Risks of overuse, burnout extend to youth athletes

5PEDS-sports-iStock_000037541652MediumPosition statement cites warning signs

By P.K. Daniel

Despite the slim odds of securing an athletic scholarship and the even slimmer prospect of playing professional sports, there’s an overemphasis today on success in competitive youth sports, including specialization and elite-level training. As such, and with the proliferation of travel teams and club sports, practitioners have seen an increase in overuse injuries and burnout.

Starting a child in sports before he or she is developmentally ready, committing early to one sport, and overtraining are cited by practitioners as risk factors for overuse injuries and burnout in a recent position statement by the American Medical Society for Sports Medicine (AMSSM).

The current literature reports that overuse injuries comprise half of all sports injuries. Lower extremity overuse injuries include medial tibial stress syndrome, osteochondritis dissecans, Osgood Schlatter disease, and Sinding-Larsen-Johansson disease (SLJD). The prevalence varies by sport, ranging from 37% (skiing and handball) to 68% (running). The AMSSM, however, suggests overuse injuries are underestimated since many of these injuries don’t result in loss of participation time.

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Specialization, weekly training loads contribute to risk in youth athletes

But the lack of time loss is not because the injuries don’t warrant rest.

“If they have an overuse injury and they’re not losing time, it’s more because people are not recognizing them or ignoring them, and that can then lead to the injury becoming worse,” said Joel Brenner, MD, MPH, FAAP, a coauthor of the AMSSM position statement, which was published in the Clinical Journal of Sport Medicine and the British Journal of Sports Medicine.

“The main thing for parents and coaches to understand is that since most kids are not going to become professional athletes and most are not going to get the college scholarship, we want them to have fun and learn lifelong physical activity skills,” said Brenner, chair of the American Academy of Pediatrics Council on Sports Medicine and Fitness. “The big thing is making sure that young athletes are not participating in one sport year-round, and also that they’re having some time off throughout the year from a particular sport to prevent these overuse injuries and burnout.”

Practitioners need to address sports readiness in terms of cognitive, social, and motor skill development, as age is not an indicator of whether a child is physically and developmentally prepared. This can also help to prevent overuse injuries and burnout.

“One of the problems we have is parents who expect their children to do certain sporting activities before they’re ready,” said Greg Landry, MD, a report coauthor and faculty member in the departments of pediatrics and orthopedics at the University of Wisconsin School of Medicine and Public Health in Madison. “A lot of times [children] get involved in team sports before they have the skills or the cognition to really do it.”

An excessive focus on early intensive training and competition—rather than skill development—can lead to overuse injury and burnout. These injuries can require extended recovery, and sometimes can lead to long-term complications. Ultimately, they can endanger future participation.

“[Youth athletes] often play with pain when they should be resting,” Landry said. “That potentially can result in long-term problems.”

Participating on multiple sports teams (in the same or different sports, particularly if the sports have similar components, eg, soccer and track) during a single season leads to overtraining and an increased risk of overuse injury. A 2008 study of 2721 high school athletes showed a relationship between hours of sport participation and risk of injury. Training more than 16 hours per week was associated with a significantly increased risk of injury requiring medical care.

Robbie Bowers, ATC, head athletic trainer at Rancho Bernardo High School in San Diego, likened the AMSSM position paper to one the National Athletic Trainers Association published on pediatric overuse injuries in 2011 that recommended no more than 16 to 20 hours per week of vigorous physical activity by pediatric athletes.

“With overtraining you break your body down before it has time to respond and restore itself to a stronger level before it gets broken down yet again,” Bowers said. “It’s going to find the weak spots and a lot of times it’s those apophyses [cartilaginous growth centers].”

Repeated injuries, coupled with extended recoveries and long-term effects, can affect an athlete’s quality of life.

“One of the things we see in the office is that they often have one overuse injury after another,” Landry said. “I think over time they begin to enjoy their sport less and less because of all the injuries. It does impact the fun of participating.”

P.K. Daniel is a freelance writer and editor based in San Diego, CA.


DiFiori JP, Benjamin HJ, Brenner JS, et al. Overuse injuries and burnout in youth sports. Br J Sports Med 2014;48(4):287-288.

DiFiori JP, Benjamin HJ, Brenner JS, et al. Overuse injuries and burnout in youth sports. Clin J Sport Med 2014;24(1):3-20.

Rose MS1, Emery CA, Meeuwisse WH. Sociodemographic predictors of sport injury in adolescents. Med Sci Sports Exerc 2008;40(3):444-450.

Valovich McLeod TC, Decoster LC, Loud KJ, et al. Prevention of pediatric overuse injuries. J Athl Train 2011;46(2):206-220.

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