As summer turns to fall, I'm bracing myself for the annual parade of injured children. It's the time of year when practices for school sports resume. Often young athletes have lost their conditioning. Their overused muscles and tendons tear, their bones break, and they end up in my office. But I worry just as much about the ones I don't see.
In the United States, we divide into two extremes. Most people are getting too little exercise. The resultant epidemics of diabetes,[1] cardiovascular disease[2] and sarcopenia[3] shorten lives, cost us billions of dollars, and cause immeasurable misery. Meanwhile, another proportion of the population, particularly youngsters, train too hard, pushing to the breaking point.
As sports physicians, we must take a lead role in helping our patients and their families find a path between these poles.
I often begin that conversation with the perspective of evolution. What attracts us to sport? In prehistoric times, we evolved from being prey to hunter. Those of our ancestors who developed the strength and stamina to hunt for 3 hours at a time could feed themselves and their families. They could pass their genes and epigenetic messages to the next generation as Darwinian fittest survivors.
