What kids, parents, and coaches need to know about early youth sports specialization and the growing number of overuse injuries in our youth athletes.

The Current State of Youth Sports

More than 30 million adolescents and children play sports in the US alone, and youth sports participation has increased in all age groups in the US over the past 15 years. Travel and club sports teams are popping up all over the country. While the rise in sports participation is great for promoting healthy activity in our more sedentary youth, there are drawbacks to the current organization and model for youth sports leagues.

Year-round competition and training schedules don?t allow for kids to take a break or participate in more than one sport because programs require dedication to a single training model in order to progress to the next level. We are treating our kids like miniature adults and the results are a rise in overuse injuries and burnout in our youth athletes. Bottom line: let kids be kids in their early developmental years.

Sports specialization is defined as intense, year-round training in a single sport with the exclusion of other sports. The American Orthopaedic Society for Sports Medicine (AOSSM) defines early sports specialization (ESS) as:

  1. Participation in intensive training and/or competition in organized sports greater than 8 months per year (essentially year-round)
  2. Participation in 1 sport to the exclusion of participation in other sports (limited free play overall)
  3. Involving prepubertal children (7th grade or roughly age 12 years)

Dr. Neeru Jayanthi, of Emory Sports Medicine and a pioneer in youth sports specialization, proposed further definition of sport specialization by categorizing degree of specialization based on the number of ?yes? responses to 3 survey questions:

  1. ??Can you pick a main sport??? (ie, single-sport training)
  2. ??Did you quit other sports to focus on a main sport??? (ie, exclusion of other sports)
  3. ??Do you train >8 months in a year???

Children are considered highly specialized if they answer ?yes? to all three questions, moderately specialized with 2 ?yes? responses, and low level of specialization with 0 or 1 ?yes? response.

A common misconception among youth athletes, parents, and youth sports coaches is that in order to become an elite or high-level athlete, kids must start focusing on one sport at an early age. Studies have reported that highly specialized youth athletes believed that specialization would increase their likelihood of making their high school sports team or being offered a college scholarship. Currently, there is no evidence to substantiate this belief, yet the current structure of youth sports leads the general population to believe that specialization is predictive of future success.

In some cases, the pressures to become successful at an early age are leading to anxiety, decreased enjoyment, and burnout. The National Alliance for Youth Sports reports that 70% of kids drop out of organized sports by the age of 13 because participating is no longer enjoyable. Common complaints among children include sports becoming too much about winning, long training hours, travel for competition, and having to work with specialty training coaches outside of regular practices.

A number of studies have found an association between injury risk with increase in age and training volume. The literature also suggests that highly specialized athletes are more likely to sustain overuse injuries than acute injuries and athletes who train for their primary sport for more hours per week than their age are more likely to report sustaining an overuse injury. Additionally, regardless of sport, athletes who compete in one sport for greater than 8 months out of the year are more likely to report an injury than those who did not exceed 8 months.

In another survey of 1,544 high school athletes, athletes who classified themselves as moderately specialized had a 50% higher incidence of sustaining a lower extremity injury. Athletes who classified themselves as highly specialized had an 85% higher incidence of sustaining lower extremity injury than those who reported a low level of specialization.

In baseball, adolescent pitchers who participate in competitive baseball for more than 8 months each year are more likely to report an upper extremity injury. Recent pitch count recommendations and regulations in Little League Baseball may be protective against future injury. In a study of Little League World Series (LLWS) pitchers from 2001 to 2009, who went on to play professionally, researchers examined how many pitchers underwent Tommy John surgery (UCLR) during their professional career.

Of the 25 players who continued to pitch professionally, 3 underwent UCLR. All 3 pitchers who had UCLR pitched in the LLWS prior to the implementation of pitch count limits. Similarly, a survey of professional baseball players found that baseball players who specialized prior to high school were more likely to report sustaining a serious injury during their professional career.

More technical sports like gymnastics, dance, swimming, and diving, typically require early specialization. High training volumes in this population are more likely to increase risk of sustaining injuries related to repetitive high impact forces during early stages of growth and prepubescent development.

Interestingly, the NFL Draft population describes a different story. In the 2018 NFL Draft, 91% of NFL Draft Day 1 picks and 88% of NFL Draft Day 2 picks were multi-sport athletes in high school. This begs to question that maybe multi-sport participation and early sport diversification can be beneficial to develop well-rounded, high-level athletes.

Current Recommendations for Youth Sports Participation

The American Orthopaedic Society for Sports Medicine Early Sports Specialization Consensus Statement states:

  • ?Children who participate in more hours per week than their age, for more than 16 hours per week in intense training, and who are specialized 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 periodized strength and conditioning (eg, Integrative Neuromuscular Training [INT]) to help them prepare for the demands of competitive sports participation.?
  • ?Youth who specialize in a single sport should plan periods of isolated and focused INT to enhance diverse motor skill development and reduce injury risk factors.”

According to Dr. Jayanthi, it is recommended that young children under the age of 12 participate in a variety of sports. In a five year follow up study, it was shown that children who participate in early sports diversification are more likely to be physically active in later years. Dr. Jayanthi has also found in his research that youth athletes who are highly specialized are more likely to be at risk for developing an overuse injury even when accounting for hours per week of athletic exposure and age.

Currently, there is not enough evidence to make a true recommendation for optimal age of sports specialization as individual sports or highly skilled sports may require earlier specialization. There is a need for more sports specific studies to evaluate performance benefits of sports specialization and to determine specific recommendations for various sports in regard to specialization age. Dr. Jayanthi recommends the following 10 Commandments of Youth Sports Specialization to minimize risk of injury and to foster positive sports participation experiences for youth athletes.

The 10 Commandments of Youth Sports Specialization

  1. The total hours of organized sports per week should be less than twice the number of hours of ?free play?
  2. Consider having at least 1 day off per week from training/competition
  3. Caution when training >16 hours per week
  4. Do not train with pain in the low back, shoulder, elbow, or knee
  5. The total hours of organized sports per week should be less than your age to prevent overuse injury
  6. Consider delaying specialization until middle or late adolescence for injury prevention and successful performance
  7. Do not compete >8 months out of the year
  8. Avoid competing on multiple sports teams that would involve more than 5 days per week of participation
  9. Acute to chronic training ratios should not exceed 1.5. (training hours should not exceed 1.5 times the previous training load in order to foster a gradual increase in training capacity to minimize injury risk)
  10. Do not increase training load <48 hours before competition

The American Developmental Model

?The International Olympic Committee is dedicated to guiding our current youth sports organizations and governing bodies to adapt the American Developmental Model in order to better develop youth athletes and minimize overuse injuries. It is recommended that youth athletes delay specialization and parents and coaches should encourage early sports diversification and variability of athletic exposure. Youth athletes should also be allowed sufficient rest and recovery time between practices and competitions. Skill development training and competition should also be fun and age appropriate. ?The IOC also recommends that training involves physical literacy and free play in order to better develop coordination and balance.

US Olympic Committee American Development Model

  • Discover, Learn, Play: 0-12 years
  • Develop and Challenge: 10-16 years
  • Train and Compete: 13-19 years
  • Excel for High Performance or Participate and Succeed: ? 15 years
  • Mentor and Thrive: for life

Creating a Better Environment for Youth Athletes: MAKE IT FUN

Physical literacy: ?the ability, confidence, and desire to be physically active for life?

Youth athlete development should be all about creating positive experiences with physical activity for kids. Parents and coaches should encourage free play and sports sampling to better develop motor competencies and the ability for kids to learn how to move and control their bodies before learning highly skilled movement patterns. Developing foundational motor control and physical literacy is key to minimizing injury risk with high level sports participation. Consider the 10 Commandments before your child suffers from a sports related injury. It may be time to consider current training programming and competition schedules in order to ensure your athlete stays healthy and continues to have positive experiences with sports participation while also minimizing future injury risk.

Resources for parents, players, and coaches:

  1. Aspen Project Play Parent Checklists
  2. Team USA Parent Resources
  3. Active for Life: Raising physically literate kids

By Kayla Fujimoto Epperson, PT, DPT, CSCS for the Ivy Rehab Network


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