Early sports specialization leads to increased injury and poor health in student athletes
We have all heard the terms ‘the more the better’ and ‘no pain, no gain.’ However, these expressions lose their value when it comes to sports and injuries, because pain typically equals damage. Approximately thirty million students participate in sports during school each year and sports-related injuries are very common for participants (Stanford Medicine, 2019). Studies reveal that overuse injuries account for 30% of sports related injuries each year (Yang, 2012). Improper training and inadequate rest can increase the likelihood of overuse injuries; this can negatively influence a student athlete’s longevity in their sport. These statistics are no different for the athletes of the Coastal Bend.
Athletes that participate in a sport year-round (vs taking time off to gain strength and limit overuse) do not have the opportunity to develop the strength, conditioning, and stability necessary to support their body during play- increasing the risk for muscle imbalances and injury. High training volumes, such as year-round sport participation, has become so concerning that several medical and sports organizations released statements advising against the trend of sport specialization in youth (Bell, 2018). Early specialization of a sport can pave a negative path of permanent consequences, with no known statistical improvement in sports performance (Smucny, Mia et al. 2015).
The American Orthopaedic Society for Sports Medicine defines early specialization as participation in one specific sport more than 8 months in a year, and for more hours in a week than their age. The adolescent musculoskeletal structure continues to mature into the late teens and early 20’s (gender relative), which early specialization puts the body at a vulnerable disadvantage and risk of injury (Smucny, Mia et al. 2015). There continues to be an undesirable trend of overuse injuries, which is now including children younger than 13 years old.
• ACL tears and reconstruction surgeries have increased in the youth athlete over the last 20 years. 2.3% overall (boys and girls) each year per 100,000 persons. Greatest incidence in females ages 15 -16 (2.6%/year) (Beck, et al. 2017). With candidates as young as 7-9 years old.
• UCL injuries in the elbow have resulting in an increase in Tommy John’s surgical intervention, with greater than 56% of all surgical candidate being children ages 15-19; with a growth rate of 9.84% yearly. (Saper et al. 2018). With candidates as young as 13 years old being recorded.
• Stress fractures of not only the feet, arms, and legs, but we are seeing an increase in insufficiency fractures about the vertebra (bones of the spine).
Fatigue from lack of rest and overtraining, deficits in athletic strength, as well as nutritional imbalances in these over worked athletes. When one thinks of the word osteoporosis, you may think of a more seasoned adult. Think again, the number of youth athletes being diagnosed with osteopenia (defined as the beginning stages of bone loss) and osteoporosis (defined as a 40-50% loss of bone mass) are on the rise. A study of over 1,000 adolescents found that over 56% had osteopenia and 6% already had osteoporosis. (Klyuchnikov S. 2019). This information is significant to digest, as these youth athletes should still be developing, however their bone structure is already deteriorating. Fatigue can also lead to early burn out and other psychosocial issues among students’ athletes. The consequences of these physical and mental manifestations can stick with those athletes for a lifetime, so it is imperative for appropriate action in the youth sport culture.
What should parents be on the lookout for?
There isn’t always one feature that turns the light on to suggest over use, but when multiple episodes begin to occur, it is time to take note. Dr. Tommy John, author of Minimize Injury, Maximize Performance: A Sports Parent’s Survival Guide, lists a few key characteristics for parents to look out for with their student athlete.
• Increases blood flow by dilating blood vessels (vasodilation)
• Helps restore movement
• Reduces pain
• Promotes relaxation
• Decreases tissue tightness and joint stiffness
• Facilitate tissue healing
• Decreases muscle spasms
• Prepares stiff joints and tight muscles for exercise
You may notice in that list there are multiples key points, which few are the actual sport. Ensuring the youth athletes get proper
• nutrition (fruits, vegetables, lean proteins, fish, calcium, and vitamin D),
• hydration (The NCAA recommends starting hydration 24 hours before event then 2-3 hours prior = 16oz, 15 mins prior = 8 oz, during event = 4oz. every 15-20 mins, after event = 16-20 oz for every 1 pounds of weight lost),
• mental stimulation (limiting technology and screen to less than 2 hours a day, ‘play time with friends’, reading, speaking with a councilor when needed), and
• sleep (good quality is more important than time, however minimum recommended time is 10 - 12 hours approximately as night)
These are vital components to not only a student athlete, but a child in general. Time to rest and recover is an absolute necessity when it comes to ensuring the longevity of a student athlete.
What is the recommended to ensure that your student athlete is participating safely in athletics?
The rule of thumb includes:
1: Do not specialize in a 1 particular sport as a youth athlete.
2: Limit the number of hours participating in 1 particular sport to fewer hours in a week than the child’s age.
3: Keeping the season to less than 8 months a year and using the remaining months for periodization to train strength and condition as well as cross training. (Post, et al. 2017).
You may now be getting nervous about what is right vs wrong when it comes to your student athlete. It is never too late to take the proper steps to reduce your child’s risk of injury or burn out. Monitoring your child’s nutrition intake, hydration, sleep time, and screen time, as well as making sure they are taking time to strengthen purposefully in the off season or during summer break. Student athletes are at their highest risk of injury during periods of increased training intensity, such as return-to-sport from injury or summer break (Jones, 2017). Periodization is an important technique to incorporate with a strength and conditioning program to prevent plateaus and maintain neuromuscular challenges – this is primarily to be performed during the off season. Strength and conditioning are not appropriate during in season; the athlete needs to focus on skill training and limit risk of over training injury. Optimal training frequency will be for 4-6 days per week. Additional training or multiple sessions per day may lead to overtraining and overuse injuries. Try to incorporate variations of your main lifts (squat, deadlift, bench press, etc.) on different days. Do your best to spread out training days throughout the week to allow for adequate rest. It is also important to avoid working the same muscle groups on consecutive days. Research has shown the benefits of supervised offseason training compared to unsupervised training in overall strength, power, and muscle mass gains (Smart, 2013). Supervised sessions not only allow you to push yourself further but also provides for increased safety and adjustments to improper technique.
The student athletes of the Coastal Bend are already an underserved population, although availability of resources have increased over the last few years. Multiple factors play into the decision for going into the wonderful world of athletics, but it is important for the student athlete to make the choice for themselves and for parents to support and nurture their progeny. Keeping the athletes safe and healthy through season is imperative, however it is the obligation of the team around the athlete to foster a mature and healthy adult. The environment these athletes grow in will be the building blocks of their future; so make sure the foundation is resilient.
Stanford Medicine. (2019). Sports injury statistics. Retrieved from Stanford's Children's Health: https://www.stanfordchildrens.org/en/topic/default?id=sports-injury-statistics-90-P02787
Yang, J. T. (2012). Epidemiology of Overuse and Acute Injuries Among Competitive Collegiate Athletes. Journal of Athletic Training, 47(2). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3418132/
Bell, D. P. (2018). Sport Specialization and Risk of Overuse Injuries: A Systematic Review With Meta-analysis. Pediatrics, 142(3). doi:DOI: https://doi.org/10.1542/peds.2018-0657
Smucny, Mia et al. Consequences of Single Sport Specialization in the Pediatric and Adolescent Athlete. Orthopedic Clinics, Volume 46, Issue 2, 249 – 258.
Beck, Nicholas & Lawrence, J. & Nordin, James & DeFor, Terese & Tompkins, Marc. (2017). ACL Tears in School-Aged Children and Adolescents Over 20 Years. Pediatrics. 139. e20161877. 10.1542/peds.2016-1877.
Saper, M., Shung, J., Pearce, S., Bompadre, V., & Andrews, J. R. (2018). Outcomes and Return to Sport After Ulnar Collateral Ligament Reconstruction in Adolescent Baseball Players. Orthopaedic journal of sports medicine, 6(4), 2325967118769328. https://doi.org/10.1177/2325967118769328
Klyuchnikov S. O., Samoylov A. S., Pushkina T. A., Zholinsky A. V., Kravchuk D. A., Ogannisyan M. G., Sholkova Y. Y., Feshchenko V. S. Osteoporosis Is a "Silent" Problem in Children’s Sport Medicine. American Journal of Pediatrics. Vol. 5, No. 4, 2019, pp. 240-245. doi: 10.11648/j.ajp.20190504.23.
John MD, T. (2018). Playing Multiple Sports Reduces Injury Risk. [online] Nfhs.org. Available at: https://www.nfhs.org/articles/playing-multiple-sports-reduces-injury-risk/ [Accessed 3 Mar. 2020].
Post, E., Trigsted, S., Riekena, J., Hetzel, S., McGuine, T., Brooks, M. and Bell, D. (2017). The Association of Sport Specialization and Training Volume With Injury History in Youth Athletes. The American Journal of Sports Medicine, 45(6), pp.1405-1412.
Jones, C. G. (2017). Training Load and Fatigue Markers Associations with Injury and Illness: A Systematic Review of Longitudinal Studies. Sports Medicine, 47(5), 943-974. Retrieved December 14, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5394138
Smart, D. G. (2013). Effects of an Off-Season Conditioning Program on the Physical Characteristics of Adolescent Rugby Union Players. Journal of Strength and Conditioning Research, 27(3), 708-717. Retrieved December 15, 2019, from https://journals.lww.com/nscajscr/fulltext/2013/03000/Effects_of_an_Off_Season_Conditioning_Program_on.22.aspx
Gentry, M. (N.D.). Strength Report: Writing the Winter Off-Season Strength and Conditioning Program. Retrieved December 15, 2019, from Collegiate Strength and Conditioning Coaches Association: https://www.cscca.org/Downloads/Writing_the_Winter_Off_Season_Program_Mike_Gentry%20(1).pdf
Nuckols, G. (2018). Periodization: What the Data Say? Retrieved from Stronger by Science: https://www.strongerbyscience.com/periodization-data/