Special Populations in Sports Medicine
Core concepts
Understand exercise considerations for children/adolescents, older adults, pregnant athletes, and athletes with disabilities or chronic disease. Pediatric considerations include growth plates (physeal injuries, Osgood-Schlatter, Little League shoulder), heat regulation differences, and resistance training safety with proper supervision. Older adults benefit from aerobic and resistance training with fall-prevention focus. Pregnancy: moderate exercise is generally safe and recommended for uncomplicated pregnancies; avoid contact sports and high-altitude or scuba activities. Athletes with disabilities need sport-specific classification awareness and attention to skin, thermoregulation, and autonomic dysreflexia in spinal cord injury.
Traps
A frequent trap is advising against all exercise in pregnancy-most guidelines encourage moderate activity. Another is attributing pediatric joint pain to "growing pains" when it is a physeal injury requiring load management. In spinal cord injury, autonomic dysreflexia (hypertension, headache, bradycardia) is an emergency triggered by noxious stimuli like a full bladder.
Rule of thumb
In children, pain at a growth plate with activity = manage load and consider physeal injury. In pregnancy, "if uncomplicated, moderate exercise is encouraged; avoid contact, altitude, and scuba." Autonomic dysreflexia is a medical emergency-find and remove the trigger.
Worked example
A 12-year-old pitcher has lateral elbow pain with throwing. This suggests Little League elbow (medial epicondyle apophysitis); management is rest from throwing, pitch-count limits, and gradual return, not simply "playing through it."