings a ‘neuromuscular spurt’ (free gains in lean mass, strength, power, speed and endurance) to accompany the adolescent growth spurt (sadly girls are not so fortunate). All the same, pubertal boys do face growing pains and heightened risk of overuse injuries as a consequence of the combined strains of rapid growth and stresses of practices and competition. The danger zone for young male athletes coincides with early adolescence. It is during this period before they fully grow into their bodies that we see musculoskeletal pain and the precursors of common overuse injuries affecting major joints. Care is required to help boys to get through this sensitive period unscathed, but we can also take a more proactive strategy and implement certain countermeasures to mitigate risks and address early signs before they develop into overuse injuries.
The period that coincides with peak height velocity (the phase of most rapid growth otherwise known as the adolescent growth spurt) and the 12 months that follow is known to be a time of elevated risk for young male athletes. Certainly a significant proportion of the young male athletes who come to me via referral from a sports injury practitioner fall into this category. Youth academies in professional (soccer) football increasingly employ special measures around this age and stage to better accommodate growth and maturation factors in an effort to reduce injury risk. This includes regular assessment to track individual growth and maturation to identify those approaching the period of heightened risk so that coaches can adjust training and practice loads accordingly.
Whilst boys do have the advantage of the aforementioned neuromuscular spurt, there is a lag before these natural gains in strength and function fully kick in. Naturally it also takes time to adapt to their changing bodies and over this phase boys must continually recalibrate their motor control and coordination to adjust to their growing limbs and increasing mass. Another issue is that different tissues do not adapt to growing limbs in a uniform manner. Muscle is most responsive, whereas connective tissues tend to lag behind and the imbalance in development may be amplified by the effects of the hormones released during male puberty. It is no coincidence that the attachment site between bone and tendon is a common site of the overuse injuries that pubertal male athletes are susceptible to.
The incidence of specific conditions depends on what sport(s) the young athlete participates in. Anterior knee pain (persistent soreness at the front of the knee, in plain language) is prevalent in court and field sports that involve frequent jumping, landing and running activity - hence it is often termed ‘jumper’s knee’ or ‘runner’s knee’. Tendinopathy affecting the shoulder is common in throwing sports, whereas tendinopathy at the hip and lower leg is more often seen in artistic and skating sports. If left unchecked, each of these can develop into more severe overuse injuries where repetitive excessive traction leads to microavulsion fractures at the region where tendon inserts onto the bone. These conditions are most prevalent among boys and include Sever’s disease affecting the heel where the achilles tendon attaches, Osgood-Schlatter disease (knee) and ‘Little League Elbow’ in throwing sports.
The injury risk factors associated with these overuse conditions also differ between boys and girls. Whereas deficits in strength and consequent movement compensations primarily drive the increased risk in girls, reduced flexibility is a major factor contributing to overuse injuries in boys, which is not typically the case with girls (if anything girls tend to suffer from too much flexibility rather than too little). For instance, restricted knee and hamstring range of motion is associated with anterior knee pain. Reduced quadriceps and upper calf flexibility is likewise a known risk factor for Osgood-Schlatter disease.
Whilst certain overuse conditions might be commonly associated with particular sports (‘Little league elbow’ being a striking example), the most important take-home message is that these injuries are preventable whatever sport(s) boys participate in. Beyond tracking growth and regulating practice volumes, steps can be taken to address specific needs and risk factors as part of young athletes’ regular physical preparation. Being proactive in addressing known risk factors is the best approach to guard against developing these conditions in the first instance. Once symptoms start to occur early intervention offers the best outcome.
Each of the conditions cited is due to biomechanical overload that overwhelms the body’s natural adaptive response. The most effective preventive measure or countermeasure when symptoms start to occur involves dryland or off-field training to fortify the relevant tissues, create reserve capacity and improve tolerance to load. Strength training does not just build muscle but also stimulates bone growth and tendon adaptation. Specifically, strength training through full range of motion at controlled tempo, including a pause during the top of the movement and going slow during the lowering or eccentric phase of the motion, is most conducive to training tendon and will also support the effort to develop and maintain flexibility as kids grow. Increasing lean mass and strength also promotes bone development during growth and maturation.
Easing the passive stress on the tissues around periods of rapid growth also means addressing soft tissue restriction and increasing active and passive range of motion. Getting the regular dose required to achieve this means incorporating flexibility training (various forms of stretching) and mobility training (actively moving through full range of motion whilst supporting their weight) in the young athlete’s daily routine. I have long been a proponent of a daily mobility regimen, especially with young developing athletes, and this should be first thing that a young athlete does when they arrive at practice.