“Why the spike in youth injuries?”

“Multiple factors, but two stand out: specialization and what we call professionalism.”

– World-renowned sports medicine surgeon Dr. James Andrews

If you are wondering, “What spike in youth injuries?”, we have mentioned some stats previously such as a 926% rise in ACL surgeries in under 15s over a decade period ending 2006. If we step back and look at our society, we see children who are increasingly being treated like they are professionals at their sport. Even from a young age, children are being pushed towards playing one sport year-round, often with practice on most days. As this attitude towards youth sports has gradually become more of a societal norm, we have seen a significant increase in overuse injuries and surgeries to treat them.

How are we treating kids like pros?

• Push towards single sport specialization at a young age.
• Increased training sessions of that sport.
• Increased training intensity of that sport.
• Increased expectations of that sport – coach, parents, the kids themselves.

These are all interlinked and come from a drive to create a successful child athlete. There are many reasons for this drive: college scholarships, lure of professional sport, and society/coach/parental pressures. Single-sport specialization is a problem because, as we will see, it does not necessarily produce the best athletes.

Let us look at the problem of single-sport-specialization.

Physical
A 2015 study¹ of anterior knee pain in middle and high school female basketball, soccer, and volleyball players found that those who were multi-sport athletes had a lower injury risk than single-sport athletes. The single-sport athletes had a 1.5x injury risk for general anterior knee pain. For specific diagnoses such as Osgood Schlatters disease they had a 4x injury risk.

A further example is in baseball. Tommy Johns surgery is now well-known and is increasingly common in baseball players; in fact most of these surgeries are seen in 15-19 year olds² and are thought to be overuse injuries that have been primed by training practice at a younger age. I recently posted a Forbes article on pitcher John Smoltz, 2015 Baseball Hall of Fame inductee, who is currently the only Tommy Johns surgery recipient in the Hall of Fame; Smoltz used his induction speech to advise teens to play multiple sports and avoid the surgery. But what are the risk factors in this and other baseball overuse injuries? Studies by the American Sports Medicine Institute (ASMI) show the following significant increases in shoulder and elbow injury risk for youth baseball players in several areas:

• 350% increase in injury risk for 9-14 year olds pitching more than 100 innings in a year³
• 500% increase in injury risk for 14-20 year olds pitching at least 8 months of the year⁴
• 400% increase in injury risk for 14-20 year olds throwing more than 80 pitches in a game
• 250% increase in injury risk for 14-20 year olds pitching a fastball 85mph or higher.

For a child who has specialized to playing baseball as their only sport, the odds of them falling into one or more of these high-risk categories is much higher than for a child who splits time between multiple sports.

Psychological
In addition to the physical issues of single-sport-specialization, we also need to consider the psychological side, specifically burnout. A 2013 study showed that elite-level athletes from a wide variety of sports who specialized at an earlier age had greater issues of early burnout and dropout from their sport⁵. This study quoted another which found rhythmic gymnasts between ages 4 to 16 who specialized earlier and spent more hours training, rated their health lower and experienced less fun. As a society we want our youth to be fit, healthy, and go on to have a healthy later life. This research suggests that single-sport pursuits could eventually lead to children dropping out of sport, which would lead to less healthy lives.

Performance
At this point you may be thinking, “I understand where you are coming from but, if my kid is talented, surely it makes the risk vs. reward worth it?” Current studies⁶ are questioning this, and are finding that playing multiple sports actually helps an athlete develop more thoroughly, which will increase their odds of success in their primary sport. This is seen when we look at a couple of tweets about the Ohio State Football program:

From the first tweet you may think that this is just one college and perhaps that is luck of the draw. But the second tweet highlights the high number of multi-sport athletes who were elite enough at football to attend the combine to try and go pro! It almost seems like it is a prerequisite to be multi-sport!

****2016 Update!***** More stats from the NFL draft supporting multi-sport athletes:

Wow, when is a good time for my child to specialize?

This is a good question, and the research is still evolving. Some suggest that in sports where post-puberty strength gains are less important, such as golf, tennis, and gymnastics, specialization to develop skill sets could occur earlier. I still do not think that in those sports we should say that this should be a sole focus. Of the specific studies out there:

• Russian swimmers who specialize age 11yr or younger spent less time on the national team and retired earlier⁷
• In tennis, elite athletes specialized later, on average at age 13, compared to near-elites, at age 11⁸
• A study on multiple sports found that elite athletes were more likely than near-elite athletes to have specialized after 12, and played multiple sports during developmental years⁹
• Another multiple sport study of Danish athletes found that elite athletes started more intense training at a later stage than near-elites at a young age (here defined as 11-15yr)¹⁰

This shows that it is very hard to give a specific guidance on age. Several of the studies suggested that at least until a child has stopped growing there is benefit to being a multi-sport athlete. All studies point towards the need for further collection of data and research. But if you combine the above figures with the tweets you will understand why I recommend that it is worth being multi-sport for as long as you can be. The truly exceptional athletes who will make college scholarships and/or go pro will get there without the over-exposure that some youth programs can give.

Reference List:

1. Hall R, Barber foss K, Hewett TE, Myer GD. Sport specialization’s association with an increased risk of developing anterior knee pain in adolescent female athletes. J Sport Rehabil. 2015;24(1):31-5.
2. Erickson BJ, Nwachukwu BU, Rosas S, et al. Trends in Medial Ulnar Collateral Ligament Reconstruction in the United States: A Retrospective Review of a Large Private-Payer Database From 2007 to 2011. Am J Sports Med. 2015;43(7):1770-4.
3. Fleisig GS, Andrews JR, Cutter GR, et al. Risk of serious injury for young baseball pitchers: a 10-year prospective study. Am J Sports Med. 2011;39(2):253-7.
4. Olsen SJ, Fleisig GS, Dun S, Loftice J, Andrews JR. Risk factors for shoulder and elbow injuries in adolescent baseball pitchers. Am J Sports Med. 2006;34(6):905-12.
5. Jayanthi N, Pinkham C, Dugas L, Patrick B, Labella C. Sports specialization in young athletes: evidence-based recommendations. Sports Health. 2013;5(3):251-7.
6. Feeley BT, Agel J, Laprade RF. When Is It Too Early for Single Sport Specialization?. Am J Sports Med. 2015;
7. Barynina II, Vaitsekhovskii SM. The aftermath of early sports specialization for highly qualified swimmers. Fitness Sports Rev Int. 1992;27:132-133
8. Carlson R. The socialization of elite tennis players in Sweden: an analysis of the players’ backgrounds and development. Sociol Sport J. 1988;5:241-256.
9. Lidor R, Lavyan A. A retrospective picture of early sport experiences among elite and near-elite Israeli athletes: developmental and psychological perspectives. Int J Sport Psychol. 2002;33:269-289.
10. Moesch K, Elbe AM, Hauge ML, Wikman JM. Late specialization: the key to success in centimeters, grams, or seconds (CGS) sports. Scand J Med Sci Sports. 2011;21(6):e282-e290.