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The Young Athlete: Part IIBy Thomas Souza, DC, DACBSP Editor's note: Part I of "The Young Athlete" was published in the August 15, 1996 issue of "DC."Some special concerns of the physical examination are as follows:8 I. Viral Infections Most viral infections are worsened by physical activity. They may adversely affect performance in the following situations:
II. Hematological Disorders These disorders are not screened for in all individuals, however in those complaining of fatigue be careful: a) Test for suspected anemia or abnormalities of the RBC. b) A sickle cell crisis can be precipitated by dehydration, lactic acidosis, or hypoxia. c) Remember the false physiologic anemia associated with increased volume expansion. III. Asthma Up to 17 percent of youngsters have exercise induced bronchospasm. Dry, cold weather and prolonged intense activity worse the condition. IV. Renal Children with a unilateral kidney are predisposed to serious renal problems with dehydration. V. Cardiovascular Disease and Hypertension Key cardiovascular concerns on the physical exam include: a. heart rate over 120 bpm or any inappropriate tachycardia; Most innocent murmurs should diminish with Valsalva's maneuver. The murmur associated with hypertrophic cardiomyopathy increases usually with sitting and standing, and also with exercise. e. resting BPs:
Conditions that have cardiovascular risk potential and should be looked for on history and physical include: i) hypertrophic cardiomyopathy (HC); ii) mitral valve prolapse syndrome; iii) marfan's syndrome; iv) congenital heart disease. Some forms of congenital heart disease are contraindications for sports participation including some conduction deficits. If there is an obvious immediate family history of cardiovascular disease it might be prudent to test the child for cholesterol/HDL. Most children with high blood pressure are "hyperadrenergic" and in fact benefit from exercise. Still it would be best to avoid purely anaerobic activities such as weightlifting. Also strong isometric exercise should be avoided. VI. Epilepsy Physical and mental activities seem to be deterrents to seizure activity. Many school systems make little distinction between epileptic and non-epileptic children in their athletic programs. Concerns here are overfatigue, skipped meals, excessive alcohol intake, and "street drugs." Hyperventilation with activity is not a concern, but voluntary or forced hyperventilation may precipitate petit mal spells. Epilepsy is not a contraindication to sports participation although caution should be used with climbing, horseback riding, diving, and swimming in general. Buddy participation is recommended. With gymnastics the biggest concern is a fall due to a seizure. VII. Diabetes Regularly exercising diabetics are better controlled than sedentary diabetics. Special concerns though are: a. One may anticipate a reduction in insulin requirements. b. Food may be necessary before, during, and after exercise to avoid hypoglycemia. c. Exercise should be avoided before bedtime to avoid hypoglycemia during sleep. d. Changes in insulin and diet need to be established by trial and error realizing that a reduction is often necessary on days of strenuous exercise. e. Active children are better controlled with two doses of insulin a day (before breakfast and dinner). f. There is an increase release of insulin from the injection site which can be decreased by the above twice a day, meal- related dosage, or injection in the abdomen instead of the arms or legs. g. Availability of a portable snack is necessary. h. In long duration diabetes with severe microangiopathic complications exercise should be limited because:
i. Children must be taught to give prompt attentions to abrasions, and lacerations, and burning or freezing of the feet. They should trim their toenails properly and not wear tight shoes or socks. j. Dehydration can complicate diabetes. VIII. Chronic Fatigue Fatigue is common with illness, lack of sleep, and poor diet. Chronic fatigue, lasting weeks or longer, should be investigated. Some of the possibilities include: a. infection IX. Other Concerns a. Unequal or unreactive pupils should be documented prior to sports participation as a comparison when head trauma is nvolved b. Look for necrotic or perforated nasal septum which would indicate drug abuse. Strength Training There is a large debate regarding the appropriateness of prepubescent participation in strength training programs. These concerns center around the tendency towards strains, tendinitis, epiphysitis, avulsions, fractures, and vertebral injuries. Most of these injuries are avoidable with proper training, supervision, and progression. It has been demonstrated that prepubescent children do increase muscle strength with training. The American Academy of Pediatrics, the National Strength and Conditioning Association, and the American Orthopedic Society of Sports Medicine have made the following recommendations:9
The prescribed program is two to three workouts per week for 20-30 minute periods. No resistance should be applied until proper form is demonstrated. Six to 15 repetitions and one to three sets per exercise are done. Weight is increased in one to three pound increments after the child is able to do 15 reps with good form. References
Thomas Souza, DC, DACBSP 5980 Indian Ave. San Jose, CA 95123
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