Should Adolescents Run Marathons?: Youth Marathon Training Injury Epidemiology and Risk Factors

Overuse Injuries, Overtraining, and Burnout in Young Athletes

Sports participation can have tremendous physical and mental health benefits for children. Properly implemented progressive training programs can yield a broad range of beneficial physiologic adaptations, but imbalances of training load and recovery can have important negative consequences. Overuse injuries, for example, can result from repetitive stress without sufficient recovery that leads to accumulated musculoskeletal damage. In addition, extended periods of increased training loads that exceed the intervening recovery can have systemic consequences such as overtraining syndrome, which results in decreased performance, increased injury and illness risk, and derangement of endocrine, neurologic, cardiovascular, and psychological systems. Burnout represents one of the primary reasons for attrition in youth sports. Broadly defined as physical or mental exhaustion and a reduced sense of accomplishment that leads to devaluation of sport, burnout represents a direct threat to the goal of lifelong physical activity and the wide-ranging health benefits that it provides. This clinical report is intended to provide pediatricians with information regarding the risk factors, diagnosis, management, and prevention of these conditions to assist in the identification of at-risk children, the treatment of young athletes, and the guidance of families in the promotion of safe and healthy sport participation.

Clinical assessment, treatment, and referral trends for adolescent runners seeking care at an injured runners' clinic

PURPOSE

Over a 10-year time frame, this study aimed to evaluate diagnosis, treatment, and referral trends for adolescent runners seeking care for running-related injuries (RRIs) at a clinic that specializes in running medicine.

METHODS

This study was a retrospective chart review of 392 adolescent runners (2,326 encounters) who sought care for RRIs between the years 2011 and 2021. Descriptive statistics were used to summarize clinical assessments, referrals, assistive devices, and medications prescribed or administered overall and by injury type. Chi-square analyses were used to compare proportions of services rendered across the 10-year time frame.

RESULTS

Patients most frequently received manual evaluations or special tests during clinic visits. Most visits resulted in at least one referral (91%), primarily for physical therapy or gait-training. Assistive devices and medications/supplements were offered at only 18% of patient visits. The majority of assessments (X2 = 69.7, p = 0.002), treatments (X2: 23.6-43.8, p: <  0.001-0.003), and referrals (X2 = 132, p <  0.001) were for shin injuries. Larger proportions of nutrition assessments (X2 = 40.7, p <  0.001), interventions (X2 = 26.8, p = 0.003), and referrals (X2 = 27.5, p = 0.002) were performed in or after the year 2015.

CONCLUSION

Clinic visits for shin injuries required the most clinical resources per episode of care. There were observed shifts in clinical assessment and treatment approaches to include more expanded nutritional and physiologic considerations.

Outpatient Runners Clinic Visit Trends and Injury Characteristics Among 392 Child and Adolescent Patients: A 10-year Chart Review

OBJECTIVE

To evaluate clinic visits and running-related injury (RRI) characteristics among child and adolescent runners seeking care at an outpatient clinic over a 10-year time frame.

DESIGN

Retrospective chart review.

SETTING

Outpatient hospital-affiliated Injured Runners Clinic.

PATIENTS

Children and adolescent runners (6-17 years) with RRIs.

INDEPENDENT VARIABLES

We examined electronic medical records (EMRs) among child and adolescent patients in the hospital database from 2011 to 2021 to obtain RRI characteristics and key demographic factors.

MAIN OUTCOME MEASURES

We assessed volume and frequency of patient visits to the clinic by RRI characteristics. Chi square analyses were used to compare the proportion of clinic visits over time and injury trends by body region and diagnosis.

RESULTS

There were 392 patients (sex: 277 F; mean age: 16.1 ± 1.3 years) and an average of 5 clinic visits per diagnosis (5 ± 4 visits; min: 1 visit, max: 31 visits). Number of visits generally increased over time up to 2016 but declined most drastically during the years of the pandemic (2020-2021; χ 2 = 644, P < 0 .001). Of the 654 new injury diagnoses, 77.68% were attributed to repetitive stress. Bone stress injuries to the tibia were the most common RRI (χ 2 = 1940, P < 0 .001; N = 132; 20.2% of all injuries) and constituted most of the clinic visits (χ 2 = 9271, P < 0 .001; N = 591; 25.4% of all visits).

CONCLUSION

We identified that adolescents with overuse injuries, particularly bone stress injuries to the tibia, constituted most of the visits to the outpatient healthcare setting. Clinicians should emphasize injury prevention efforts in clinical practice to reduce RRI burden.

Youth Distance Running and Lower Extremity Injury: A Systematic Review

Distance running is a popular youth sport. This systematic review identified and examined the effects of youth distance running and lower extremity musculoskeletal injury. Scientific databases were searched from database inception to May 2020. Two hundred and fifty-eight full texts were screened, with nine articles retained for data extraction. Seven of the studies were case reports or case series. Two case reports involved an apophyseal hip fracture. No correlation was found between running mileage or gender and sustaining an injury. Middle school runners reported fewer injuries than high school runners. Cross country accounted for less than 10% of injuries in youth under 15 compared to other track activities. The main finding was a paucity of research. Available literature suggests youth can participate in distance running with minimal adverse effects. One exception may be increased vulnerability to growth plate injury. Additional research is needed, especially in those under 10, as literature in this population is nonexistent.