Dangers of Sports Specialization

Marc Kowalsky, MD Shoulder & Elbow Surgery, Sports Medicine

Dangers of Sports Specialization

Marc Kowalsky, MD October 3, 2017

Orthopaedic & Neurosurgery Specialists

The Epidemic

• 30 million children (75%) participate in organized sports

• 30% of youth athletes are highly specialized

• Young athletes specialize in sports and positions at an earlier age

• 3.5 million children under age 14 treated annually for sports injuries

• Overuse injuries account for half of all sports injuries in middle school and high school

Safe Kids USA

National Federation of State High School Associations

Jayanthi et al. AJSM, 2015

Sport Specialization: Definition

• Participation in intensive training and/or competition in organization sports > 8 months per year

• Participation in 1 sport to the exclusion of participation in other sports

• Involvement of prepubertal children (seventh grade, or 12 years old)

• Limited overall free play

Motivation

• Ability to compete at the next level

• College admissions

• Collegiate athletic scholarships

• National, Olympic team selection

• Professional contract

Motivation

• Success

Motivation

• Success

Drivers

• Athletes

• Parents

• Coaches

• Media

Drivers

• Eastern European olympic development • Sports in which peak performance occurs early

– Figure Skating – Gymnastics – Swimming – Diving

• Early selection • High-volume training • Rigorous coaching

Rationale

• “10 Year / 10,000 Rule” – Simon & Chase. “Skill in

Chess”. American Scientist. 1973

• 10K to 50K hours of practice to become a master.

– John Hayes. “10 Years of Silence”.

• 500 works of classical music between 1685 – 1900

• None were composed before 10 years of “practice”

Rationale

• Deliberate Practice – “The role of deliberate

practice in the acquisition of expert performance”

– Ericsson and colleagues, 1993

– Relevant to performance improvement

– Level of performance directly related to deliberate practice

– Early deliberate practice benefit over peers

Questions

• Is early sport specialization safe? Does early

sport specialization increase the risk of injury in youth athletes?

• Is early sport specialization effective or necessary in achieving elite performance?

Concern: Skeletal Maturity

Concern: Skeletal Maturity

Concern: Skeletal Maturity

Concern: Psychosocial Maturity

• Need to enjoy activities of their domain

• Need to have sense of control over their lives

• Do not respond favorably to isolation

• Less able to participate with others outside peer group

• Less prepared to deal with stress / anxiety

Risk: Year-round Participation

• Year-round training is a key component of sport specialization

• Important risk factor for injury – pitching > 8 months / year – no break for one sport season / year

Risk: Repetitive Technical Skills

• Repetitive high risk mechanics in skeletally immature athlete

– Introduction of kick serve < 13 years old

increased shoulder/elbow injury

– Repetitive impact in gymnasts with volume of training and skill level

wrist pain

– Pitch type, volume and poor mechanics in young pitchers

elbow injury

Risk: Overscheduling

• Competitive demands higher for specialized athlete

• More frequent and intense formal competition

• Competition is associated with increased risk of injury

• Inadequate rest & recovery associated with increased risk of injury

Effect of Early Sport Specialization

• Execute less age-appropriate sport skills

• Do not develop protective neuromuscular patterns

• Increased organized play over free play doubles injury risk

• Specializing before age 12 years increases injury risk

Effect: Overuse Injury

• Early specialization associated with injury – hockey hip labrum injury – tennis femoroacetabular (hip) impingement – baseball shoulder / elbow injury

Effect: Psychological Burnout

• Adult-driven specialized training

• Characteristics – Loss of (intrinsic) motivation

– Lack of enjoyment (younger)

– High perceived stress, anxiety

– Ineffective stress coping strategies

– Fear of reinjury at young age

Effect: Psychological Burnout

• Manifestations

– Mood disturbances

– Social isolation

– Eating disorders

– Dropout

Effect: Psychological Burnout

• Swimming – decreased time on national

team – earlier retirement from

sport • Hockey

– increased off-ice training time

– earlier initiation of participation

– more prone to dropout

10 Year / 10,000 Hour Rule

Nature Versus Nurture

• Elite athletes are more likely to have parent or sibling who played collegiate or professional sports

• Pushing a child to specialize early WILL NOT compensate for lack of athletic genetics

Evidence: Early Specialization

• Of 35,000 highly qualified young Russian athletes in sport school, only 0.14% reached high level status

• Among German athletes chosen for early specialization, only 0.3% achieved elite status

• Among US high school athletes, only 0.2 – 0.5% achieve professional level

Evidence: Later Specialization

• Elite athletes pursued intensive trainer later in adolescents than their near-elite peers

• 2004 Olympians initiated sports at average age 11.5 years

• 1500 German Olympic national athletes initiated training in primary sport later

• Among NCAA athletes, 70% did not specialize in their sport until age 12 years

• No difference in training profiles of experts and nonexperts in field hockey, soccer, and triathlon until ages 13, 15, and 20.

Evidence: Diversification

• 1500 German Olympic national athletes on average participated in 2 other sports

• Among NCAA athletes, 88% participated in more than one sport

Benefits of Early Diversification

• Enhance physical literacy

• Motor skill development

• Psychosocial and cognitive skills

• Protective neuromuscular patterns

• Crossover effect of multiple sports

• Accommodates psychological well-being

Development Model of Sport

Early diversification does not hinder elite sport participation

Early diversification is linked to a longer sport career and has positive implications for long-term sport involvement

Early diversification allows participation in a range of contexts that most favorably affects positive youth development

High amounts of deliberate play during sampling years builds a solid foundation of motivation through involvement in activities that are enjoyable

High amounts of deliberate play during sampling years establishes a range of motor and cognitive experiences that children bring to their sport of interest

Toward end of primary school (age 13), children should have the opportunity to choose to specialize in their favorite sport or continue with recreational sport

Late adolescents (age 16) have the physical, cognitive, social, emotional and motor skills to become highly specialized in one sport

Protective Strategies

• Provide opportunities for free, unstructured play

• Ratio of weekly hours in organized sport to weekly hours in free play should remain below 2:1

• Weekly hours of sports participation should not exceed child’s age, or total 16 hours

• Avoid specialization before age 13 years

• Structured strength & conditioning program

Sport-Specific Policies

• Tennis

– Minimum 12 year-old junior tournament player

– < 12 hours / week of organized tennis

– < 12 tournaments / year

– Consider another sport during “off-season”

– 2 hours / week injury prevention training

Sport-Specific Policies

• Observe pitch counts and rest periods • No overhead throwing for 2-3 months per

year • No competition for 4 months per year • No pitching > 100 innings per year • Avoid pitching for multiple overlapping teams • No pitcher / catcher combination • Avoid radar guns • Avoid showcases

Aspen Institute

Aspen Institute

THANKS

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