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:
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;
b. arrhythmias;
c. midsystolyic clicks;
d. murmurs that are Grade 3 or 4.
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:
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:
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
b. anemia
c. burnout
d. depression
e. overtraining
f. ergolytic drugs
g. endocrine dysfunction
h. respiratory and cardiovascular dysfunction
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
References
When sports chiropractors first appeared at the Olympic Games in the 1980s, it was alongside individual athletes who had experienced the benefits of chiropractic care in their training and recovery processes at home. Fast forward to Paris 2024, where chiropractic care was available in the polyclinic for all athletes, and the attitude has now evolved to recognize that “every athlete deserves access to sports chiropractic."
It is estimated that 61% of patients with CTS avoid taking surgical options due to postoperative complications and costly surgical procedures. Chiropractic care offers a comprehensive and effective treatment for carpal tunnel syndrome, addressing the condition from multiple angles. Recent studies also have unveiled a game-changing adjunct to chiropractic treatments for CTS: nerve flossing.
Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
