Author: Sensei Lincoln

Physical and sport education is quickly becoming recognised as a vital aspect of our everyday lives, and the benefits of a healthy mind and body are promoted frequently through the media, advertising and our educational institutions. Through our schools, the importance of being active and playing sport is stressed, and young children are encouraged to participate in various sports from volleyball to football to karate. If the school curriculum is successful, a vast majority of these children will be channelled into many "after school" sports and weekend competitions. It is at the age of ten and eleven years when the excitement of competitive sport begins to engulf its young participants as they strive to run faster, jump higher and so on. It is also during this period that children can be affected by Cumulative Trauma Disorders. These disorders can have a pronounced effect on the growth and development of these children as they enter adulthood and later, old age.

Cumulative Trauma Disorders are disorders which are more often than not caused by excessive repetition and inadequate scheduling of work and rest periods. (Parker and Imbus, 1992 p1.) Commonly, Cumulative Trauma Disorders are known as RSI, or Repetitive Strain Injuries.

Cumulative Trauma cases often begin as simple muscle pain and fatigue to an overused area of the body, and if recognised early, a short period of rest will ensure the pain does not worsen. However, if ignored, a Cumulative Trauma Disorder may eventuate result in nerve entrapment syndromes, myalgia, tendonitis, tenosynovitis, osteochondrosis or common repetitive injuries such as "tennis elbow" or "little league arm". (Parker and Imbus, 1992 p1.) The pertinence of these injuries to children and teenagers cannot be underestimated as serious cases of Cumulative Trauma Disorders in our young can have marked effects on their growth and development right through until old age.

There are technically two types of growth centres responsible for the growth of the bone. These are the "epiphysis" and the "apophysis". (Leadbetter M.D., cited in Taylor and Taylor, 1988 p290.) The epiphyses are located at the ends of bones, and in children, the shaft of the bone and the epiphysis is separated by an epiphyseal cartilage or plate. This plate provides the means for the bone to increase in length (Spence, 1990 p95.) and hence, only growing persons (children) have epiphyses. Being cartilaginous, these epiphyseal plates are vulnerable to the stresses and strains placed on them by repetitive, continual activities. Once adulthood is reached and growth is completed, the epiphyseal plates fuse and are replaced by bone. It is the period before this fusing that is of concern to us, and the period which can dictate the successful "normal" development of a child’s bones.

The phenomenon of "little league elbow" has been documented as a prevalent example of an injury to the epiphysis of children’s bones. "Little league elbow" can be endured by children who repeatedly throw a baseball (especially pitchers) during their childhood years. As a normal part of the child’s growth, stress is applied to the epiphysis by the strong pull of enlarging and growing muscles. (Leadbetter, cited in Taylor and Taylor, 1988 p290.) Coupled with these normal stresses, the repetitive trauma of throwing a baseball can exert a great amount of force on, and can injure, the epiphyses. Fahey (1979 p151.) suggests that bone growth depends on its blood supply, and if the epiphysis is injured, blood supply will be interfered with and ultimately, growth could be hampered. Injuries to the epiphyses can result in angulation deformities especially around the elbow and this can give rise to either cosmetic deformities or modifications in the normal functioning of the limb. (Leadbetter, cited in Taylor and Taylor, 1988 p290.) For this reason, any trauma to the child resulting in swelling, pain or an inability to play his or her sport should necessitate and x-ray.

The second type of growth centre injury occurs to the "apophysis". The apophyses are found at the attachments of muscles and accommodate for longitudinal growth of the bone, and also allow for tendon and muscle attachments to keep up with growth. (Leadbetter, cited in Taylor and Taylor, 1988 p290.) Like the epiphyses, the apophyses can be affected by "osteochondrosis" which is a disease of the growth centres of the bones in children. This disease leads to a compaction, destruction and altered architecture of the bones. (Julsrud, cited in Taylor and Taylor, 1988 p290.) Importantly, it is implied that some type of trauma is needed to begin this dilapidation of the bones - this trauma can come from injuries sustained from repetitious activity. In adolescents, osteochondrosis is referred to as apophysitis, where the trauma is mainly occurring at the tendon or ligament insertion into a bone. (Julsrud, cited in Taylor and Taylor, 1988 p290.)

A very common example of this syndrome occurs in children playing consistent, competitive sport where continual running on hard surfaces occurs (long distance runners for example.) or "slamming" the feet down during certain activities (such as bowling when playing cricket). Here, swelling of the ligaments and tendons surrounding the tibial tuberosity occurs, causing inflammation and extreme pain. The tibial tuberosity is located on the anterior or front of the lower leg. Its job is to provide an anchoring point for the tendons of the quadriceps and secure the patella tendon. (Spence, 1990 p141.) As mentioned earlier, continued exsertion can cause a swelling of this area which can be extremely painful.

This condition is known as Osgood-Schlatter’s disease. I myself have experienced this pain and between the ages of eleven and seventeen, found it very difficult to walk the day after playing cricket. I still find it impossible to kneel down because of the localised pain to the tibial tuberosity. I have no doubt that playing the amount of cricket I was (approximately 2-3 hours per day) contributed to the abnormal structure of my lower legs. Osteochondrosis is a serious disorder which is affecting more and more children who push themselves and are pushed to play elite, competitive sport.

Although these are injuries are very real, the incidence of such injuries is low. To many physicians, the repeated "microtraumas" that occur over a period of time to the young athlete’s whole body are just as important as the Cumulative Trauma Disorders. (Arnheim and Pestolesi, 1978 p144.) These "microtraumas" are experienced by footballers for example, who put their bodies through the rigours of a full contact sport from a very young age - resulting in such problems as stress fractures. All of these conditions may lead to problems in later life, and these problems need to be addressed.

The aftermath of epiphyseal plate damage and osteochondrosis can have marked effects on the child’s physical growth and development as he or she enters adulthood and old age. In rare cases, repetitive activities such as the tennis and baseball pitching have brought about a stretching of the epiphyseal growth centre. (Leadbetter, cited in Taylor and Taylor, 1988 p290.) Hence, the active arm can actually become longer than the untrained arm. The stretching of the arm is a characteristic common with professional adult baseball players and tennis players. Even though this bone hypertrophy (bone enlargement) has never been documented as being detrimental to the athlete, (Leadbetter, cited in Taylor and Taylor, 1988 p290.) it is still important to note that the "normal" growth and development of the child has been impaired through intense, repetitive activity.

This bone hypertrophy is often combined with excessive muscle hypertrophy. Professional tennis players can regularly be seen with larger forearms and biceps on their dominant arm compared to their untrained arm. Rowers, for example, participate in an activity that is very repetitive and can cause a strain on such muscle groups as the pectorals located on the front of the chest. This continued loading on the pectorals leads them to undergo hypertrophy and they become larger and stronger.

Working the same muscle group over and over, and ignoring the opposing muscle group can lead to a muscle imbalance. (Dzelzkalns, 1988.) This imbalance occurs when a particular muscle group is over worked (ie. Pectorals) and the opposing muscle group (in this case are the rhomboids located in the upper back) is underworked. This disturbs the body’s symmetry and puts the athlete at greater risk of strain and pain. If these muscle imbalances are not corrected early in the athlete's career, they may lead to poor posture, instability and a reduction in the ability to produce smooth movement. (Dzelzkalns, 1988.) Also, depending on what muscles were overused, the degenerative ailment of todays modern society - back pain, can eventuate.

As mentioned earlier, osteochondrosis can have many long-term effects on the human body. Initially, osetochondrosis is associated with tenderness, and localised pain and swelling to the area. These symptoms will not persist if treated properly. However, in extreme cases such as Osgood-Schlatter’s disease with myself, a calcification of the tendon and ligament attachments at the tibial tuberosity occurs. (Julsrud, cited in Taylor and Taylor, 1988 p290.) This causes an enlargement of the tuberosity which is very painful and limits movement. Various physicians believe that in extreme cases, osteochondrosis may lead to arthritis in old age, a debilitating disease which is painful and severely reduces the movement potential of the affected body part(s).

Problems as epiphyseal plate damage and osteochondrosis can have drastic effects on a young child’s body right through the adolescent years. If severe enough, they can have a marked effect on the child’s normal development into adulthood and on his or her quality of life in old age. For this reason, Cumulative Trauma Disorders need to be examined in our physical education programs starting at our primary schools and secondary schools. Karate teachers should also take careful note of the potential damage which can be caused to young bodies by excessive, repetitive high energy training.

The question then leads to "how hard should children train?" and what adjustments need to be made to our physical and sport education programs and karate syllabii.. It is true that the damage to a young athlete’s bony structure depends on the type of activity, the intensity and duration of the activity and the suitability of the child to that activity. Table 1. below shows the three main somatotypes (body types) and the activities for which they are suited:-

Table 1. Somatotypes and suitable activities. (Sports Injury Prevention Program, 1985 p71)

Ectomorph Mesomorph Endomorph
Predominantly long boned and thin Predominantly stocky and muscular Predominantly round and fat
Favour endurance activities
ie. Long distance events
Favour power events
ie. Sprint events, football contact sports
Favour events where buoyancy is an advantage
ie. Long distance swimming

This table indicates the types of activities suitable for various body shapes. A table such as this can be used when recommending children to play certain sports. Although it is important that children receive exposure to a number of different sports, physical educators can "channel" individuals into activities which would not place too much stress on their bodies. For example, a physical educator may recommend that an ectomorph not spend his life concentrating on being a baseball pitcher, but perhaps a batter or catcher where the strain on his slender limbs is not as great.

Many physical educators have realised the effect repetitive activity can have on the musculo-skeletal systems of our children. Today, organised baseball games in Australia have been modified to try and reduce the incidence of Cumulative Trauma Disorders. For example, at the secondary school level, a pitcher may only pitch a maximum of four innings out of a possible seven. Cricket, like baseball has similar guidelines. A bowler may only bowl a maximum of four overs during a twenty over match.

In both of these sports, administrators have tried to increase the involvement of all participants by limiting the amount of influence a select and gifted few can have on the game. In doing this, physical educators have been able to reduce the likelihood of Cumulative Trauma Disorders. It must be noted that at an interschool level, baseball and cricket competitions can involve playing up to five or six matches in a day, and if a participant is permitted to bowl or pitch for an unlimited amount of time, (a baseballer could throw upto seven hundred pitches in a day!) the risk of repetitive strain injuries becomes great. As these sports are only played for one day a year, the injuries acquired here may not produce obvious long-term affects. As mentioned earlier however, the repeated microtraumas caused by short term, yet intense activity can build up to produce chronic or degenerative conditions in the future.

Physical educators are also beginning to introduce resistance training such as weight lifting into their class design or as a part of a child’s training for his or her competitive sport. It would seem advisable that growing children are not subjected to heavy resistance type training Because of their immature bony structure, children could safely participate in a program of low weights but with many repetitions. (Davis, Kimmet and Auty, 1991 p145) Importantly, the repetitions should be monitored to reduce the risk of injury.

Today, physical educators need to be aware of the strain various activities can place on a young child’s bones. For this reason, an overdoing of activities such as throwing, excessive running, jumping and strength training to a specific area must be avoided. Specifically for karate activities, excessive kicking of all types should be avoided. Teachers and coaches need to develop a variety of training methods to extend their participants, but not harm them.

Cumulative Trauma Disorders are a very real part of today’s physical education agenda, and if ignored, can pose acute problems to the successful normal development of the child into adulthood and old age. Children participating in activities that involve repetitive jumping and landing, running kicking (particularly the air) and throwing are the most at risk of epiphyseal plate damage, and diseases such as osteochondrosis and Osgood-Schlatter’s disease. If managed through rest and medical advice, trauma to the effected area can be reduced, even corrected. If ignored however, repetition injuries can result. This can lead to poor posture, deformities around joints, inhibited movement and localised pain. During old age, these problems can also lead to arthritis and chronic back pain.

Thankfully, physical educators (and hopefully, karate teachers) are beginning to understand the importance of repetitive strain injuries. Consequently, many activities are being modified to reduce the workload that can be given to any child at a given time. In today’s world of professionalism, elitism and prizemoney in sport, it is difficult to remember the strain we are placing on our children’s bodies. If Cumulative Trauma Disorders are not considered, many great sporting prospects may never take the field again and live the rest of their lives in pain...

Reference List.

1. Arnheim, D.D. Essentials of Athletic Training. USA: Times Mirror/Mosby College Publishing, 1987.

2. Arnheim, D.D. and Pestolesi, R.A. Elementary Physical Education. USA: The C.V. Mosby Company, 1978.

3. Davis, D. et. Al. VCE Physical Education. South Melbourne: Macmillan Education Australia, 1991.

4. Dzelzkalns, L. "Balancing Your Muscles" in Dance Excersise Today. (Publisher and year unknown)

5. Fahey, T. Good Time Fitness for Kids. New York: Butterick, 1979.

6. Julsrud, M.E. "Osteochondrosis (Osteochondritis Dissecans: Apophysitis)." in Conquering Athletic Injuries. Illinois: Leisure Press, 1988.

7. Leadbetter, W.B. "Epiphyseal Injuries." in Conquering Athletic Injuries. Illinois: Leisure Press, 1988.

8. Parker, K.G. and Imbus, H.R. Cumulative Trauma Disorders. USA: Lewis Publishers, 1992.

9. Spence, A.P. Basic Human Anatomy. California: The Benjamin/Cummings Publishing Company, 1990.

10. Sports Injury Prevention Program. New South Wales: Cumberland College of Health