Early Sports Specialization and Injury Risk

Over the last few years there has been a spike in athletic injuries in our community's youth and adolescent athletes.  Authors believe the spike can be blamed in part on the pressure placed on young athletes by their parents and coaches to specialize in sports early in their childhood.  Specialization is described as intensive year round training in a single sport at the exclusion of other sports (Jayanthi. Sports Health. 2013).  70% of junior tennis athletes specialized at an average of 10 years old while close to all specialized by age 18 (Jayanthi J Med Sci Tennis. 2011).   The American Academy of Pediatrics reports the risks of early specialization include burn out, dropping out of sports, and overuse injuries.  The components that define early sports specialization include

1. Selecting a main sport
2. Participate in 1 sport for >8 months out of the year
3. Stopping all other sports to focus on their main sport

Authors use these variables to place an athlete at low, moderate, or high risk of injury based on their sports specialization.  For example an athlete who meets all 3 criteria would be at a high risk of any injury and serious overuse injury, but a low risk of acute injury.  Conversely, an athlete who meets 0-1 of the criteria above would be at a low risk of overall injury or serious overuse injury, but would be at a moderate risk for an acute injury.  The variables allow us to identify young athletes at greatest risk of injury due to sport specialization.   

Additional risk factors in the literature include 

> 16 hours of total sports participation (regardless of sport)
Athletes who play at higher level of competition

An recent article by Jayanthi et al. (Am J Sports Md. 2015) examined close to 1200 young athletes ages 7-18 years old.  The authors attempted to document the impact of early sports specialization in athletes compared to their peers who change sports each season.  The authors found a highly specialized athlete was twice as likely to sustain an injury than their matched peers even when the hours per week of activity were the similar.  It appears early specialization has its' own inherent risks of injury for young athletes.  

Authors believe early specialization is more risky than season sports participation in the young athlete because of 3 reasons.  First, early specialization increases the exposure to injury over a longer duration than a shorter season.  Prior research has shown a direct correlation between number of exposure hours and injury risk (Rose Med Sci Sport Ex. 2008).   In addition, authors noted athletes who did not take one season off during the year where also at risk for future injury.  A balanced sports year may allow athletes to reduce their sport exposure and allow for their bodies to recover from the demands of their sports.  

A second reason for concern is the lack of variety in training or mechanics involved in a single sport.  Playing multiple sports in the same year allows an athlete to develop many aspects of their fitness including strength, speed, agility, coordination, and balance over a variety of movements.  Conversely, playing the same sport year round at an early age does not let an athlete "cross train" and maintains a constant, consistent level of stress on the body.  In addition, athletes who specialize early may be pressured to attempt mechanics (ex. curveball in baseball, top spin serve in tennis) that their bodies cannot handle at an early age.  

Finally, early sports specialization leads an athlete to greater numbers of competitions per year which are associated with greater injuries.  In addition, athletes who compete more often have greater mental, emotional, and physical demands placed on their bodies than their peers.  These athletes often forgo necessary rest periods between training sessions or competitions placing their bodies at risk for overuse or traumatic injuries.  

Authors recommend the following to reduce the injury risk among our youth athletes (Myer et al. Sports Health. 2015)

1. Youth should be given opportunities for free, unstructured play to improve motor skill development and parents and educators should encourage child self-regulation to help limit the risk of overuse injuries. 
2.  Parents and educators should help provide opportunities for free, instructed play to improve motor skill development during the growing years, which can reduce injury risk during adolescence
3.  Youth should be encouraged to participate in a variety of sports during their growing years to influence the development of diverse motor skills and identify a sport, or sports, which the child enjoys.