Is Only One Too Much?

Is Only One Too Much? Weighing the Risks of Early Sport-Specialization Corey Lanois, MS, LAT, ATC

School is almost out which means a lot of children will be replacing sedentary time in the classroom with active time outside. While this traditionally meant neighborhood games and impromptu get-togethers with friends, a growing number of young athletes are dedicating themselves to the pursuit of one specific sport. This phenomenon of “early sport specialization” is becoming a hot debate among parents, coaches, and health professionals within the sports medicine field.

With a considerable amount of emphasis being placed on athletic performance and immense pressure to obtain athletic scholarships from colleges, more and more kids are trading time on the playground for scheduled practices and travel teams. The benefits of participating in organized sports are plentiful but what are the physical and emotional costs of early sport specialization?

Growing Pains An estimated 50% of pediatric sports related injuries are overuse in nature. It has been discussed that participating in a single sport limits the variability of applied musculoskeletal stresses, which may lead to an increased risk of injuries, especially the overuse type. This can be particularly concerning in growing children and adolescents for several reasons: • Their growth plates have not yet been fully closed. • Their cartilage is less resistant to forces. • Their bone density may lag behind during peak growth.

A position statement on pediatric overuse injuries by the National Athletic Trainers’ Association describes growth-related injuries that are unique to children and adolescents. These injuries, such as Sever’s and Osgood-Schlatter disease, largely afflict the developing growth plates.

Several studies have demonstrated that early sports specialization increases the risk and incidence of musculoskeletal injuries in adolescents. One of the studies performed by Hall et al. indicated a 4-fold greater risk with regards to patellar tendinopathy and Osgood-Schlatter disease, both overuse injuries, in single-sport adolescent girls. Moreover, a review of these studies showed that this risk increases with each degree of specialization. The authors defined the degrees of specialization in 3 parts: 1. Year-round training (>8 months of organized training per year) 2. Choosing a single main sport 3. Quitting all other sports to focus on main sport

It has been theorized that young athletes who meet all 3 criteria are at the highest risk of serious overuse injuries.

Benefits of Strength Training Parents and coaches believe young athletes are strong from the sports they play. Sports develop strength to a certain degree, but a well-rounded strength program corrects imbalances and promotes proper movement to reduce injuries in sport. Ultimately, the stronger the athlete, the more likely she is to reduce her risk for injury.

A common misconception is that strength training means lifting heavy weights but strength training can be as simple as a plank or a bodyweight squat. Any exercise performed correctly with repetition that allows children’s muscles to respond and produce movement will create strength. Summer is a great time to start a program to ensure the body is adequately prepared for the upcoming season.

Burn Out, Fade Away The psychological aspect of specialized athletes must also be recognized. While children and teenagers generally do not have the same stressors as adults, demands from participating in a single sport may potentially lead to exhaustion, staleness, and burnout. Studies by Barynina and Wall found that early specialized athletes are more likely to withdraw from sport as a result of burnout.

Burnout, loosely defined, is a response to stress where one becomes exhausted and loses interest in an activity they previously enjoyed. The symptoms vary by person, but include: • Fatigue • Depression • Loss of appetite • Anxiety • Decreased self-confidence • Lack of mental concentration

Safeguarding Against Negative Impacts Participating in multiple sports provides several benefits for children and the decision to participate remains a very individual one. For some, committing to a single-sport may be the right move. Some sports, such as gymnastics and figure skating, may actually require early sports specialization. So how should you protect yourself against possible injuries and mental fatigue if this is the case?

The best answer is to remain attentive of potential physical and mental effects of early sports specializations. Li and colleagues state that a focus on long-term development and open communication were safeguards against burnout. While more research is needed, some recommendations exist as a guide for young specialized athletes: • Hours of weekly organized sport participation should not exceed the age of the athlet • Periodized strength and conditioning programs should be implemented to prepare for competitive seasons • Athletes should limit organized participation to under 8 months per year

Ultimately, the time commitment and intensity level should be determined by the participant but input from family and other resources should not be ignored. Whether focusing on one sport or participating in multiple sports in early ages, the type and level of sport participation should be frequently reevaluated. The level of commitment and enjoyment relative to the costs and benefits of the athlete needs to be considered. Parents, coaches, and young athletes should remain vigilant of the early signs of physical and emotional fatigue.

References 1. McLeod TCV, Decoster LC, Loud KJ, Micheli LJ, Parker JT, Sandrey MA, White C. National Athletic Trainers’ Association Position Statement: Prevention of Pediatrci Overuse Injuries. J Athl Train. 2011. 46(2). 2. Hall R, Foss KB, Hewett TE, Myer GD. Sports Specialization is Associated with An Increased Risk of Developing Anterior Knee Pain in Adolescent Female Athletes. J Sport Rehab. 2015;24(1):31-35. 3. Flachsmann R, Broom ND, Hardy Ae, Moltschaniwskyj G. Why is the adolescent joint particularly susceptible to osteochondral shear fracture? Clin Orthop Relat Res. 2000 Dec;(381):212-21. 4. d’Hemecourt PA. Risks of Early Sport Specialization. Knuttgen keynote lecture at New England Chapter of the American College of Sports Medicine Fall Conference; November, 2018; Providence, RI. 5. Myer GD, Jayanthi N, DiFiori JP, Faigenbaum AD, Kiefer AW, Logerstedt D, Micheli LJ. Sports Specialization, Part II: Alternative Solutions to Early Sport Specialization in Youth Athletes. Sports Health. 2016;8(1):65-73.