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As seen within this thematic issue on children’s and youth sports, sports medicine has a complex relationship with child health. On the one hand, much of the world is experiencing an epidemic of childhood obesity. The physical activity inherent in sports is viewed as a means of combating this epidemic. However, sports also lead to injuries which can cause short- and long-term disabilities. With homage to legendary UCLA basketball coach John Wooden, the role of sports medicine in promoting the health of children fits within the construct of a pyramid. Coach Wooden used a pyramid to describe the qualities necessary for success.1 A pyramid depends upon symmetrical strength, a firm foundation, and a solid heart at its centre. Its peak is the goal, which in this case is child health. The pyramid of sports medicine and child health is shown in fig 1 and described below.
A firm foundation
Lower-left cornerstone: physical activity promotion
Lack of physical activity is becoming a worldwide problem,1 and sports are a wonderful means of increasing physical activity. Observational studies show sports participation in youth is associated with higher overall levels of physical activity.2 3 A study of youth wearing accelerometers found that approximately one-quarter of daily moderate–vigorous physical activity was due to sports.4 Furthermore, participation in youth sports is positively associated with physical activity in adulthood.5
Lower-right cornerstone: injury prevention
Approximately 30–40% of adolescents seek medical attention annually for a sport-related injury.6 Sports have inherent acute risks, and injury-prevention programmes can decrease the rates of certain injuries. The future approach must be threefold.
1. Accurate assessment of injury rates. The future must not be dominated by anecdotal reports. Is there an epidemic of injury among girls who play sports? In this issue, Knowles et al present evidence that girls, in fact, have lower …