Optimisation of health and performance progression of youth divers and triathletes through the athletic pathway

Abstract

Athlete health and performance are closely linked, with early identification of health problems key to maintaining training consistency and support both short-term performance success and long-term career sustainability. However, the effectiveness of early identification depends on its integration into timely, individualised and evidence-informed management plans that are systematically monitored and modified in response to athletes evolving health and performance profile. For youth pathway triathletes and divers, routine and longitudinal health problem monitoring is often lacking. This constrains the development and implementation of effective prevention strategies. Therefore, the overall aim of this thesis was to identify and document health problems in youth high-performance divers and triathletes across various stages of growth and maturation and investigate associations with training loads and somatosensory function to inform the development of prevention and management strategies. This aim was achieved through a systematic review of the literature, and a series of three linked studies. The review explored acrobatic and aesthetic athletes, the first study focussed on youth divers, and studies three and four focussed on youth triathletes. First, the systematic review of the literature identified five key themes impacting performance health of acrobatic and aesthetic athletes; bone health outcomes; injury, illness and pain; anthropometrics; biomechanics; and training. One main finding was bone health was often found superior pre puberty in gymnasts, yet injury risk increased post puberty, particularly when combined with low energy availability and later maturation. The second study identified high prevalence of injury and illness in youth divers using the Oslo Sports Trauma Research Centre (OSTRC-H) questionnaire, which proved effective in the early capture of health problems when engagement was maintained. The third study found comparable outcomes to divers amongst youth triathletes with high rates of injury and illness. Triathletes had increased severity of health problems post peak height velocity (PHV). This study also highlighted the importance of discipline and sex-specific training load prescription tailored to an athlete’s stage of growth and maturation to optimise bone health and reduce injury risk. The final study further demonstrated sex-specific differences in somatosensory function mid-adolescence and its relationship with growth tempo. These results support the need to implement skills based strength and proprioception training before PHV. This research provides evidence for integrating growth and maturation, sex-specific considerations and training load longitudinal monitoring, alongside early identification of health problems in youth triathletes and divers, starting pre PHV, to promote long term performance success. By recognising the individual, dynamic and asynchronous pattern and tempo of maturation across physical development, health, and somatosensory domains, this research supports a broader understanding of athletic ‘success’ across adolescence, one that prioritises sustained participation, tissue adaptation and progressive skill acquisition as precursors to senior elite high-performance outcomes. By clarifying these key risk factors linked to specific maturational stages, this research provides a foundation for future research and provides practical guidance for coaches, performance staff and parents/guardians. This knowledge allows for more precise, age and sex-specific interventions and from the earlier identification of emerging health problems, better informed training strategies, ultimately reducing injury and illness risk, and supporting the safe sustainable progression along the athlete high-performance pathway.

Date of Award	2025
Original language	English
Supervisor	Jocelyn MARA (Supervisor) & Gordon WADDINGTON (Supervisor)