Early Sport Specialisation and Injury Risk: Let kids be kids.
With all these amazing Olympic performances going on at the moment, I frequently get the urge to put my 18 month-old daughter into her swimmers and take her down to the nearest pool to start her Olympic training to be a world class swimmer by 14, a multi-millionaire by 20, and early retirement for Mrs Hughes and I by 55.
As much as I joke about this, as a physiotherapist I have seen first-hand many unnecessarily injured children who have been pushed into one sport, too aggressively, way too early. So if you’re a parent reading this, PLEASE, PLEASE, PLEASE resist the urge to push your children into one sport, and one sport only, in the attempt that they will be an Olympic champion one day. If you’re a coach reading this, PLEASE, PLEASE, PLEASE consider allowing your young athletes to try different sports in alternate playing seasons to experience different movement patterns and training methods.
We no longer should be living in the dark ages when in comes to injuries, and we certainly should not be taking the “survival of the fittest” or “the cream rises to the top” approach to training our young athletes. The “10,000 hour” rule has not been shown as a vital component to future success (1), and many young kids have been broken down, way before their time, who could have gone on to bigger and better things, if only they were given a chance to experience other sports and other movement patterns.
Research consistently shows that early sport specialisation (ESS), or single sport specialisation (SSS) causes unnecessary overuse injuries, contributes to "burnout", and does NOT guarantee future sport success (1).
By definition ESS/SSS is:
Participation in intensive training and/or competition in organised sports greater than 8 months per year (essentially year round).
Participation in 1 sport to the exclusion of participation in other sports (limited free play overall).
Involving pre-pubertal (seventh grade or roughly age 12 years) children (1)
In a perfect example of increased injury risk associated with ESS/SSS, one study found that young athletes participating in more hours of sport per week than their age in years, or whose ratio of organised sport : free play-time was greater than 2:1, had significantly increased odds of sustaining an overuse injury in the future (2).
As a result of a number of studies performed on ESS/SSS showing its direct link to injury, there have been some recommendations published by leading sports medicine authorities that are a real positive step forward in reducing injuries and burnout in young athletes:
1) The International Olympic Committee (IOC) recommends that that children be encouraged to participate in a variety of different activities and develop a wide range of skills and avoid specialisation until at least puberty (3).
2) To avoid mental “burnout” and physical injury, The American Medical Society for Sports Medicine (4) recommends that:
Coaches and medical staff consider using a valid and reliable tool to monitor burnout
Avoiding overscheduling and excessive time commitments
Emphasise skill development and fun
Emphasise lifelong physical activity skills
3) Expert Consensus Statements (5, 6). Summary of recommendations below:
Children who participate in more hours per week than their age, for more than 16 hours per week in intense training, and who are specialised in sport activities should be closely monitored for indicators of burnout, overuse injury, or potential decrements in performance due to overtraining
All youth (including inactive youth) can benefit from periodised strength and conditioning to help them prepare for the demands of competitive sport participation.
Youth who specialise in a single sport should plan periods of isolated and focused neuromuscular training to enhance diverse motor skill development and reduce injury risk factors.
Some sports, most notably baseball and cricket, have also taken notice of the alarming trend in injury rates, and have enforced restrictions on the amount of pitches and balls bowled in young athletes. See links below:
In closing up my blog, the moral of this story with children/youth athletes is:
Variety is the spice of life
Please share this blog widely. I have a very keen interest in injury management and injury risk reduction (injury prevention) in adolescent athletes and it stems from seeing a lot of young athletes broken down with chronic injury way too early. If we can reduce the injury burden when they are younger, they will be less likely to be injury-plagued and better performing athletes when they are older. Don’t forget; Less injury equates to greater team and individual success (see previous blog). Even if these kids choose not to go onto the professional level, less injuries when they are younger will mean less injury burden on the public/private health sectors in the future (see previous blog). Coaches of all levels of coaching, and parents of young athletes really need to read this.
LaPrade RF, Agel J, Baker J, Brenner JS, Cordasco FA, Cote J, et al. AOSSM Early Sport Specialization Consensus Statement. Orthopaedic journal of sports medicine. 2016 Apr;4(4):2325967116644241. PubMed PMID: 27169132. Pubmed Central PMCID: PMC4853833. Epub 2016/05/12. eng.
Jayanthi NA, LaBella CR, Fischer D, Pasulka J, Dugas LR. Sports-specialized intensive training and the risk of injury in young athletes: a clinical case-control study. The American journal of sports medicine. 2015 Apr;43(4):794-801. PubMed PMID: 25646361. Epub 2015/02/04. eng.
Bergeron MF, Mountjoy M, Armstrong N, Chia M, Cote J, Emery CA, et al. International Olympic Committee consensus statement on youth athletic development. British journal of sports medicine. 2015 Jul;49(13):843-51. PubMed PMID: 26084524. Epub 2015/06/19. eng.
DiFiori JP, Benjamin HJ, Brenner JS, Gregory A, Jayanthi N, Landry GL, et al. Overuse injuries and burnout in youth sports: a position statement from the American Medical Society for Sports Medicine. British journal of sports medicine. 2014 Feb;48(4):287-8. PubMed PMID: 24463910. Epub 2014/01/28. eng.
Myer GD, Jayanthi N, Difiori JP, Faigenbaum AD, Kiefer AW, Logerstedt D, et al. Sport Specialization, Part I: Does Early Sports Specialization Increase Negative Outcomes and Reduce the Opportunity for Success in Young Athletes? Sports health. 2015 Sep-Oct;7(5):437-42. PubMed PMID: 26502420. Pubmed Central PMCID: PMC4547120. Epub 2015/10/27. eng.
Myer GD, Jayanthi N, DiFiori JP, Faigenbaum AD, Kiefer AW, Logerstedt D, et al. Sports Specialization, Part II: Alternative Solutions to Early Sport Specialization in Youth Athletes. Sports health. 2016 Jan-Feb;8(1):65-73. PubMed PMID: 26517937. Pubmed Central PMCID: PMC4702158. Epub 2015/10/31. eng.