Medical and coaching staff from sports national governing bodies send in detailed information about the occurrence of injury and illness in athletes, and their exposure to risk in training and competition.

Rod Jaques, Director of Medical Services at EIS, says it is important to understand the nature of illness and injury incidence before putting in place new treatments.

And each sport has a specific set of recommendations for reducing the risk of injury or illness. This is just as important to take notice of as making sure you have the best kit and training environment and coach. Paul Jackson, another EIS Sports Physician, works with pentathletes. He says the information on the link between some lower limb injuries and training load has helped them change injury prevention drills.

Prehab, short for prehabilitation , is a relatively new idea in sports medicine and therapy. It is a personalized exercise program that is individually designed for athletes to help them prevent injury in their given sport.

In some respects, you can view athletic training for peak performance in a sport as a form of repetitive strain, with the potential to result in injury in much the same way as computer operators can get occupational injuries like carpal tunnel syndrome and shoulder problems.

With repetitive use, muscles become tight, the body develops imbalances in strength and muscle coordination.

These happen naturally during activity, but because training is repetitive, they become repeatedly reinforced with each workout, unless that workout also incorporates some compensating activity, such as in a prehab routine.

A common problem in athlete training is that many athletes and coaches follow the traditional methods of upper and lower body lifting, or basic sprinting and lifting exercises, as a way to develop strength outside of the specific sport drills.

But this can leave the core weak in comparison. A prehab program in this case would start with core stability, perhaps focusing on hips, stomach and back core. Once the basic core program is in place and working, the prehab is updated to include more subtle and focused movements that increase dynamic stability and improve skills in the given sport.

To ensure the best chance of success with prehab, the athlete should start practising it before injury occurs. But unfortunately the usual route to prehab is via injury. A typical scenario is the athlete injures him or herself, goes to a sport therapist or specialist trainer for rehabilitation rehab , and the therapist then persuades them to sign up for prehab to stop it happening again.

Another way to keep prehab useful and working for the athlete, is to ensure it continually evolves with the needs and changing fitness and ability of the individual. The exercises should be progressive and re-evaluated regularly. There is also the important need to challenge and motivate the athlete, and stop them becoming bored, or habituated to the program.

Stew Smith, graduate of the US Naval Academy, former Navy SEAL, and author of several fitness and self defense books, advocates prehab as a way to prevent common injuries of daily life and sport. There are many natural imbalances in the body:.

They also advise coaches and parents to consider the emotional stress that the pressure to win can cause for a young athlete, and recommend they adopt these principles:. They should be rewarded for trying hard and for improving their skills rather than punished or criticized for losing a game or competition.

The main goal should be to have fun and learn lifelong physical activity skills. Doping in sports is a big issue. What is it and what is being done to stop it? This spotlight looks at some of the issues, including gene doping and….

When pain or swelling accompanies the popping sound in a knee, it may indicate an injury or medical condition. did not clearly distinguish between their athletes and controls [ 33 ]: It remains unclear, therefore, how generalizable the results are.

Although the non-athletes in Pietrowsky et al. This makes comparisons beyond the different rower groups unreliable. A very specific problem resulted from the sample composition of Ferrand et al. Any result found could thus be due to gender characteristics rather than sports type specific or control group related.

A further weakness of many of the studies was sample size. For example, both Arroyo et al. and Martinsen et al. had a substantial difference in group sizes between athletes and controls, which might distort the results [ 13 , 30 ].

Two other studies [ 35 , 41 ] only examined very smalls groups so that it is hard to determine how valid results are even if relatively specific instruments were used [ 35 ]. Summarizing these data, larger studies in particular seem to suggest that young elite athletes are not more at risk for pathogenic weight concerns and weight-control behaviour than non-athletic controls.

Participating in elite sports might even be a protective factor. However, due to the overall limited number of studies, with simultaneously dozens of different sport types to be examined there is not enough data in total.

Additionally, several methodological problems across the different studies make a clear final conclusion impossible.

Three studies suggest that restrict weight-control is particularly prevalent in leanness-sports defined as sports emphasising leanness or low body weight such as aesthetic or endurance sports [ 33 , 34 , 42 ]. Reinking and Alexander [ 33 ] could show that within their NCAA Division I athletes, those competing in leanness sports scored significantly higher on the sub score for Body Dissatisfaction than those competing in non-leanness sports.

Equally, athletes from leanness sports had a lower mean desired body weight than athletes from non-leanness sports. Parks et al. They could show a significant difference between these two groups, with runners expressing more weight concerns and aiming for less weight than footballers who wanted to if anything gain weight.

Rosendahl at al [ 34 ] could show in addition to the comparisons with controls mentioned above that athletes competing in leanness sports scored higher for weight-control behaviour than those competing in non-leanness sports. In contrast, four other studies did not find any differences between leanness- and non-leanness sports weight-control behaviour [ 13 , 18 , 19 , 32 ].

Greenleaf et al. As a result, over half of the athletes The majority of them wanted to lose weight, on average around 5. However, only a small minority indicated purging behaviour: 2.

For all weight concerns and weight-control behaviours, no difference could be found between the various types of sports.

basketball, volleyball, soccer , finding no difference [ 32 ]. Johnson at al [ 44 ] could show some differences between different types of sports. However, this was only true in two instances and with no particular connection to the categories of leanness and non-leanness sports: In female athletes gymnasts scored higher on the Drive for Thinness Scale than swimmers and basketball players.

Male football players showed greater body dissatisfaction than gymnasts and cross-country athletes. In their study about psychosocial correlates of bulimic symptoms, Anderson et al.

They could show that the level of body dissatisfaction as well as restrictive eating was related to the amount of experienced pressure from teammates and coaches.

There was no relation between the two components themselves. No difference with regard to type of sport could be shown. Looking at weight-dependent sports only, two studies described methods of rapid weight-control amongst judo athletes [ 4 , 35 ]. A large survey by Artioli et al.

Most of them regained this lost weight at least partially within one week after competition. The fluctuation of weight was confirmed by a study from Rouveix et al. showing that rapid weight reduction is an inherent part of the lives of judo athletes [ 35 ].

Nearly two thirds limited their choice of food on a constant basis. Other studies examined only selected sports types [ 31 , 45 ] describing the prevalence of weight concerns and weight-control behaviour in a particular field. Thiel et al.

The majority of athletes did not score pathologically for weight concerns and weigh-control behaviour. In particular, there was no difference between the male rowers and wrestlers.

Only if they formed a subgroup of athletes with the diagnosis of a subclinical eating disorder based on the EDI-2 [ 39 ] Drive for Thinness subscale scores, did they find a difference on Body Dissatisfaction scale in comparison to the rest of the subjects.

Marshall at al examined female Canadian elite field hockey players [ 31 ]. In general, only a very low number of athletes 3. However, they did find a fivefold higher frequency of athletes scoring at risk for the Body Dissatisfaction BD scale, which made the authors conclude a higher prevalence of weight concerns.

Rouveix et al. included a comparably small sample size of only 24 athletes [ 35 ]. Reinking et al. on the other hand had a substantial difference in group sizes with only 16 athletes competing in leanness sports as opposed to 68 athletes competing in non-leanness sports [ 33 ].

also showed a significant difference in the group sizes of athletes with only 25 wrestlers but 59 rowers, which further reduce the generalizability of results found [ 45 ]. This study raises additional concern because they found differences only after creating a subgroup scoring pathologically for subclinical eating disorders, which makes their conclusions questionable [ 45 ].

In contrast, two studies used large, balanced samples [ 4 , 44 ]. A specific problem of the study by Johnson et al. was that large parts of their results were based on a self-created, unvalidated questionnaire that had its main focus on eating disorders [ 44 ].

Anderson et al. tried to make their results more generalizable by using a variety of universities to get their sample from which clearly reduces local biases [ 18 ]. Again, a lack of clear definitions made interpretation difficult: Two studies did not state clearly at which level their athletes competed [ 32 , 34 ].

In the study of Ferrand et al. Additionally, the sample of swimmers consisted of female and male athletes whereas the two other groups were female samples only. Two studies did not state clearly how the sample of athletes was collected so it is hard to judge the quality of each study [ 35 , 42 , 45 ].

Summed up, the evidence seems to point towards no higher prevalence of pathogenic weight concerns or weight-control behaviour in athletes competing in leanness sports.

However, this behaviour does seem to be particularly present in weight-class sports where success is often dependent on the class an athlete is competing in.

Although it is suggested that female athletes are more susceptible to developing eating disorders or at higher risk for pathogenic weight-control behaviour than male athletes, one study by Artioli et al. did not find any gender differences [ 4 ].

They examined active judo competitors with the Rapid Weight Loss Questionnaire [ 46 ]. Increased exercises and restricted fluid intake were the favourite methods to lose weight. They did not find any differences between gender — neither in prevalence nor manifestation of pathogenic weight-control.

Looking at male athletes only, Galli and Reel [ 47 ] explored the body image and body enhancing behaviour of male athletes from various sports types in qualitative interviews. The findings show that male athletes want to reduce fat and gain muscle mass, desiring a more muscular, stronger body.

Patients who suffer from it perceive their body as too slim or not muscular enough, even if there is no objective evidence [ 48 ].

As a result of their perception, patients withdraw from social activities out of shame or stick to extensive workouts or usage of anabolic drugs [ 50 ]. Clear strength of the study by Galli et al. is clearly the insight gained through qualitative data. The majority of studies included in this review did find a higher frequency of pathogenic weight concerns and weight-control behaviour in female athletes than in male ones.

Martinsen at al [ 13 ] could show in their study that female athletes have more concerns about their weight and a higher urge to improve their appearance than male athletes. Additionally, they used more pathogenic weight-control methods than their male counterparts.

Johnson et al. This was true for vomiting and use of laxatives as well as diet pills over a lifetime. However, no statistically significant difference could be shown for use of diuretics or steroids.

In general, female athletes wanted to reduce their body fat down to a percentage where they would stop menstruating risking osteoporosis within one year. Rouveix [ 35 ] at al examined 24 judo athletes and came to mixed conclusions. Nearly two thirds of the athletes lost more than 2.

Most common methods were intensification of exercising and reduction of fluid intake. There was a gender difference in methods to reduce weight, though: female athletes fasted significantly more. Interestingly, athletes reported their parents and society as equally important sources for the pressure to lose weight as their own drive to do so.

Additionally, there was a clear gender difference for the ideal body with female athletes desiring a much lower body weight than male athletes. A definite strength of this study is its clear definition of the athlete level and a good control of the comparison group, who did not engage in sports activities more than three times a week.

This confirms different mindsets and intentions behind weight-control behaviour in female and male athletes. Only two studies also draw conclusions about the role of age in pathological weight concerns and weight-control behaviour.

One study by Artioli et al. suggests that the earlier in life athletes started reducing weight before competition, the more aggressive they were with respect to their methods [ 4 ]. Another study from Marshall et al. However, both studies have their limitations: Whereas Artioli only asked athletes retrospectively where memories could be distorted; Marshall compared two different age groups in a cross-sectional study.

Both did not examine athletes longitudinally to follow up the same cohort and their development. In summary, a number of studies provide evidence for pathogenic weight-control behaviour in both genders.

The form of pathogenic weight-control behaviour is different in male and female athletes. Whereas female athletes mostly want to reduce weight and focus on a slim appearance, male athletes mostly want to gain weight through muscle mass.

Concerning weight-control behaviour in connection with age, no uniform conclusion can be drawn, as only two studies looked at it at all. Results are heterogeneous, with one giving evidence that the age of an athlete starting with pathogenic weight-control behaviour might play a decisive role for the prognosis [ 4 ] whereas the other does not seem to see any connection with age [ 31 ].

To our best knowledge, this is the first systematic review on weight-concerns and weight-control behaviour in young elite athletes. It appears that young elite athletes are engaged in pathogenic weight-control behaviour despite long-term health being very important for the development of their sports career and achievement of peak performance.

Comparing athletes with non-athletes or controls, the majority of studies, several of which were large scale, found either no difference or an even lower risk of athletes for pathogenic weight concerns or weight-control behaviour [ 13 , 30 , 33 — 35 , 45 ].

Only one study could show a higher prevalence of pathogenic weight concerns but not weight-control behaviour in athletes [ 32 ]. Because of different demands associated with different sports types, we further analysed the studies found according to clusters.

We decided to use the classification into leanness and non-leanness sports for the sub-analysis of different sports types, as this is a very common distinction first introduced by Sundgot-Borgen [ 51 ] in connection with eating disorders in elite athletes.

Several of the studies included in our review used this particular classification. However, we are aware that there might be additional ways of clustering different types of sports that were not considered in this review. Focusing on leanness-sports, three studies give evidence of a higher prevalence of weight-control problems in leanness-sports [ 33 , 34 , 42 ].

However, four other studies did not find any differences in the prevalence between these two categories [ 13 , 18 , 19 , 32 ], and there was no study in which a higher prevalence of pathogenic weight-control behaviour in non-leanness sports could be shown.

Whether leanness-sports are a risk factor for pathogenic weight-control or whether the higher prevalence is merely due to a selection bias has to be further investigated.

It was suggested that gender plays an important role for the prevalence of pathogenic weight-control behaviour. In total, only two studies made a clear statement about gender with contradictory results: whereas one study showed no difference between female and male athletes [ 4 ], the other one clearly supported the theory that female athletes are more engaged in pathogenic weight concerns and weight-control behaviour [ 13 ].

Two other studies showed mixed results within their different outcome variables [ 35 , 44 ]. Additional studies focus on female or male athletes alone, making gender comparison hard.

However, they help to get a deeper understanding of gender specific ways to worry about body shape or weight-control. Our review had to encounter several problems. In general, difficulties seem to arise when looking at the topic of pathogenic weight concerns and weight-control behaviour.

Specifically, there does not seem to be a clear common definition of what weight concerns and weight-control behaviour are. As a result, a variety of different measuring instruments are used.

This heterogeneity makes consistent conclusions difficult. In our review, we included all studies that used these two terms. However, further research should clarify what these terms comprise exactly to get a better idea of what appropriate measures might be.

Another problem arises with choosing appropriate screening instruments. This is due to the fact that in some sports types the very same behaviours can be pathogenic or non-pathogenic depending on circumstances.

Normally, screening instruments used are not specifically designed for or even adapted to athletes and their specific demands which might incorrectly classify non-pathogenic, functional behaviour as part of a pathogenic one [ 25 ]. Furthermore, the next difficult distinction is the thin line between pathogenic weight-control behaviour and eating disorders in elite sports.

This is especially supported by the fact that in leanness-sports a very thin look is considered normal, and more radical forms of weight-control are often accepted by coaches and athletes [ 2 , 6 , 8 , 52 ].

According to her, female athletes suffering from it show an intensive fear of gaining weight or even becoming obese, although the athlete is not overweight at all. To achieve their individually set ideal weight, these athletes use a variety of pathogenic weight-control techniques [ 8 ].

On the other hand, it is impossible to deny that for some sport disciplines a change of body weight is a necessary part of training and competition. Here, it is most crucial to support athletes in losing or gaining weight in a healthy way. Several organizations and associations have acknowledged this fact and now provide specific guidelines for healthy weight management in elite athletes [ 9 , 53 ].

Therefore it seems crucial to combine the two sources by providing trainers with additional information about the topic of weight concerns and weight-control behaviour in young elite athletes. Another challenge for this review was the broad heterogeneity of studies. Their sample sizes ranged from 10 to participants.

Some examined groups only consisted of athletes from a special type of sport, and some had no control-groups to give evidence of the differences between athletes and non-athletes Furthermore, results are mostly based on self-rating questionnaires and no expert interviews. This may have affected the validity, because many athletes might not answer truthfully or withhold their pathogenic concerns or weight-control behaviour.

When some studies cooperated with the respective sports association or college, it cannot be excluded that athletes held back some information, as they might have been scared to lose privileges within their system.

In any case, this would have only lead to an underestimation of the results found. Additionally, the methods differ strongly between cross-sectional studies with big cohorts and qualitative interview studies with small samples.

Whereas, for example, Johnson et al. examined nearly athletes from 11 different universities [ 44 ], Galli and Reel examined 10 male athletes over ten in-depth semi-structured interviews regarding body image in male athletes [ 47 ]. Both methods are respectable forms of research but make a comparison difficult if not impossible.

Taken together, the examined papers show that there is some prevalence of pathogenic weight concerns and weight-control behaviour in elite athletes.

However, there is no certainty that the prevalence is higher than in control groups. Only in leanness-sports, where athletes are encouraged to be thin for either appearance or performance, the prevalence of pathogenic weight-control behaviour is higher in frequency than in non-athletes.

The pressure of competitive sports seems therefore to be a risk factor for both genders. Thus, special attention should be paid to athletes in leanness sports who have experiences with dieting and who show body- or weight-dissatisfaction. Further research is necessary to get a better understanding of the connection between elite sports and pathogenic weight-control behaviour.

First results show that this combined approach provides comprehensive data [ 55 — 58 ]. In addition, long-term studies are needed to see what happens if young athletes stop competing as adults. Article Text. Article menu. Article Text Article info Citation Tools Share Rapid Responses Article metrics Alerts.

Resistance training among young athletes: safety, efficacy and injury prevention effects. Abstract A literature review was employed to evaluate the current epidemiology of injury related to the safety and efficacy of youth resistance training.

Statistics from Altmetric. Footnotes Funding GDM received funding support from the National Institutes of Health grants RAR and RAR Competing interests None.

Linked Articles Warm up Are kids having a rough time of it in sports? Dennis J Caine. British Journal of Sports Medicine ; 44 Published Online First: 21 Dec doi:

Latest content Current issue Archive For authors Resources About New editors. Close More Main menu Latest content Current issue Archive For authors Resources About New editors. Log in via Institution. You are here Home Archive Volume 44, Issue 1 Resistance training among young athletes: safety, efficacy and injury prevention effects.

Email alerts. Article Text. Article menu. Article Text Article info Citation Tools Share Rapid Responses Article metrics Alerts. Resistance training among young athletes: safety, efficacy and injury prevention effects.

Abstract A literature review was employed to evaluate the current epidemiology of injury related to the safety and efficacy of youth resistance training. Statistics from Altmetric.

Footnotes Funding GDM received funding support from the National Institutes of Health grants RAR and RAR Competing interests None. Linked Articles Warm up Are kids having a rough time of it in sports? Dennis J Caine. British Journal of Sports Medicine ; 44 Published Online First: 21 Dec doi: Read the full text or download the PDF:.

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Summary Read the full fact sheet. On this page. Resistance training for beginners Warming up before resistance training Safety tips for resistance training Safety when using heavier weights in resistance training Where to get help.

Warming up before resistance training Before doing your strength training exercises, you need to warm up for about five minutes. Safety tips for resistance training Be guided by your doctor or gym instructor, but general safety suggestions include: Proper technique is essential.

Start slowly. Once your muscles, tendons and ligaments get used to weight training exercises, you may be surprised at how quickly you progress. Once you can easily do 12 repetitions with a particular weight, gradually increase the weight.

Only use safe and well-maintained equipment. Faulty equipment will significantly increase your risk of injury. Breathe normally while lifting by exhaling during the exertion or harder phase and inhaling during the easier or relaxation phase.

Control the weights at all times. Maintain a strong form while lifting, as this will prevent injury through incorrect technique. Always lift weights within your own capabilities and slow down or stop if you feel the weight is out of control or too heavy.

Use the full range of motion. It is important when lifting a weight that it travels through the full range of motion of the joint.