Serious injuries are on the rise among young athletes, and those who seek to change the culture of competitive youth sports say specialization is largely to blame.
Kids who play a single sport year-round before they reach puberty are at greater risk of injuries related to muscle development and repetitive motion such as shin splints, pitching elbow and runner’s knee, said Risa Isard, program associate for Aspen Institute’s Project Play program, which promotes access to quality sports opportunities for kids. While most sports-related injuries are minor, some require surgeries and hospitalization, which result in medical care costs, absences from school and potential long term health effects.
“Sports specialization is definitely a trend we are seeing, especially among families with the resources to put their kids on travel teams and pay for private lessons,” she said. “We know that specialization too early not only leads to overuse injuries, but also to burnout, social isolation and decreased athletic development.”
For kids younger than age 12, she said, “There is medical consensus that specialization does not make sense.”
Using data from the U.S. Consumer Product Safety Commission’s (CPSC) National Electronic Injury Surveillance System, researchers at Indiana University School of Medicine in Indianapolis found the number of kids ages 5 to 18 who visit the emergency department for sports-related injuries increased each year between 2001 and 2013.1
The 100 hospital emergency departments included in the study treated nearly 486,000 pediatric sports-related injuries during those years, which translates to an estimated 16 million young athletes who visit all emergency departments nationally, the researchers estimated.
Football, basketball, soccer and baseball resulted in 75 percent of all pediatric sports-related injuries, while golf, martial arts, ice hockey, ice skating and lacrosse accounted for the fewest number of injuries.
The study authors noted it is unclear whether athletes are injuring themselves more often due to the growing emphasis on competition, or whether the rise in sports-related injuries is attributable to more kids participating in sports. They note, too, that the data may underestimate the national estimate because non-severe injuries are often treated outside the emergency department by primary care providers, athletic trainers, urgent care centers and sports medicine doctors.
Either way, sports injuries have become a serious problem.
Developing Growth Plates
Kids are more vulnerable to injuries because their bones are still growing, said John Engh, executive director of the National Alliance of Youth Sports in West Palm Beach, Florida, which advocates for positive, safe and fun athletics.
“You are supposed to wait for kids to hit puberty before you choose a single year-round sport, but we are seeing travel ball for 5- and 6 year-olds,” he said, noting the age at which kids play competitive sports continues to drop. “Parents are signing their kids up because they see their friends and neighbors doing it and they worry that their kid will fall behind.”
Growth plates are the softest and weakest sections of the skeletal tissue located at the end of long bones near the ankle, hip, knee, and wrist, according to the Mayo Clinic medical research group in Rochester, Minnesota.
Injuries to the growth plate are caused by a fall or blow to the limb and causes can include car accidents, competitive sports (such as football, basketball, running, dancing or gymnastics), and recreational activities like biking, skateboarding, and sledding, the Mayo Clinic reports.2
While most growth plate injuries heal without incident, it adds, severe fractures can increase the risk of crooked, accelerated, or stunted bone growth.
According to the Mayo Clinic, growth plate fractures occur twice as often in boys as in girls, because girls finish growing earlier. By age 12, most girls’ growth plates have already matured and been replaced with solid bone.
Girls, however, are eight times more likely to suffer an anterior cruciate ligament (ACL) knee injury than boys, according to nonprofit advocacy group Safe Kids Worldwide.
While specialization is a likely cause of musculoskeletal injuries among young athletes, the medical community is also paying closer attention to training techniques as a possible source, said Bryan Heiderscheit, a physical therapist, Ph.D., and professor in the departments of orthopedics and rehabilitation and biomechanical engineering at the University of Wisconsin-Madison, in Madison, Wisconsin.
“It is not just about the total number of hours you put into one sport, but what you are doing during those hours,” he said in an interview. “Are they all at a very high intensity level? Are the coaches and team staff using good sports medicine science to guide proper training strategies to try to reduce injury risks?“
Awareness may also be a contributing factor in the apparent rise of youth sports injuries.
Parents, coaches and healthcare providers are better educated now on the signs and symptoms of concussions and repetitive motion, and are more likely to accurately report them and intervene earlier with therapy, said Heiderscheit.
“Some injuries heal very well with rest and modification, but others require more attention, like knee injuries that require complex surgery and can result in more arthritic issues as the child gets older,” he said. “We know a lot more now and we are taking these injuries more seriously.”
While kids are generally known to “bounce back” from physical injury faster than adults, for example, a compelling body of research illustrates how concussions impact children disproportionately.
“Because their brains are still developing quite rapidly, early evidence suggests that when children sustain that kind of trauma it can have greater ramifications, affecting their ability to focus, and leading to dizziness and headaches,” said Heiderscheit.
How to Minimize Risk of Injury
It is impossible to prevent all injuries. After all, accidents happen.
But Isard said participation in multiple sports at least until age 12 can reduce their risk of overuse injuries and promote healthy muscle development.
“Playing a variety of sports can help offset specialization and overuse injuries by getting young athletes to practice a number of different skills,” said Isard, noting multi-sport athletes are more likely to develop a lifelong interest in physical fitness
It is not enough, however, to simply play two sports. Those sports should also use different muscle groups.
Safe Kids Worldwide notes children who participate in two or more sports where similar muscles are used, like swimming and baseball, are at higher risk of overuse injuries than those who participate in sports with different muscle emphasis, like track and golf.
Safe Kids Worldwide also suggests parents and coaches can reduce preventable injuries by preparing kids for the demands of playing sports. That means ensuring they receive pre-participation physical exams performed by a qualified healthcare professional before they play organized sports.
Other tips include setting time aside before every practice and game to warm up and stretch properly, remembering to hydrate, wearing appropriate sports gear, and making rest a priority.
A pre-season conditioning program or camp can also help young athletes who are starting a new sport by gradually building strength and endurance.
Once teens reach high school, she said, a better case can be made for specializing in a single sport.
“There is a time and a place to focus on a single sport, and every family needs to make decisions for their own kids, but specialization too early is ultimately not what is best for the child or for their athletic development,” said Isard, noting breaks built in throughout the year to allow kids time off from sports entirely is also wise. “Science overwhelmingly shows the best athletes played a variety of sports at least through age 12 and frequently through high school.”
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1 Indiana University School of Medicine, “Trends in pediatric sports-related injuries presenting to US emergency departments, 2001-2013,” 2015.
2 Mayo Clinic, “Growth Plate Fractures,” June 16, 2016.