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Providing medical care to children and adolescents engaged in sports and various recreational physical activities is truly a team effort. The field of sports medicine has evolved from the integration and application of the concepts derived from many different basic and clinical exercise science disciplines. The goals of primary care sports medicine are to apply these concepts and knowledge for lifelong health promotion, and to practice prevention and medical management of diseases in relation to physical activity, for those who engage in sports and other physical activities.

In sports medicine literature (including this book), the terms physical activity, exercise, and sports are often used interchangeably. Physical fitness is generally defined as a set of attributes that a person has regarding the ability to perform physical activities that require aerobic fitness, endurance, strength, or musculoskeletal flexibility. The degree of individual physical fitness is influenced by a combination of physical activity and genetic ability. Physical activity is defined as any bodily movement produced by skeletal muscles which results in an expenditure of energy. Exercise is a physical activity that is planned and structured. Physical activity is integral to sport participation but participation in sports occurs within a social context. For children and adolescents, physical, psychological, and social growth and development have direct implications for sport participation and vice versa.

Our goal is to provide a perspective of the child and adolescent athlete within the context of their growth and development. Young children engage in a wide range of play and physical activities that is spontaneous and fun and are able to stay within the limits of their abilities. As they get older and especially as they reach adolescence, sport participation takes on a new meaning: extrinsic influences from adult society tend to increase and sport participation changes from being simply fun to being a more organized, planned, and purpose-driven activity. In pediatric sports medicine, most patients seen by practitioners are in the adolescent age group; this group is the major focus of our book.

The main goal of Pediatric Practice: Sports Medicine is to provide guidance on a range of issues encountered by the pediatrician or other medical practitioner caring for children and adolescents in the office or clinic setting. Because it is impossible to cover every problem encountered in one's practice, we have included conditions that are commonly seen and can be managed in the primary care setting. Some topics are included because they have significant implications for the health and well-being of the athlete. Other topics, although considered uncommon in pediatric athletes, are included because we have encountered these problems often enough over the years. Many conditions that once were considered problems affecting only the adult athlete are being seen in adolescents because of the increasing trend of adolescents to participate in sports more intensely, more competitively, and at younger ages than before.

We would like to express our most sincere thanks to Anne M. Sydor, executive editor at McGraw-Hill, for her encouragement and professional guidance of this project from start to finish with great zeal. We also thank Robert Pancotti, project development editor at McGraw-Hill, for making sure, among other things, that all words and numbers match and for his incredible patience throughout this work. Thanks also to the other staff members at McGraw-Hill who diligently worked on this book. Dilip Patel would like to thank Donald Greydanus for introducing him to something called "sports medicine" in the early years of his training. Dilip Patel also expresses his heartfelt appreciation and thanks to Terry Nelson, MD, for his years of support, teaching, and wisdom in sports medicine, and all the staff at K Valley Orthopedics for their commitment to sports medicine. We are indebted to our medical students, residents, and sports medicine fellows over the years for keeping us on our toes and honest. Once again, special thanks to Megan Greydanus for her excellent drawings.

Special thanks and appreciation to Dr. Robert Carter, CEO and Assistant Dean at Michigan State University Kalamazoo Center for Medical Studies, for fostering an environment in which scholarly pursuits like this one are possible.

We sincerely hope that our readers will find this book useful in their daily practice and will be inspired and motivated to seek more knowledge and acquire more skills in pediatric sports medicine.

Dilip R. Patel
Donald E. Greydanus
Robert J. Baker

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