Special Populations and Psychosocial Issues
Youth athletes
Children have a greater surface-area-to-mass ratio, lower sweating rates, and slower acclimatization, which raises heat-illness risk. Growth plates are vulnerable to repetitive traction and compression, so apophyseal and physeal injuries are more common than tendon ruptures. Resistance training is safe with proper technique and supervision. Early specialization and high competition volume are associated with overuse injury and burnout.
Female athletes and energy availability
Relative energy deficiency in sport links low energy availability to menstrual dysfunction, low bone mineral density, impaired immunity, and reduced performance. The old female athlete triad is now understood as a broader syndrome affecting males too. Screen for disordered eating, menstrual history, and stress fracture history.
Pregnancy
Most pregnant athletes can continue moderate exercise after clearance. Avoid activities with high fall or abdominal trauma risk, scuba diving, and exercise in extreme heat or altitude. Absolute contraindications include ruptured membranes, preterm labor, persistent bleeding, and preeclampsia.
Masters and adaptive athletes
Masters athletes have reduced VO2max and recovery capacity but respond to training. Adaptive sport uses classification to promote fair competition; the team physician supports the athlete's health, not classification decisions.
Psychosocial issues
Screen for depression, anxiety, substance misuse, burnout, and hazing. Mental health conditions are common and treatable; confidentiality and referral pathways matter. Overtraining and depression can look similar.
Traps
Do not assume a lean athlete is healthy. Do not equate absence of menstrual periods with normal training adaptation. Do not exclude pregnant athletes categorically.
Worked example: a 16-year-old gymnast has two stress fractures, amenorrhea, and low body weight. This suggests low energy availability; evaluation and multidisciplinary care are indicated, not simply a training adjustment.