Winning at what cost? More children getting hurt amid growing pressure to excel in youth sports

Gwenaelle Mak was just five years old when she fell in love with artistic gymnastics.

At age six, when most of her kindergarten peers were learning how to ride a bicycle, Gwenaelle was doing cartwheels with ease and preparing for competitions.

From Primary 5, she began representing her school at the National School Games (NSG) and competed in other competitions such as the National Championships and Singapore Open.

From training once a week, the frequency of her sessions increased to eight hours weekly three times a week when she started to compete for her school and a club.

She continued to love her sport, but the intensity of the training caught up with her body.

Gwenaelle, who is now 16, said that as the frequency of training increased, the risk of injury is higher.

In Secondary 2, she experienced heavy swelling in her knee that would not go away despite lighter training. An MRI scan confirmed that she had a torn meniscus, a condition that could have been caused by too much training or a bad landing.

Her doctor recommended surgery, because it is hard for the meniscus to heal by itself. And at her age, she had a good chance of making a full recovery.

She went ahead with the operation, which required just an overnight stay in the hospital but nine months of physiotherapy. Six months after her surgery, she was able to return to a scaled-down training routine.

Gwenaelle is one of a growing number of young athletes seeking treatment for sports-related injuries.

Both KK Women’s and Children's Hospital (KKH) and the National University Hospital (NUH), which are the only two public hospitals in Singapore that admit paediatric orthopaedic cases, said that they have observed a growing number of such cases. They were, however, unable to provide any figures.

As children here increasingly take part in sports and competitive sports from a young age, health experts are concerned that such injuries among young athletes will only continue to grow and have a lasting effect on their health as adults.

INJURIES PREVALENT AMONG YOUNG ATHLETES

Doctors who spoke to CNA TODAY said that the age when young athletes are most affected are between eight and 15 years, because this is a period of rapid growth.

Children and teenagers have growth plates, also known as epiphyseal plates, which are specialised areas of cartilage located near the ends of long bones, where new cartilage continually forms. Once puberty ends, these plates harden into solid bone, allowing bones to lengthen.

In the meantime, the growth plates with the softer cartilage are vulnerable to repetitive loading, because they are weaker than the surrounding bones.

In contact sports such as football and rugby, high-impact collisions could cause trauma-related growth plate fractures.

Doctors said that the common injuries they see in young athletes are acute ones such as fractures, sprained ankles, kneecap dislocations, as well as injuries linked to the meniscus and anterior cruciate ligament (ACL) at the knee.

At NUH, up to 50 per cent of teenagers treated for the first time by the orthopaedic department suffer from acute injuries or chronic complaints related to sports.

Footballer Muhammad Muzammil Hairman, for example, underwent surgery in February after suffering a tear at the ACL during a friendly match. He was pushed to the ground and landed on his knee after he and an opponent chased after the ball.

The accident happened in August 2025, when he was 13 years old.

However, his doctor suggested delaying the surgery until 2027 when he turns 15, because that is when a teenager's bones are fully grown and it would help minimise the chances of the ACL tearing again.

He heeded the doctor's advice at first, but after about six months of restricted movements and limited physical activity, Muzammil decided to go ahead with the surgery earlier than advised.

"It was difficult to move around with the knee brace and I was not able to do any exercise, not even light jogging," the 14-year-old said.

“My parents and I felt that it would be difficult to continue like this so long.”

After the surgery, he had to miss two weeks of school and rely on crutches for a month.

He also had to attend regular physiotherapy sessions and checkups with the doctor in order to get full flexion (bending) and to straighten his leg.

"I missed out on the NSG, friendly games and regular training for almost a year.

"I cannot wait to get back to playing, but I believe that recovery takes time to come back to my fullest potential."

Muzammil used to play football almost every day as part of school training or just for fun with friends. In primary school, he also played rugby and took up silat, a Malay martial art.

Doctors said that young athletes are also seeking treatment for chronic injuries – known as overuse injuries – such as jumper's knee, shoulder pains or elbow pains from racket sports.

Chronic injuries tend to develop when there is pain for more than 12 weeks.

Dr Zackary Chua, a consultant orthopaedic surgeon in private practice at ACME Orthopaedics, said that for young athletes, lots of running and jumping, in contact or non-contact sports, can lead to conditions such as Sever's disease (heel pain) and Osgood-Schlatter disease (knee pain).

The high-impact repetitive pounding on hard surfaces can also cause stress fractures in the midfoot.

At Milestone Physiotherapy, which specialises in helping athletes return to sports after injury or surgery, a vast majority of their young clients are seen for overuse injuries.

Mr Goh Chun Kiat, a musculoskeletal and sports physiotherapist working there, said that during growth spurts, a child's bones grow faster than their muscles and tendons, which creates a natural tightness and alters their biomechanics.

This makes them significantly more susceptible to injury.

A chronic injury was what 12-year-old Neo Hean Kai developed, after almost a year of attending basketball training up to five times a week.

His father Neo Yong Aik said that they first suspected he had Osgood-Schlatter disease about two years ago, when he was in Primary 4, because of recurring knee pain during training.

The diagnosis was officially confirmed with an X-ray last year.

Hean Kai continued with training, but now wears special knee guards on both legs during the sessions, which helps to lower the pain significantly. He also manages the pain by doing more stretching before and after training, and by massaging both legs after training sessions.

CHILDREN DON'T ALWAYS BOUNCE BACK

Coaches and healthcare professionals said that they are seeing some children pushed to their limits to excel, not just for the love of the sport, but because they feel the pressure to use their sporting prowess to get into their school of choice.

This year's NSG will see its highest participation to date, with around 69,000 student-athletes from more than 300 schools competing in 29 different sports.

This is up from the 66,000 last year.

A good sporting performance at the NSG, as well as attendance at recognised sports academies, helps Primary 6 pupils enrol in their preferred secondary schools through the Direct Schools Admission (DSA) exercise.

The DSA is a pathway for students to gain entry to schools based on their interests and aptitude in certain areas such as sports.

In the 2025 DSA for secondary school (DSA-Sec) exercise, there were 41,700 applications received from 15,700 students. Of these, about four in 10 applications were for sports and games.

While the interest in sports and games reflects the sustained enthusiasm for physical sports among students, the pursuit of DSA places and competition results should not come at the cost of a child's health and well-being, the Ministry of Education said.

It added that DSA-Sec is not a pathway that suits every student, and that parents should discuss with their children and make the decision together. This means taking into consideration the child's strengths and interests, as well as the school's programmes and ability to develop specific talents.

Ms Tan Kang Yi, 25, a professional basketball player and youth basketball coach at JumpShot 3x3 Academy, who used to comepete in the NSG, recalled that thrice-weekly school training was the norm during her school days.

"Now, if you only train three times a week and don't have any enrichment classes in any area, parents may feel the pressure and think that the kid is missing out.

"As a coach, I do feel worried when I see kids pushing themselves without any rest," Ms Tan said. She heads a youth programme, as well as one designed for young girls only.

At Technique Pro Football Academy, coaches are seeing more interest in parents signing up their children for one-on-one coaching sessions to improve their technical skills.

These "enrichment sessions" are in addition to training sessions at an external football academy or school team that these children attend.

Mr Terry Lee, co-founder of the academy, noted: "About 10 per cent of the whole cohort of football players used to do such training, perhaps. Now, about four in 10 would have attended such classes."

Mr Goh, the sports physiotherapist, said that the landscape of school sports has become "incredibly competitive" and this is heavily driven by the desire to secure a DSA spot.

"It is no longer just about attending school co-curricular activities three times a week. We frequently see students stacking their schedules – school training, external club training, private one-on-one coaching and weekend tournaments.

"This pursuit of technical mastery and exposure often leads to sudden spikes in training load, without the proportional rest required for developing bodies to recover."

Mr Goh also said that one of the biggest misconceptions among parents is the "kids bounce back easily" myth, because youth athletes "seem to have boundless energy".

Since they rarely complain of fatigue in the same way adults do, parents and coaches often assume that the young ones can handle limitless volume, he cautioned.

Associate Professor Mohammad Ashik, head and senior consultant at the department of orthopaedic surgery and the Singapore Sport and Exercise Medicine Centre at KKH, said that in growing children, musculoskeletal systems are still developing.

Growth plate fractures and ACL injuries can cause lasting problems such as unequal leg lengths, joint deformity or chronic pain if ignored or undertreated.

Even though fractures generally heal well in children, a severe fracture or one that occurs near the growth plate could lead to a deformity of the bone, which may have long-term consequences into adulthood.

Ligament tears in the knee or ankle also vary in severity.

Some children may recover with just physiotherapy while others may need surgery.

WAYS TO MINIMISE INJURIES

There is no single validated threshold, but a commonly used sports medicine guideline to avoid or minimise injury for children is to keep the hours spent on organised sport each week to no more than their age in years.

Associate Professor Mohammad Ashik, head of the Singapore Sport and Exercise Medicine Centre at KK Women's and Children's Hospital, said that a 10-year-old, for example, should ideally spend no more than 10 hours in structured sporting activities weekly.

Another orthopaedic surgeon highlighted the importance of body conditioning.

Adjunct Assistant Professor Rishi Malhotra from the National University Hospital's division of paediatric orthopaedic surgery said that apart from looking at the number of hours spent on a sport, one should look at the gradual increase in activity level over time.

"A basic rule is that if you generally do a certain number of hours a week, the number of hours you spend on sports the next week should not exceed 1.5 times your usual activity level."

He pointed out that there are many other factors at play, such as the intensity of sport and the recovery process after the sport.

Therefore, having a good coach who can monitor and provide guidance is important.

Dr Low Chee Yong, director of the High Performance Sport Science & Sport Medicine team, which is part of the High Performance Sport Institute under Sport Excellence Singapore, said there is "no one-size-fits-all approach".

Given athletes' diverse needs, the emphasis should be on individualised planning to optimise performance while reducing burnout and injury risk.

"Different sports have varying training environments, loads and recovery needs.

"Athletes also peak at different ages and development stages depending on their sport. For example, gymnasts typically start earlier."

Doctors also recommended taking part in different sports, and avoiding excessive single-sport participation, especially before the age of 12.

Dr Zackary Chua, a consultant orthopaedic surgeon at ACME Orthopaedics, said studies have shown that early specialisation in one sport is strongly linked to a higher risk of injury.

Children focusing on one sport year-round suffer more stress fractures, tendonitis, and lower-extremity injuries compared to multi-sport athletes.

Adequate rest is underrated but no less important, Dr Chua stressed – for all athletes, not just young ones.

Experts also said that student athletes should take a break from sports, including at least one to two full rest days a week, and two to three months off a single sport a year.

This will ensure adequate rest and recovery for tissue repair, as well as down time for psychological recovery.

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Adjunct Assistant Professor Rishi Malhotra, an orthopaedic surgeon in NUH’s division of paediatric orthopaedic surgery, said that for those who require surgery, not everyone can get back to their usual level of sports and may suffer long-term issues later in life as a result of the injury.

Health issues aside, Mr Goh cautioned parents who are hoping to bring out the best in their children by pushing them hard in sports, that such a plan might backfire entirely.

"Pushing them through pain during this phase under the guise of 'building mental toughness' often leads to chronic issues that force them out of the sport entirely," he said.

JUST SUPPORTING THEIR LOVE OF SPORT

Parents interviewed by CNA TODAY said that they were just being supportive of their children's love of sports and they do not force their children to attend training sessions.

For Mr Neo, his son Hean Kai's daily training arose simply because he enjoyed playing basketball and wanted to be better at it.

As Hean Kai improved, he also started to take the sport more seriously, eventually setting his sights on the DSA route and applying for it this year.

Gwenaelle's father, Mr Kenneth Mak, said he knew that athletes who train competitively would encounter some form of injury, but he had not expected her to experience such a serious one.

"I now tell her to ensure that she conducts warm up properly and use K-tape (kinesiology tape) or supports if necessary," the 52-year-old civil servant said.

There has been no change to Gwenaelle's training schedule after surgery, but her parents now urge her to be more self-aware and to impose some boundaries.

Mr Mak said: "Whenever she jumps or lands and something feels out of place, we tell her to inform the coach not to push any further. It is really about knowing when it is time to stop."

He added: "We never put any expectations on her in the sport or pressure her to perform. The amount of time and training she has invested in it all boiled down to her own interest and passion.

"As parents, we just supported her as much as we could."

As a coach, I do feel worried when I see kids pushing themselves without any rest.

Similar to Mr Neo and Mr Mak, other parents said that their children would frequently seek more opportunities on their own to engage in their favourite sports.

Avid footballer Mohamad Azim Mohd Adlil Wafi, for example, did not suffer a multiple fracture of the right tibia (bone at the front of lower leg) during a formal training session – but at his daily after-school kickabout with neighbourhood friends.

He was trying a trick with the football when he fell and his leg landed directly on the ball. As a result, he needed surgery to insert a metal plate to help his bones fuse.

He was hospitalised for three days and away from school for two months, before being able to resume sports six months later. It also cost him a shot at a DSA trial.

The teenager, who is now 16, said: "In the first few weeks of training, I suffered from calf cramps, especially in the injured leg, because my muscles were weaker. It took a few months before normal fitness levels returned." He had to undergo a second procedure to remove the metal plates in his leg.

His parents, at first expecting a small hairline fracture, were shocked when they saw his X-ray results and learnt that he needed surgery.

Mr Muhammad Nadzrie Mohd Nadzir, 39, a property officer, said that the injury was unfortunate, but they are aware that being active in sports comes with such risks.

He and his wife have always believed that their son is naturally gifted in sports and encouraged him to choose and pursue a sport he enjoyed. Mr Nadzrie said that he nudged his son to return to sports after the surgery.

"When someone is passionate about what they do, they will naturally give their best," he added.

"Our role as parents is simply to support, encourage and stand by him throughout his journey."

Azim eventually used his recovery period to do administrative work at Singapore Rugby, where he also helped out as a ball boy and learned about the management and tactics of adult players.

The experience cemented his interest in rugby and he decided to drop football, so as not to overexert himself.

He now trains about three times a week for school and for an external rugby club. He did well enough to qualify for the Singapore Rugby 7s under-17 team last year.

Though he continues to feel some minor after effects, such as tingling in the ankle, and frequently gets calf cramps, he has learnt to manage these issues by doing more stretching.

He now takes a more disciplined approach towards sports, such as avoiding playing recreationally.

For all the physical risks, both parents and children alike believe in and appreciate the immeasurable benefits from sports.

These include the pure fun and joy from simply playing a favourite sport, the invaluable lessons learnt on the field, and the values that they inculcate and instill in the players.

Hean Kai, for instance, worked his way up to becoming his school's lead player through "consistent training and sheer hard work", his dad said, even taking the initiative to watch his diet and work on his fitness.

Mr Neo added: "Basketball has taught him discipline, resilience and the value of putting in consistent effort."

And for Azim, he simply cannot imagine a life without sports.

"From the incident, I learnt that accidents and injuries can easily happen. What's important is how we bounce back and persevere in order to become better and achieve more in the sport."

Source: CNA/ma/sf