Monday, January 13, 2014
Lionel Messi returned last week to playing soccer after a torn muscle sidelined him for two months. This was his third injury of the season and fifth in 2013. At just 26 years old, Messi has suffered through several torn muscles and hamstring injuries. Nevertheless, his accolades continue to pile up. This year, he became the first player to score four hat tricks in the Champions League, and he has scored 24 hat tricks in his career. He has scored the most away goals in league history. He may be the best player ever, and he will certainly be in the top 10 no matter when his career ends. He plays for FC Barcelona, but he is Argentinian and led the Argentine national team to an Olympic gold in 2008. His list of individual honors totals 101 between 2005 and the present, meaning he averaged 14.5 awards a year. That list doesn’t include 28 team league victories in La Liga, the Olympics, Copa America, Copa del Rey, UEFA Champions League, and several others. His contributions to his teams in particular and the popularity of soccer in general can be measured both in boosting fan interest and the incumbent financial benefits for his clubs and opposing clubs. Barcelona’s investment in the player (as legend has it, sealed with a contract written hastily on a napkin) when he was just 13 has been repaid a hundred-fold.
So how did he come to play for Barcelona as a youth player? Messi had been clearly identified as one of the best youth players in Argentina by age 8. Argentina’s powerhouse club River Plata took an interest in him. However, it soon became obvious that Messi was lagging behind his peers in growth and size. While soccer definitely offers opportunities for smaller players, clubs often shy away from them. When he was diagnosed at age 11 with growth hormone deficiency, his parents made the decision to embark on nightly hormone injections. The therapy soon strapped the family financially. They asked River Plata to take on the expense as part of their investment should they sign Messi as a youth player, but the club refused. Through relatives in Spain, the family made overtures to teams there, and FC Barcelona agreed to take the young player on and pay for his hormone treatment. Even with the growth hormones, Messi grew to just 5-foot-6, not necessarily small for a professional soccer player, but certainly smaller than most. Nevertheless, he proved to be a tenacious and skilled striker. What plagued him were injuries.
Weak muscles and thin bones are common in children diagnosed with growth hormone deficiency, so in general the treatment improves both muscular and skeletal conditions. The treatment stimulates the liver to release a second hormone called insulin-like growth factor-1 (IGF-1). Together, growth hormone and IGF-1 tell the bones, muscle and tissue to grow by adding more cells. This results in bones that are strong and long and can increase a player’s size up to 2-3 inches a year until the end of puberty. The known adverse effects are a possible increased risk to develop diabetes, stimulating already existing cancers to grow dangerously, and to expedite colon-rectal cancer later in life. Studies on what happens to rapidly growing muscles and bone growth plates have not established a link with serious injuries. In fact, without the treatment children can suffer with thin, weak bones as they move into adulthood. Because levels of human growth hormone fade as we grow older (because we are done growing!), some people believe that increasing the levels in adulthood can delay the aging process. Despite no proof, many adults use it for that purpose, while other adults use the hormones to help muscle development and definition. These are not approved uses.
Overall, Messi just seems to be prone to injury. But those injuries, while keeping him sidelined for a period of time, heal, and he comes back with the same skills and power he had before the injury. The question is will those injuries eventually catch up to him. At 26, he has the injury history of older players with a longer playing career than he has had. In 2013, he suffered through five injuries of which four related to his hamstring. His latest injury was a torn muscle.
My youngest son always measured in the lower 5 percent on the growth charts, but he eventually grew to be as tall as Messi without the addition of growth hormone therapy. My husband was 4-foot-8 when he entered high school and grew two inches after we got married. His short stature kept him from playing the high school sport he most wanted to play, baseball, but he found a niche in wrestling, although each year he had to change weight classes as he slowly grew. Robbie is adopted, so he didn’t get his abbreviated height from our genes, and his half-brother is 6-foot-3, so genetically tall growth was possible. They both had the same birth mother who was only 5-foot-3. We never even considered having Robbie tested for growth hormone deficiency, and I suspect he never had the condition. But as parents we often need to consider the issue when faced with an athletic child who doesn’t seem to be sprouting. In this age of hormone abuse by athletes, growth hormone therapy for children falls in a completely different realm of empowerment. On the other hand, parents must be cautious about wanting to improve their child’s chances of competing in sports at the teen years and beyond by subjecting them to a treatment they may not need. The condition should be carefully tested for and evaluated by an endocrinologist since the child must endure daily shots for possibly as long as four years.
Some people have accused FC Barcelona and Messi’s parents of attempting to create a “super-athlete” by having Messi treated. Since none of us are privy to his medical records, we can only hope that the treatment was appropriately prescribed for an actual condition. However, I do know of parents who have consulted doctors that they hoped would agree to the treatment, even using some bullying techniques to ensure it for their child. The thin line between necessary treatment and desired treatment can easily be crossed by zealous parents and coaches, especially when a child shows promise in a sport. Treatment for growth issues can be and has been done with anabolic steroids, a serious and potentially dangerous decision for any child. In addition, insulin has also been used to stimulate growth. With some diligent doctor hopping, parents can always find someone to prescribe questionable treatments. Therefore, it’s important to keep things in perspective. If a child is growing slowly, like my husband, and an endocrinologist says her growth is normal, no parent is doing their child a favor by insisting that something be done to speed up or augment that growth. Even though slow growth can prevent some kids from participating in certain sports, we sometimes just have to accept that our child isn’t going to be that athlete we had hoped for. The world is made up of so many other wonderful professions and skills, we can’t just fixate on sports.
While medical solutions can be drastic steps which most of us wouldn’t even contemplate unless clearly indicated, we can consider other ways to boost our child’s abilities. Good nutrition would be an admirable option to help our child achieve his optimal performance, but again we have to avoid zealousness that leads us to rely heavily on supplements and vitamin regimens that haven’t been proven to be either beneficial or even safe. No one regulates these supplements. In April, the FDA issued a warning that several nutritional supplements contained dimethylamylamine or DMAA, which is a stimulant and causes rapid heart rate, increased blood pressure and even heart attacks. You can actually overdose on vitamins and minerals, especially since so many foods are now enhanced with things like calcium and vitamin C. You may take a safe dose of a vitamin in the morning, but because your cereal, juices, yogurts, and other foods have boosted their vitamin and mineral content, you could be giving yourself or your child toxic levels of these. Even more worrisome is how some supplements can interact with prescription drugs in a dangerous way. “All natural” isn’t always “all safe;” arsenic and digitalis are also natural products. We can also provide extra condition training for our children. Again we need to be cautious. Training should be age appropriate for the musculo-skeletal developmental level of the child and shouldn’t be over-strenuous. Muscles, tendons, and ligaments need time to relax after any workout. Keeping them in a constant state of exercise can cause tremendous and, on occasion, irreparable damage, certainly not the result anyone is looking for. Find an educated and credentialed trainer, not just someone at the gym with a great physique and a loud voice. Be watchful for signs of stress on joints, muscles and tendons. Always have a medical physical before augmenting any sport activity and get your physician’s approval for the program you’ve selected for your child.
While Messi adds to his string of honors, he also adds to his hamstring problems. Most likely his growth hormone treatment helped to make him taller, but more importantly improved his bone and muscle strength. Without the treatment, he might well have already had a career-ending injury. For some children, medicine can promise a stronger body and a healthier life. As parents, if we suspect some insufficiency in our child’s well-being, we need to seek out the best medical, nutritional, and physical help we can find. What we shouldn’t do is pin our hopes for a superior athletic child on any treatment. Instead we should simply be looking to improve the child’s health. Messi was an amazing player before his treatments, and for all we know may have been just as amazing without the treatments. The problem is there is no way of knowing unless we can borrow Mr. Peabody’s Way Back machine and replay history without growth hormones. Therefore, we must pursue what is right for our child based solely on sound medical reasons and advice, not on our dreams of her becoming a stronger competitor. Messi may eventually be completely incapacitated by his injuries, but he was given an opportunity to overcome a serious medical condition and, for whatever period of time, shine.