Early Diversification

20 Dec Early Sports Specialization – Part 3

For all of the readers patiently awaiting the solution for how to help support our patients or children who participate in year-round sports at a young age, here is part 3 of the three-part series on Early Sports Specialization. In part 1 of this series, I discussed the definition and reasoning behind this concerning trend in athletic participation, and in part 2, I talked about the increased risk of overuse injuries with early sports specialization and the biomechanical factors that underlie these types of injuries. Finally, in the last part of this series, I will lay out an action plan to help prevent injury and maximize athletic success in our young athletes.

As I alluded to in the prior blogs, due to a growing body of literature linking early sports specialization and musculoskeletal injury, various organizations including the American Medical Society for Sports Medicine in 20131 and the American Academy of Pediatrics in 20162 have released position statements warning against early sports specialization. In terms of a solution, it is also important to note that these organizations have published guidelines that serve to help protect the young athlete who is considering or is already committed to a year-round sport. The most basic recommendation concerns age of participation. There is no general consensus on when sports specialization is clearly detrimental and when it becomes beneficial to the elite athlete. Generally speaking, age 12 is considered a rough cutoff as this is the age at which puberty and skeletal maturation begins. The current evidence suggests that in the majority of sports, delaying sport specialization until 15-16 years of age or generally after puberty will minimize the risk of injury and lead to a higher likelihood of athletic success. As an aside, there do appear to be a few sports such as gymnastics, diving, and figure skating where this age guideline may not hold true as peak performance primarily occurs in these sports before full physical maturation.1

What do we do about our young athletes who have already chosen a pathway of early sports specialization? In regards to volume, again it is not clear what exact amount of training is needed to maximize success and minimize risk of injury as well as burnout and drop out. Some helpful rules of thumb are the following. First, the athlete should participate in fewer hours of organized sports per week than their age. Secondly, the athlete should restrict training to less than 16 hours per week. In addition, it is important to institute periods of rest during year-round sports to allow for physical and psychological recovery. The athlete should have at least a total of 2-3 months off during the year in increments of one month, during which time it is alright for them to remain active in other activities. During the rest period, the athlete might consider focusing on strength and conditioning. This specifically refers to periods of isolated and focused integrative neuromuscular training to enhance diverse motor skill development and reduce injury risk factors including general (strength building exercises) and specific (exercise targeted to motor control deficits) conditioning activities.3 In addition to this guideline, there are also recommendations regarding weekly and daily periods of rest. On a weekly basis, in order to decrease the chance of injury, the athlete should have at least 1-2 days off per week from their particular sport of interest and 1 day off from any organized sports participation. Finally, on a day to day basis, it is important to emphasize relative rest from repetitive movements; for example, in baseball, adhering to the guideline for pitch counts is imperative.What would the potential impact be from enforcing these guidelines in our highly specialized young athletes? In 2017, a study using injury prevalence rates predicted that because there are over 20 million young athletes who are highly specialized and have an increased risk of sport-related injuries, that over 2 million potential injuries per year could be prevented by adhering to sports volume recommendations and prescribing appropriate rest periods for these athletes.4 Clearly, these guidelines are important.

But what do we do with the young patients in our office or the children in our home who are participating in year-round sports before the age of 12 and who may not be adhering to the volume and rest guidelines above? The physicians, physical therapists, trainers, coaches and parents should all be closely monitoring the physical and psychological well-being of these young athletes. Specifically, the clinicians mentioned above should take a thorough history with a focus on the athlete’s training volume and rest periods. This should include questions about participation time outside of sports practice and competition (think additional teams i.e. school or “all-star” teams, private lessons, practice with parents or teammates, and even PE classes). It is also important to evaluate for any signs of psychological distress such as anxiety or burnout. In addition, the clinician should complete a comprehensive physical exam focusing on the injured area and any abnormal biomechanics contributing to the injury including muscle weakness or imbalance, muscle inflexibility, and ligamentous laxity. The treatment of the injury should include complete rest of the injured area and consideration of physical therapy for targeting the injury and correcting any associated biomechanical deficits.

In the future, it my desire that a blog like this and moreover the body of accumulating literature on this topic will lead to a more informed discussion between clinicians, coaches, and parents about the risks of early sports specialization and the ways to help prevent game changing injuries in our young elite athletes. It is also my hope that the tides will turn away from the concerning trend of young athletes training intensely in 1 sport year-round and move towards the model of early diversification mentioned in part 1 where children sample multiple sports and moreover engage in free play and unstructured physical activity. After all, isn’t the point of all this to help our children develop lifelong healthy lifestyle habits and have fun? Let’s work together to keep our young athletes healthy and happy.

1 AOSSM Early Sport Specialization Consensus Statement.
https://www.ncbi.nlm.nih.gov/pubmed/27169132

2 Sports Specialization and Intensive Training in Young Athletes.
http://pediatrics.aappublications.org/content/early/2016/08/25/peds.2016-2148

3 Bukowsky, M et al. FUNdamental Integrative Training (FIT) for physical education. J Phys Educ
Rec Dance
. 2014;85(6):23-30.

4 Post, EG et al. The Association of Sport Specialization and Training Volume with Injury History in Youth Athletes. American Journal of Sports Medicine. 2017; 45(6):1405-1411.

Images used under creative commons license – commercial use (12/19/2017)  Marco (Flickr)