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7th EFSMA – European Congress of Sports Medicine, 3rd Central European Congress of Physical Medicine and Rehabilitation, Annual Assembly of the German and the Austrian Society of Physical Medicine and Rehabilitation

Austrian Society of Physical Medicine and Rehabilitation

26.-29.10.2011, Salzburg, Austria

Age Upgrading of Young Players into Adult Competitions – Proposal of a Medical Evaluation Protocol

Meeting Abstract

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7th EFSMA – European Congress of Sports Medicine, 3rd Central European Congress of Physical Medicine and Rehabilitation. Salzburg, 26.-29.10.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. Doc11esm192

doi: 10.3205/11esm192, urn:nbn:de:0183-11esm1926

Published: October 24, 2011

© 2011 Miranda.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: In recent years there has been an increase on demand of young players (15-16 years old) to compete in adult teams, the main reason being shortage of players or good sports skills and seldom the main reason being early maturational development and growth.

Sports federations rules and national laws impose a sports medical evaluation to get the clearance to an age upgrading of young athletes, but there are no established criteria to support this decision and no studies describing the consequences of this action. Adding to this, in Portugal the decision cannot be reversed, that is, the age upgrading is “for life”, no matter the consequences it may have.

We are aware that the inclusion of a young athlete in an adult competition may have effects at several levels that may affect their physical, mental and social well-being.

This presentation is based on the attempt to create a medical evaluation protocol for the age upgrading of young athletes and is included in a major multidisciplinary project trying to evaluate the personal and social repercussions, with the aim of providing feedback to the sports doctors who are in charge of taking this decision and at the same time provide information to sports agents about these same repercussions and what they can expect when using young athletes in adult sports competitions.

Until mid-2010 the decision following the medical evaluation protocol, which included bone-age determination, blood analysis and echocardiogram, was based in a very much subjective “feeling” of adequacy to the age upgrading and on some empirical cardiologic maturation parameters that were gathered in our Centre for the last 30 years, but never compiled or subject to re-evaluation.

Material/Methods: 65 young players (11 F, 54 M) were evaluated in the last 8 months, and a medical evaluation protocol which included body composition (skinfold), sexual (Tanner) and bone-age (Greulich&Pyne) evaluation, height, weight and BMI percentile (Portuguese approved tables), echochardiogram (morphological study and body-surface corrected left ventricular mass index) and blood tests was standardized. Results for each parameter were defined as Adequate, Possibly Adequate or Non-Adequate for the age upgrading of that athlete for that particular sport. Factors that influence this decision are related to sports classification in contact/non contact and/or exhaustive/non exhaustive sports. Cut-off values (M/F) for body composition were set at 55/50% muscle mass and >10% body fat, growth cartilage closure (18/16y), corrected Left Ventricular Mass for Body Surface Area above 100/92 g/m² and, in contact sports, height and weight above the 75th percentile of the approved growth tables for the ages 18/16y and sexual maturity of 5 in all stages.

Results: Sports that most frequently applied for age upgrading were Basketball (B) (n=16, 2F/14M), Field Hockey (FH) (1M), Football (Ft) (n=19, 17 soccer, 2 indoor, all M), Handball (H) (n=6, 2F/4M), Table-Tennis (TT) (1M), Volleyball (V) (n=4 3F/1M) and Waterpolo (W) (n=18, 4F/14M).

4 players (B, F, H, V) were not allowed any age-upgrading and 19 players were allowed to play only in the immediate upper age group (3B 1F/2M; 8Ft 8M; 4A 2F/2M; 3W, 3F; 1V 1F). The main reasons for this decision were either low bone age and/or non-adequate heart adaptation and in some borderline cases there was a conjugation of all the other parameters.

Conclusion: Young players that are requested to participate in adult competitions may be subject to negative health consequences and this preliminary presentation is an attempt to overcome the absence of an objective protocol for the medical evaluation of these adolescents that is not just based on size or sexual maturation. We feel very confident that the evaluated parameters are the correct ones but we still have to gather more data to determine cut-off values. The re-evaluation of all players will allow us to gather data relating to injury, drop-out or other factors incidence, as well as the rate of remainder growth and/or maturation. In our opinion, the limitation of the age upgrading to the remaining season would allow a more “liberal” evaluation because the decision would be reversible in case unexpected problems would occur.


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