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Kids Will Be Kids

Although he would go on to win back-to-back Academy Awards for starring roles in Philadelphia and Forrest Gump, Tom Hanks garnered his first Oscar nomination for the 1988 fantasy/romance Big. The succinctly titled film told the story of Josh Baskin, a 13-year-old kid from suburban New Jersey who finds himself at an awkward stage in life. While he still loves playing with walkietalkies, miniature cars, and robots, Josh also lusts after Cynthia Benson, a more developed classmate who thinks Josh is cute but would rather hang out with upperclassmen who are, well, bigger. In the depths of his dejection, Josh runs head-on into Zoltar Speaks, a mystical carnival machine that can grant wishes. Dropping a quarter into Zoltar’s slot, Josh whispers his longing to be big. When Josh awakens the next day, he has been transmogrified into the 30-year-old Tom Hanks. Rejected by his frantic mother as a home invader who has kidnapped her son, Josh escapes to Manhattan until he can figure out how to become little again. After spending his first night in the big city crying himself to sleep in a seedy hotel, Josh quickly rises in the world, propelled by his math skills and his child-like personality. Hired for a data-entry position by a large toy company, Josh is abruptly promoted to vice-president of product development when the CEO notices his uncanny ability to sense what toys would appeal to young boys. In one of the movie’s most indelible scenes, Josh and his boss dance out 4-footed versions of Heart and Soul and Chopsticks on a giant keyboard in the 5th Avenue flagship store of toy merchant FAO Schwarz. Big’s charm and intrigue flow naturally from the clash between Josh’s 30-year-old body and his 13-year-old personality. Tom Hanks’ bravura performance captures the essence of an adolescent simultaneously yearning for the independence of adulthood and the simplicity of childhood. Josh’s spontaneity, sincerity, and vulnerability contrast sharply with the cynical, calculated behavior of his adult workmates. One of Josh’s most worldly female colleagues is attracted by his uncomplicated nature, which she ironically perceives as grown-up compared with the disingenuous scheming of her many prior liaisons. Ultimately, this leads to some hilarious misunderstandings and tender encounters that could only be described as a 13-year-old boy’s ultimate wish fulfillment. Big achieves its success by reminding us of the enormous differences between adults and children, differences that are also pertinent to a number of issues in orthopaedic sports medicine. One of these issues is injury prevention, a particularly timely topic in light of the current AOSSM STOP Sports Injuries campaign. Much research and many pages of AJSM have been devoted to analyzing and attempting to modify movement patterns that might contribute to noncontact anterior cruciate ligament (ACL) injuries, particularly in female athletes. Beginning at puberty, the risk of ACL injury in girls and women seems to increase in comparison with their male counterparts, at least in certain sports. Some researchers have attributed this difference to a divergence in neuromuscular development that occurs during adolescence. Several training programs have been proposed to counteract this divergence, with most research focusing on their effectiveness in adolescents and older teens. Some authors hold that the best age to introduce an injury prevention program is prior to adolescence. This assumption underlies the study ‘‘Effects of an Age-Specific Anterior Cruciate Ligament Injury Prevention Program on Lower Extremity Biomechanics in Children’’ by DiStefano et al, which appears in this issue of AJSM. Injury prevention programs that are effective in postpubescent athletes may not be automatically transferrable to prepubescent children. These 2 distinct groups of youngsters differ in their neuromuscular function, response to strengthening exercise, attention span, and mode of learning. In an earlier study, DiStefano et al found that when the same injury prevention program was administered to youngsters aged 10 to 13 years and high school students aged 14 to 17, the older group made greater changes to their movement patterns, even though the younger subjects had more room for improvement and trained for a longer period of time. Accordingly, the authors devised a pediatric injury prevention program specifically aimed at the capabilities of this younger age group. In the current study, the authors used cluster randomization to allocate youth soccer players 10 (61) years of age to the pediatric prevention program, a ‘‘traditional’’ prevention program, or a control program that included no supplementary training. The ability to effect changes in the players’ performance of a cutting task was chosen as the primary outcome. Although both training programs were designed to address balance, flexibility, strength, and agility, the designated pediatric program used more gradual progression, smaller components, greater variety, and other adaptations for the children’s cognitive abilities and attention span. Unfortunately, the results were disappointing. Although the study met its a priori sample size targets, the traditional program produced no significant Editorial