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