Triad of Dysfunction in Youth Fitness and Sports

Sara Fleming

The youth fitness issues making headlines these days are childhood obesity and sports injuries.  According to the CDC, in 2012, over one third of children and adolescents were classified as overweight or obese.  At the seemingly opposite end of the spectrum, in 2009, over 2.6 million children were treated in hospitals for injuries related to sports or recreation.  This number does not take into account children suffering from less acute sprains, strains, and other overuse injuries.  Although these two problems seem to be unrelated, we believe they have close ties to one another.

image youth triad 1

The world has changed drastically in the past few decades.  Access to technology, digital entertainment, increasingly competitive academics and sports, and overscheduling has created lifestyles that are largely sedentary and devoid of organic play.  Unfortunately, this is impacting our youth a great deal more than we think.  Previous generations grew up exploring nature, doing physical chores, and spending more time playing than doing homework or going to specialized sports practices.

Instead of only seeing the two extremes of childhood obesity and higher rates of sports injuries, we have identified three problems that contribute to both and with some attention, can be easily solved.  They are as follows:

  1. Lack of joint stability and postural strength. .
  2. Poor body image and awareness.
  3. Lack of organic physical play and other physical activities.

We believe this “triad” of dysfunction are the factors contributing to physical downfall of our youth.  Fortunately, by making coaches, teachers, and parents aware of these problems, we can begin to address these not only at home, but in the classroom, and on the field.  It doesn’t take a lot of effort, but the payoff is big.

Youth dysfunction triad

Bottom line, kids these days are weak.  Ask a group of elementary school kids to do pushups, squats, or anything else requiring a stable core and you will see that the majority are incapable of maintaining good posture through a full range of motion.  Walk into any classroom in America and the majority of kids are slouching over their desks, in front of a computer, or over their tablets and phones.  This doesn’t get any better when they stand up.  Carrying heavy book bags and having their heads buried in digital devices erodes postural strength.  Being unable to support one’s posture affects balance, center of gravity, coordination, and overall endurance.

In the last 20 years of practice, the prevalence of forward head posture/anterior head carry in both youth and adults has exploded.  What used to be on occasional postural finding has now become sadly the norm.  Computer use, Video games, lap top computer use, smart phones, tablets and general inactivity have been the drivers of this postural distortion.  The head becomes flexed forward to view the screens, this creates a shortening of the anterior neck flexors and a weakening of the neck extensors.  For every inch the head moves off the midline it adds ten pounds of weight as far as the supportive muscles are concerned.  This increased muscle tension leads to all kinds of health ailments including: neck pain, upper back pain, spasms, headaches, TMJ pain, muscle weakness and decreased vital lung capacity to name a few. –Dr. Allen Ashforth, D.C., C.C.W.P

The digital age has created physical deficiencies.

The increased number of overuse injuries in joints is not just from overuse, but from a lack of integrity.  Again, joints that lack muscular and connective tissue strength that comes from weight bearing exercise are more likely to be injured.  Girls in particular have more joint laxity in boys and consequently have a higher risk of ACL and other injuries.

Childhood obesity is not the only weight problem facing kids these days.  The media and social obsession with six-pack abs has done a great disservice to our youth.  Anorexia and bulimia, once thought to mainly affect girls, has become commonplace among boys as well.  Anorexia and bulimia during childhood and adolescence has dire consequences on development and can negatively affect sexual maturation, bone density, and overall growth.  Likewise, excessive weight in developing children can negatively impact joint formation and overall musculoskeletal health which can lead to a lifetime of pain and mobility issues.

Lack of vigorous physical play is becoming more and more a problem.  We can mostly blame it on the introduction of video games and easy access to digital media.  Safety concerns and hectic schedules mean that most kids don’t play outside.  They aren’t learning the basic motor patterns that most kids engage in naturally during play:  running, jumping, hopping, skipping, climbing, crawling, throwing, and catching.

flag football
Playing sports doesn’t have to be formalized. The key word being “play”.

The Triad of Youth Dysfunction

1.     Postural and Joint Instability:

Contributing Factors

Reality Check Solutions

Screen time (entertainment and homework)

Sitting at school for long periods.

Weakness from lack of general acitivity.

Poor development of basic motor patterns.

Lack of play.

Strength is required for competent movement patterns.Regular movement and activity is a requirement for healthy development.

Sedentary children become sedentary adults.

Unfit children are too unfit to enjoy play.

Focused strength training

Weight bearing “exercises” and regular physical activity,

Practice basic movement patterns and postures.

Awareness of good posture and good movement in every day life.


2.     Poor Body Image and Awareness

Contributing Factors

Reality Check Solutions
Lack of parental knowledge and guidance about good nutrition.Fashion ideals vs healthy ideals.

Extrinsic expectations of ideal body composition from parents peers, and the media.

Kids’ bodies go through a number of changes during healthy growth and development that are not fashion ideal.Fashion ideal is far from healthy/normal/real ideal.

Body image needs to be based on intrinsic (performance and feelings of well-being) rather than extrinsic (aesthetics) factors.

Let form follow function, don’t seek the form through function.

Nutritional education for parents and children.

Prioritize making better nutritional choices and finding opportunities to move more.

3.     Lack of Vigorous Play

Contributing Factors

Reality Check Solutions
Sports and school are an assembly line of increasing demands.Parental aspirations often cloud what children actually need.

Families are over-scheduled.

Children’s sports are overly specialized and competitive.

Some kids aren’t fit enough to play vigorously.

Youth sports have become more about competing and building character than simply playing the game and moving.

Kids aren’t physically ready to specialize in a single sport until adolescence.Overscheduling is stressful for the whole family.

Less than 0.1% of kids will get a scholarship or make it to the pros.

Overuse injuries and burnout are at an all time high with the number one contributing factor being overzealous parents and coaches.

Program and limit your screen time.

Let play be organic, allow it to happen by turning down the background noise, turning off the electronics, and having free time.

“Play” a variety of sports and activities, not everything has to be at a high level of competition.

Make time for fun physical activities as a family or groups of friends.

These may look overwhelming, but the solutions for all of these problems are simple.  They simply require an adjustment in our thinking. 

  1. Pay attention to the messages you are sending to kids regarding body composition and function/performance. This should be based on intrinsic, not extrinsic factors. 
  2. Play is no longer building the strength and movement patterns it once did. We need to work on this to fix the deficiencies of our modern lifestyles through practice. 
  3. The “play” that does exist is no longer about play, it is about competition and reaching an ultimate performance/aesthetic goal. We need to make time for pure organic play that does not involve measurements.

Final Thoughts

Good physical health for our children is not that much different from adults.  It all comes down to a balance of Awareness, Work, and Play.  All three are essential for building strong, capable, active children who will become strong, capable, and active adults.

Be Aware of one’s capabilities, posture, movements, and how one’s body feels and functions.  Awareness must be about capabilities, not delusions of fashion and lifestyle aspirations.

In order to fix the deficiencies of our modern lives, its going to take Work.  Make time in your week to build strength simply by focusing on posture and joint stability.  It must be focused and the work high quality.  This will make the work more efficient and make more time for play.

Encourage Play as much as possible.  Learn to enjoy moving at multiple intensities and modes.  This is important not only for physical, but social and emotional development.  The best way to do this is to be more active as a family.  Introduce your children to new activities together, explore local parks on foot or on a bike, exercise together.  There are many ways to do this.

*On a final note, a word to parents, trainers, teachers, youth sports coaches, or anyone else who works regularly with children:  Not all families have the time or knowledge to build good strength and physical health.  There are many families who simply do not have the time or finances to have their children involved in sports.  Inactive children become inactive adults.  Children need to build not only strength and endurance, but physical confidence and an enjoyment of physical activities.  Making a difference in our youth today will greatly impact our future adults.  Consider volunteering in local schools, incorporating physical activity in the classroom, and introducing basic strength training in sports practice.  Our book, Play the Ball as it Lies, is a comprehensive primer on teaching strength for all ages.  Our supplemental Practical Strength Youth Fitness booklet describes how to specifically apply those concepts to children and adolescents.  Complicated approaches are not needed.  Developing basic strength, an endurance base, and a love of physical activity will make the biggest difference for the youth of today.  We encourage all of you to help change the course of physical fitness for future generations.

References and Suggested Reading:

  1. Strength Training by Children and Adolescents, PEDIATRICS Vol. 121 No. 4 April 1, 2008, pp. 835 -840
  2. Youth Fitness Trainer, Second Edition – Dr. Thomas D. Fahey, EdD – ISSA, 2006
  3. Science and Practice of Strength Training, Second Edition – Vladimir Zatiorsky and William J. Kraemer – Human Kinetics, May 2006 pp 191-213
  4. Strength and Conditioning for Team Sports, Paul Gamble
  5. When to initiate integrative neuromuscular training to reduce sports-related injuries in youth? Gregory D. Myer, Avery D. Faigenbaum, Kevin R. Ford, Thomas M. Best, Michael F. Bergeron, and Timothy E. Hewett, Curr Sports Med Rep. 2011 May-Jun; 10(3): 155–166.
  6. The Effects of Generalized Joint Laxity on Risk of Anterior Cruciate Ligament Injury in Young Female Athletes, Gregory D. Myer, Kevin R. Ford, Mark V. Paterno, Todd G. Nick, and Timothy E. Hewett, Am J Sports Med. 2008 June ; 36(6): 1073–1080.
  7. National Athletic Trainers’ Association Position
    Statement: Prevention of Pediatric Overuse Injuries, Tamara C. Valovich McLeod, Laura C. Decoster, Keith J. Loud, Lyle J. Micheli,  J. Terry Parker, Michelle A. Sandrey,  Christopher White, Journal of Athletic Training 2011;46(2):206–220
  8. Overuse Injuries and Burnout in Youth Sports: A Position Statement from the American Medical Society for Sports Medicine, John P. DiFiori, Holly J. Benjamin, Joel Brenner, Andrew Gregory, Neeru Jayanthi, Greg L. Landry, and Anthony Luke, Clin J Sport Med 2014;24:3–20

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