Last Friday I had the pleasure of speaking in London at the Centre for Youth Sports Medicine (CYSM) Annual Conference 2026, on a topic close to my heart: how we protect young athletes while helping them develop. My talk was titled “Protecting young athletes: performance progressions, realistic expectations and injury prevention,” and what follows is a short summary of what I covered, the science behind it, and a new project I shared at the end

Young athletes are not mini-adults

The starting point of the talk is a simple but frequently ignored idea: a young athlete is not a scaled-down version of a senior one. Youth development sits on an individually unique and constantly changing base of physical growth, biological maturation and behavioural development. Because of this, success at an early age does not guarantee success at senior level, and selection systems in most sports quietly favour early maturers — children who happen to be bigger and stronger sooner, not necessarily those with the most long-term potential.

This matters because the way we coach, test and select needs to account for where a child actually is in their development, not simply how many years have passed since their birth.

Age is not just a number

A large part of the talk dealt with the difference between three kinds of age:

• Chronological age — years since birth.
• Training age — how many years a young person has spent in structured training.
• Biological age — where the individual actually sits on the maturation curve, based on physiological markers.

Two children of the same chronological age can be years apart biologically. Around the growth spurt — the period of Peak Height Velocity (PHV) — this gap becomes especially important for training and injury risk. I walked through the methods we use to assess maturity status and timing, from skeletal age estimation (Tanner–Whitehouse, Greulich–Pyle, Fels) to anthropometric approaches based on height, leg length and body mass. I also flagged an important caution from our own work: prediction methods developed on one population can systematically over- or under-predict in another, so the difference between skeletal and chronological age should be used to put test results into context rather than as an absolute truth (for some recent work on this, read this paper from Dr Lorenzo Lolli here).

Talent, the relative age effect, and the road from youth to senior

I then turned to talent identification and the relative age effect — the well-documented bias in which athletes born early in the selection year are over-represented in youth squads and ranking lists. Across athletics and team sports such as Italian football, the data show how strongly birth-quarter skews youth selection. Yet relatively younger or later-maturing athletes often progress better when they transition to senior level — the so-called “underdog hypothesis.”

This connects to one of the central findings I shared, drawn from analyses of tens of thousands of athletes’ careers: early success is not a prerequisite for success as an adult. In jumping events in track and field, only around 8% of males and 16% of females ranked in the world top 50 at age 16 went on to reach the top 50 as seniors. In sprints, on average only about 17% of men and 21% of women were in the top 50 both as under-18s and as seniors. Different pathways can lead to similar outcomes, and many talented juniors never make the transition — for reasons ranging from maturation and selection bias to injury, burnout, loss of funding, or simply moving to another sport.

Injuries and load in young athletes

The final scientific section focused on injury. Young athletes face a distinct set of growth-related conditions — Osgood-Schlatter disease at the knee, Sever’s disease at the heel, gymnast’s wrist, Little League shoulder and elbow, apophysitis around the hip, and more. Our own prospective work in a full-time athletics academy was, to our knowledge, the first to examine growth rates and skeletal maturation as injury risk factors in a large adolescent cohort engaged in full time athletics. We found that rapid growth in stature and leg length, a younger skeletal age and a faster maturity tempo were all associated with an increased risk of bone and growth-plate injuries.

This raises hard questions about how we manage load. Most studies still quantify training simply as “time,” without accounting for what athletes actually do in that time — two athletes can train for the same number of hours doing completely different work. Better load monitoring, including the thoughtful use of wearables and AI, is one of the areas where I think we can genuinely improve.

The book chapter: The Young Athlete

Much of this material is drawn together in a chapter I co-authored with Gennaro Boccia, Paolo Riccardo Brustio, James Baker and Eirik Halvorsen Wik — Chapter 9, “The Young Athlete,” in the Sports Physician Handbook (Fourth Edition of the FIMS Team Physician Manual), edited by Pitsiladis, Yung, Hutchinson and Pigozzi (Academic Press, 2026, pp. 199–235, the link the book is here).

The chapter brings together the themes of the talk into a single reference for clinicians and practitioners: defining the elite young athlete, understanding growth and maturation and why they matter, the relative age effect and the junior-to-senior transition, performance progression and realistic expectations, and the prevention and management of youth injuries and illness — including data from recent Youth Olympic Games.

A thank you to the CYSM, ISEH and the audience

I want to thank the Center for Youth Sports Medicine and the Institute of Sport, Exercise and Health for hosting me and for the care they put into convening this event. The ISEH has been a genuine centre of excellence for sport and exercise medicine since its creation as a legacy of the 2012 London Olympic Games, and its commitment to the health of young athletes is exactly the kind of leadership this field needs. I was equally grateful for the audience — the questions, the engagement and the obvious dedication of so many practitioners to getting this right. Youth sport sits at the intersection of health, development and performance, and it is genuinely encouraging to see so much interest in protecting the young people at the centre of it.

Bringing athletics data to life: a new (experimental) project

One recurring frustration in this area is that the data needed to put a young athlete’s results into context — how the best in the world actually developed over time — is hard to access and harder to compare against. So I have been building something to help coaches interested in Athletics.

I am sharing here an early look at the Athletics Performance Tracker, an AI-assisted project that brings athletics results databases to life and makes them accessible to everyone. The aim is to let coaches, athletes, parents and researchers explore how performance develops with age and compare a young athlete’s results against those of top-ranked athletes.

It currently covers around 30 World Athletics events with thousands of athletes and tens of thousands of performances, and includes:

• Development curves showing how the world’s best progress from age 12 to 40, with mean values and confidence intervals across the top 10, 20, 50 or 100 athletes.
• Year-on-year analysis of absolute and percentage improvements for individual athletes or whole cohorts.
• World top lists for every event, with comparisons to the previous year.

You can explore it here: athletics-tracker.fly.dev.

An important caveat: this is very much an experimental project and still under active development. It is intended for research and exploration, it is not affiliated with World Athletics, and features and data will continue to change. I would welcome feedback as it evolves.

In summary

Early success is not a requirement for success as an adult. Assessing maturity status is key to interpreting training and test results. Training should be progressive, varied and developmentally appropriate, and we need to understand injury patterns — and load — far better than we currently do, with more work needed on young female athletes in particular. Above all, health and longevity in sport should always come before performance at a young age. If we get that balance right, we give more young athletes the chance to fulfil their potential — and to stay healthy doing it.