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Risk Factors and Assessment Early Athletic Specialization

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Risk Factors and Assessment Early Athletic Specialization : February 2017 Flatfoot questions: Risk PLUS: factors and assessment • Energy costs of footwear, bare feet Early athletic specialization: • Brace wear time in clubfoot Misconceptions and hazards • Lower extremity risk in martial arts : iStockphoto.com #498580822 news From the editor: 5 Shoes add to energy cost of gait Sports in the tiger-parenting era compared with barefoot walking Footwear should allow dynamic activity By Greg Gargiulo It doesn’t surprise me that focusing on achievement in a single sport at a young age substantially raises 6 Sensor data quantify clubfoot the risk of overuse injuries and can lead to other patients’ reported, real brace use physical and developmental issues. Parents overestimate wear times But experts quoted in our current feature (See “Early By Peaches Yeilding athletic specialization: Misconceptions and hazards,” page 15) brought up some less intuitive points about 7 Martial arts students at for risk the increasingly common practice of intense for lower extremity injury, sequelae concentration on a single sport at a young age. Traumas increase with age, skill level Many children who specialize are trading the slim hope of elite By Chris Klingenberg achievement—and often, parents are the driving force behind these hopes— for the benefits and pleasures of the noncompetitive play that used to characterize childhood. Not only did such varied play promote the fundamental mastery of many motor skills, playing different sports allowed features children to find their athletic niche naturally, rather than be routed onto a narrow path. 9 Flatfoot questions: Greg Myer, PhD, associate professor of pediatrics and director of research Risk factors and assessment and the Human Performance Laboratory in the Division of Sports Medicine The proposed association between obesity and pediatric flexible flatfoot at Cincinnati Children’s Hospital Medical Center in Ohio, said his biggest (PFF) may depend more on the reliance on subjective, 2D footprint-based concern about early specialization is that it probably means many kids aren’t assessments than true correlation. And recent research has identified playing the sport for which they’re best suited. another potential risk factor, whole body and joint hypermobility. Lower extremity practitioners can help their young patients by schooling By Hank Black parents on the facts, both obvious and subtle, starting with the data showing 15 Early athletic specialization: specialization can expose children to significant risks for injury now and in the future, and to issues ranging from emotional burnout to eating disorders. Misconceptions and hazards And, in an era of tiger moms and dads, reminding parents, as does a Most elite athletes didn’t concentrate on one sport as adolescents, and longtime coach and athletic director in our feature, that despite the elusive there’s a strong link between early sport specialization and physical injury allure of college scholarships and elite-athlete status, fun and a love of the and emotional burnout. Yet, many parents think this risky path is the only game are perhaps better—and certainly less risky—reasons to play. route to high achievement and college scholarships. By P.K. Daniel Emily Delzell, Senior Editor lerpediatrics.com 02.17 3 Shoes add to energy cost of gait compared with barefoot walking Footwear should allow dynamic activity By Greg Gargiulo Shutterstock.com 139016207 A recent study of the metabolic costs of familiar with the shoe type and had time to barefoot versus shod walking found walking accommodate to walking on the treadmill. said Caleb Wegener, PhD, the footwear re - in shoes required a higher energy expendi - Researchers proposed several factors search and innovation developer for Syd - ture and had a poorer economy than bare - potentially responsible for shod walking’s ney, Australia-based Mack Boots and foot walking. These outcomes suggest going poorer economy. The footwear’s added honorary research associate at the Univer - barefoot may be preferable for children mass may have increased energy costs dur - sity of Sydney. whenever it is deemed safe and appropriate, ing gait. A 2015 study by Shultz and col - Consequently, the decreased energy and highlights the need for practitioners to leagues evaluated a subset of the current cost of barefoot walking found here should recommend properly fitted shoes designed cohort and found an increased stride length further guide clinicians’ footwear recom - for dynamic activity to minimize any negative in the shod condition (1.03 ± .14 m) versus mendations for children. impact on foot develop ment. the barefoot condition (1 ± .13 m). These “Although we didn’t measure shoe fit in “Previous adult data has shown a simi - longer stride lengths could have had a sim - this study, properly fitted shoes that mini - lar result, but our study does seem to solid - ilar effect to the added mass and changed mize any negative impact on foot develop - ify the sports science findings that shoes vCoM, both of which are believed to in - ment are very important, and I recommend change our walking dynamic, which alters crease the metabolic cost of walking. allowing kids to go barefoot whenever it is economy,” said lead author Sarah Shultz, safe and appropriate—most likely around PhD, a senior lecturer in the School of Sport the home—to help strengthen the foot and and Exercise at Massey University in promote positive development. Playing Wellington, New Zealand. Shod gait recruits more hip sports will probably require shoes,” Shultz For example, a 2011 study published in muscles while barefoot walking said. Gait & Posture found walking in industry- Wegener also noted why children’s ha - recommended athletic footwear was asso - depends more on the ankle and bitual behaviors need to be considered. ciated with increases in knee and hip net “Since the clinical effect required is to joint moments compared to barefoot walk - greater plantar flexor energy. minimize the biomechanical and physiolog - ing, including a 9.7% increase in the first ical effect of footwear, very flexible shoes peak knee varus moment. are required,” he said. “Clinically, I have The 25 healthy participants (aged 8-12 Data from the 2015 subset study also tended to recommend the requirements for years, 14 girls) completed two five-minute suggested the two modes of walking re - the foot, and then the activity, and the nature trials on a treadmill at a self-selected speed quire unique mechanical demands, with of children’s play throughout the day means (1 ± .13 m/s), doing one trial barefoot and shod walking recruiting more hip muscula - that all footwear worn by children should be the other shod in a standardized lace-up ture, and barefoot depending more on the designed for dynamic activity.” athletic shoe with an elevated heel, rounded ankle and generating greater plantar flexor Still, Shultz believes future resear ch will toe, arch support, and stiff midsole (total energy. These specific features may have help to explore the specific factors at play weight, 248 g ± 28 g). also led to differences in elastic energy stor - in this study. Investigators sampled force plate data age and affected overall walking economy. “Since this is a descriptive study and in each trial in 20-second intervals (120, “I do not think that any one factor is can only suggest possible reasons, further 180, and 240 seconds) and used data col - more significant than another [in contribut - investigations using more of an intervention lected at the 240-second time point to cal - ing to poorer economy], mainly because approach could help to determine the im - culate vertical center of mass displacement there are multiple and overlapping relation - portance of any one factor that we iden ti - (vCoM). They used a portable gas analyzer ships between them,” Shultz said. “For in - fied,” she said. to collect expired gases and measure oxy - stance, you cannot discriminate between Greg Gargiulo is a freelance medical writer gen consumption and then calculated en - effects on walking economy as a result of ergy expenditure, walking economy, and changes in stride length and changes in based in San Francisco. substrate utilization. vCoM because there is an existing relation - Source: The children’s oxygen consumption ship between stride length and vCoM.” Shultz SP, Houltham SD, Kung SM et al. Metabolic and energy expenditure were significantly The International Journal of Sports differences between shod and barefoot walking in higher and economy significantly decreased Medicine published the study in May 2016. children. Int J Sports Med 2016;37(5):401-404. Keenan GS, Franz JR, Dicharry J et al. Lower limb while wearing shoes compared with bare - “This study nicely complements the ex - joint kinetics in walking: The role of industry recom - foot walking. Barefoot walking also elicited isting literature that shod and barefoot gait mended footwear. Gait Posture 2011;33(3):350- significantly less vCoM than the shod condi - are significantly different and that footwear 355. Kung SM, Fink PW, Hume P, Shultz SP. Kinematic and tion. Children weren’t given time to get used has a substantial impact on the kinematics, kinetic differences between barefoot and shod walk - to the study shoes, but Schultz said all were kinetics, and physiology of children’s gait,” ing in children. Footwear Science 2015;7(2):95-105. lerpediatrics.com 02.17 5 Sensor data quantify clubfoot patients’ reported, real brace use Parents overestimate wear times By Peaches Yeilding Researchers who used temperature-sensi - Stu dy authors recruited 48 partici - tive devices to measure brace-use adher - pants who had completed the first three ence in children with clubfoot found months of full-time brace use, with 12 pa - parents overestimate brace wear time tients enrolled in four age-based groups: when reporting to clinicians and that chil - six to 12 months, 13 to 24 months, 25 to dren are not in their braces as long as their 36 months, and 37 to 48 months.
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