Sports specialization guidelines need higher profile
By Keith Loria
Youth sport coaches are concerned about the increased risk of overuse injuries seen among young athletes who play a single sport year-round or otherwise train at high volume. Most are unaware, however, of sport-volume recommendations created to reduce these injuries, according to recent research from the University of Wisconsin-Madison (UWM).
Lead author Eric G. Post, MS, ATC, research assistant in the UWM College of Health Sciences Department of Kinesiology, noted that the recent trend toward high-volume, competitive, year-round participation is strongly linked in the literature with injury and burnout.
“We hope that by improving awareness of injury risk and of recommendations for reducing sport specialization we can encourage a safer and more child-focused youth sports system,” he said.
For the study, 253 youth sport coaches (207 men) completed an anonymous online questionnaire about their knowledge of general sport (vs sport-specific) volume recommendations and attitudes and beliefs about sport specialization. Two-thirds responded that year-round participation in a single sport was “very” or “extremely” likely to increase an athlete’s risk of injury. Most respondents (94%) reported believing that playing multiple sports was more beneficial than sport specialization for developing athletic ability.
Yet, approximately four of every five surveyed coaches reported being unaware of any recommendations on weekly or monthly sports volumes or of recommendations regarding simultaneous participation in multiple sports leagues.
Youth athletes should participate in no more than eight months a year in a single sport, limit organized sports participation to no more hours a week than the athlete’s age, and should not participate simultaneously in multiple leagues of the same or of different sports, according to general sport-volume recommendations issued in 2016 by the American Academy of Pediatrics’s Council on Sports Medicine and Fitness and endorsed by the National Athletic Trainers’ Association and the National Strength and Conditioning Association.
“I think the biggest reason [coaches are unaware] is that general sport volume recommendations are fairly new and have not been well-disseminated,” Post said. “In our study we saw baseball coaches were well aware of the MLB Pitch Smart pitch count recommendations, which have been heavily promoted by Major League Baseball and have been around for more than five years. Our hope is that with a similar effort at disseminating the general sport volume recommendations, we can raise awareness among parents and coaches.”
Sylvia Czuppon, PT, DPT, OCS, associate professor of physical therapy and orthopaedic surgery at Washington University in St. Louis School of Medicine, Missouri, thinks that one of the challenges is that many coaches are “average moms and dads” who volunteer to coach because they once played the sport.
“Unless one of their players sustains a major injury, most ‘average joe’ coaches will assume injuries are just a part of the game, and not potentially related to modifiable factors such as training volume and mechanics,” Czuppon said. The primary message that lower extremity specialists should deliver to parents and coaches, she said, is that children specializing in a single sport are more likely to suffer from overuse injuries—and that specialization isn’t the pathway to college scholarships or professional sports.
“Injuries reduce playing time and will reduce athletic performance as you work to recover to your preinjury status,” Czuppon said. “Many elite athletes report playing multiple sports through high school—this includes professional athletes and Olympic athletes—so the myth that you have to specialize to get to that level is busted.” (See “Early athletic specialization: Misconceptions and hazards,” February 2017, page 15.)
Gregory D. Myer, PhD, FACSM, CSCS*D, associate professor of pediatrics and director of research and the Human Performance Laboratory in the Division of Sports Medicine at Cincinnati Children’s Hospital Medical Center, Ohio, said, ultimately, to promote injury prevention, lower extremity specialists should be looking at training and quality of movement and at ways children can develop fundamental movement skills.
“If they are going to specialize, that makes them susceptible to a smaller quantity of perturbations or risk factors,” he said. “They’re less resilient to unanticipated things that could happen to them, so their neuromuscular profiles might be reduced, which may be why they are at increased risk.”
Athletes who specialize, he said, should include neuromuscular training in their regimen to create a more diverse, adaptable neuromuscular profile.
Eric Post warns that parents and coaches sometimes think the answer to sport specialization is to have their child or athlete participate in different sports simultaneously, but noted this pattern also increases the risk of overuse injuries.
“Coaches should encourage youth athletes to sample different sports during the different seasons and encourage time throughout the year away from organized sports, when the youth athlete can participate in unorganized and unstructured free play,” Post said.
Czuppon also believes health professionals need to do more to spread awareness. From pediatricians seeing athletes for an annual checkup, to physical therapists treating youth overuse injuries in the clinic, to athletic trainers working with the athletes on the field, everyone, she said, has an obligation to educate athletes and their parents about the dangers of early sports specialization, as well as the benefits of sports diversification.
Keith Loria is a freelance writer in northern Virginia.
Post E, Trigsted SM, Schaefer D, et al. Knowledge, attitudes, and beliefs of youth sports coaches regarding sport volume recommendations and sport specialization. J Strength Cond Res 2018 Feb 22. [Epub ahead of print]
Brenner JS; Council on Sports Medicine and Fitness. Sports specialization and intensive training in young athletes. Pediatrics 2016;138(3). pii: e20162148.