Sports medicine for specific athletes: children and young athletes, adult and older athletes, female athletes (including the female athlete triad), athletes with disability

Different athletes have different physiological needs and different injury patterns. The HSC syllabus expects you to know the specific considerations for children and adolescents, older athletes, female athletes, and athletes with disability.

Children and young athletes

Children are not small adults. The developmental physiology produces specific injury patterns and specific responsibilities.

Growth plates

Bones grow at growth plates (epiphyseal plates). These cartilaginous areas are weaker than the surrounding bone and are vulnerable to specific injuries:

• Sever's disease. Inflammation of the heel growth plate, common in active 8-14 year olds.
• Osgood-Schlatter disease. Inflammation at the tibial tuberosity (top of shin), common in 10-15 year old athletes who jump and kick.
• Salter-Harris fractures. Fractures through growth plates. Require careful management because misalignment can produce limb-length differences and angular deformities.

Growth plate injuries that are not managed properly can have lifelong consequences. This drives the higher caution applied to youth sport injury assessment.

Strength training

Strength training is safe and beneficial for children when properly supervised. Older "no weight training under 14" guidance is outdated. The current consensus position (NSCA, AAP):

• Light resistance training with high repetitions is safe from primary school age.
• Heavy lifting (close to 1-rep max) should be deferred until skeletal maturity (around age 14-16).
• Supervision and technique focus matter more than load.

The benefits include injury prevention, motor skill development, and confidence. The risks are overuse injuries and growth plate stress with poor technique.

Overuse injuries

Children specialising in a single sport too early experience higher rates of overuse injuries. The American Academy of Pediatrics and Sports Medicine Australia recommend:

• One day off per week.
• One season off per year from the primary sport.
• Limit hours of training per week to roughly the child's age (e.g., 12 year old: roughly 12 hours per week).

Early specialisation is increasingly common in Australian youth sport. The trade-off (faster skill development vs higher overuse injury and burnout risk) is debated.

Thermoregulation

Children are less efficient at regulating body temperature than adults. They have a higher surface area to body mass ratio and lower sweating capacity per kg. They are more vulnerable to heat illness in summer sport.

Management:

• Hydration breaks every 15-20 minutes.
• Heat policies (no play above set wet-bulb temperatures).
• Modified clothing.
• Awareness training for coaches and parents.

Adult and older athletes

Older athletes (typically defined as 35+ in masters sport) face different considerations.

Physiological changes

• VO2 max declines by roughly 10% per decade after age 30 in sedentary adults, slower in trained athletes (around 5% per decade with continued training).
• Strength declines about 1-2% per year after age 50, faster in inactive adults.
• Recovery time lengthens. Muscle protein synthesis is slower; soreness lasts longer; sleep needs increase.
• Cardiovascular function changes - maximum heart rate declines, vascular stiffness rises.
• Hormonal changes (testosterone decline in men, menopause in women) affect performance and recovery.

Injury patterns

Older athletes have higher rates of:

• Tendon injuries (Achilles, rotator cuff). Tendons stiffen and develop micro-damage with age.
• Joint degeneration (osteoarthritis), especially in previously injured joints.
• Stress fractures in osteoporotic bone (particularly in postmenopausal women).
• Cardiac events during exertion (rare but the absolute risk per session is higher than in young adults).

Considerations

• Medical screening before substantial new exercise programs, particularly for athletes returning to sport after years of inactivity.
• Longer warm-ups (10-15 minutes vs 5-10 for younger athletes).
• Lower training volume, higher quality principle.
• More recovery time between intense sessions.
• Strength training is particularly important to preserve muscle mass and bone density.

The masters sport scene in Australia is large and growing (masters swimming, athletics, triathlon, cycling). It is one of the strongest cases for lifetime physical activity.

Female athletes

Female athletes share many considerations with male athletes but have specific issues the syllabus expects.

Anatomical and physiological differences

• Q-angle (the angle of the thigh bone to the lower leg) is wider in females. This increases the risk of ACL injuries in cutting sports.
• Bone density is lower on average. With other risk factors, this elevates stress fracture risk.
• Iron requirements are higher due to menstrual losses. Female endurance athletes have higher rates of iron deficiency anaemia than male equivalents.

The female athlete triad / Relative Energy Deficiency in Sport (RED-S)

A specific syndrome covered in the syllabus.

The traditional triad:

1. Low energy availability (eating too little for training load, either intentionally or unintentionally).
2. Menstrual dysfunction (amenorrhoea, oligomenorrhoea).
3. Low bone mineral density (with elevated stress fracture risk).

RED-S (Relative Energy Deficiency in Sport) is the broader contemporary framing introduced by the IOC. Low energy availability affects:

• Menstrual function.
• Bone health.
• Metabolic rate (basal metabolic rate declines).
• Immune function.
• Protein synthesis (muscle building).
• Cardiovascular function.
• Endocrine function.
• Mental health.

RED-S can affect male athletes too, though presentation and the menstrual signal differ.

Management of the triad/RED-S:

• Increase energy intake to match training load.
• Reduce training load if energy intake cannot rise.
• Address underlying disordered eating where present.
• Refer to a multidisciplinary team (sports doctor, dietitian, psychologist).
• Treat resulting health consequences (bone density, low ferritin).

Pregnancy and post-partum

Sports medicine for pregnant athletes is increasingly addressed by governing bodies. Most physical activity can continue through pregnancy with modifications. Specific guidance from the AIS and Sport Australia covers training adaptations, return to play, and parental leave.

Athletes with disability

The syllabus expects you to recognise that athletes with disability access sport at lower rates and face specific medical considerations.

Types of disability in sport

• Physical disability (amputee, wheelchair user, cerebral palsy, dwarfism).
• Sensory disability (vision impairment, hearing impairment).
• Intellectual disability.

Specific considerations

• Equipment. Sport-specific adaptive equipment (racing wheelchairs, prosthetics, modified balls). Cost is a barrier; programs like the National Disability Insurance Scheme partially address it.
• Coaching. Inclusive coach education is growing but specialist coaches are still scarce.
• Facilities. Accessibility of changerooms, transport, training venues.
• Classification. Paralympic sport uses classification systems to ensure fair competition. Athletes are grouped by functional capacity.
• Medical management. Athletes with disability may have specific conditions (spinal cord injury related issues, cerebral palsy spasticity management, prosthetic care) that require sports medicine attention.

Pathways and elite participation

The Australian Paralympic Committee (now Paralympics Australia) runs the elite pathway. Recent achievements include strong Paralympic performance, with Australia consistently in the top 10 medal tables.

Recreational and grassroots participation rates for people with disability are substantially lower than the general population. Sport Inclusion Australia, AusABLE, and state-level inclusion programs work on the participation gap.

How this dot point applies

Strong HSC answers on specific athletes:

1. Name the syllabus categories explicitly (children, older, female, disability).
2. Cite specific physiological considerations for each.
3. Use specific terminology (female athlete triad, RED-S, growth plate, classification).
4. Recognise interactions (older female athletes face both age and sex specific issues; an Indigenous female adolescent athlete with disability faces compounding considerations).