Youth Sports Injury Prevention Strategies: Evidence-Based Guidelines
Introduction
A large part of sports medicine practice involves the care of young athletes. In fact, over 30 million children and adolescents participate in organized sports in the United States.¹⁻³ While there are certainly clear benefits of participation in youth sports such as motor skill development and social development opportunities, some of the known risks include sport-related injury and burnout.⁴⁻⁶ The purpose of this blog post is to highlight two studies that resulted in evidence-based guidelines to help limit the risk of overuse injuries in young athletes.
Defining Injury Types
Injuries can be categorized into three types:
Acute
Overuse
Concussion
An acute injury is defined as one that is traceable to a single traumatic event while an overuse injury occurs gradually without a specific traumatic event.⁷ Examples of acute injuries include ankle sprains, ACL tears, shoulder dislocations, and traumatic fractures. Examples of overuse injuries include stress fractures of the shin (tibia), Little Leaguer’s Shoulder, Little Leaguer’s Elbow, Osgood-Schlatter Disease (a stress injury of the knee), and Sever’s Disease (a stress injury of the heel).
Key Studies in Orthopaedic Sports Medicine Literature
A 2015 publication by Jayanthi et al. in the American Journal of Sports Medicine evaluated the potential relationship between sports specialization, weekly training volumes, growth rates and risk for injury and serious overuse injury in young athletes.⁷
The study included 1190 youth athletes ages 7-18 enrolled at two academic medical centers in the Chicagoland area. There were 822 injured patients and 368 uninjured patients. The 822 injured patients sustained 846 unique injuries, of which 276 (32.6%) were acute and 570 (67.4%) were overuse. Of the 570 overuse injuries, 134 (15.8% of all injuries) were considered serious overuse injuries. Examples of serious overuse injuries included stress fractures of the lower back, ankle, foot, ankle, and knee.
Sport specialization was defined as “year-round intensive training in a single sport at the exclusion of other sports.”⁸ The degree of sport specialization was based upon a patient’s response to the following 3 questions:
“Can you pick a main sport?” (ie, single-sport training)
“Did you quit other sports to focus on a main sport?” (ie, exclusion of other sports)
“Do you train 8 months in a year?” (ie, year-round training)
The sum of the above 3 questions was used to assign a degree of specialization:
3 = highly specialized
2 = moderately specialized
1 or 0 = low specialized
The key findings of the study were as follows:
There was an increased risk of injury and serious overuse injury in young athletes who specialized in a single sport, independent of training volume and age.
Young athletes who participated in organized sport for more hours per week than their age had increased odds of having a serious overuse injury.
Young athletes whose ratio of organized sports to free play time was >2:1 hours/week had increased odds of having a serious overuse injury.
There was no difference in growth rates between injured and uninjured athletes.
A 2020 study by Jayanthi et al., published in the Orthopaedic Journal of Sports Medicine evaluated the same group of patients over the course of 3 year follow-up to see if there were long-term associations between sport specialization, intense training patterns, and injury risk.⁹
The study found results consistent with the baseline study:
Highly specialized athletes were significantly more likely to be injured or have an overuse injury compared to less specialized athletes.
Females were at greater risk for all injuries and overuse injuries.
Young athletes who trained more hours per week than their age, or who trained twice as many hours as their free play time, were more likely to be injured.
Why Does Sport Specialization Result in Increased Overuse Injury Risk?
The answer to this question is an area of active research. One possible reason may be that specialized athletes expose their musculoskeletal system to one set of movement patterns (i.e., pitching in baseball or serving in tennis) and thus are more likely to stress the same body area(s) repetitively, resulting in eventual injury due to limited rest periods throughout the year.
Key Recommendations
The study results serve as the evidence-basis for the following youth sports participation recommendations:
Avoid or at least delay sport specialization for as long as possible. A diverse sports participation experience (multiple sports throughout the year, each in its own dedicated season) is recommended.
The number of training hours per week should be less than or equal to an athlete’s age (i.e., a 12-year-old tennis player should participate in organized tennis activities for no more than 12 hours per week).
The ratio of organized sports to free play time should be <2:1 (i.e., if 4 hours per week are spent in free play, time dedicated to organized sport participation should be less than 8 hours).
Links to Studies
The two studies within this blog post are available at the following links below:
Appointment
If you are the parent of a young athlete with a sports-related injury, please contact Dr. Verma’s office to schedule an appointment for an evaluation. Appointments can be made via telephone, online, or the NorthShore Connect App.
References
DiFiori JP, Benjamin HJ, Brenner JS, et al. Overuse injuries and burnout in youth sports: a position statement from the American Medical Society for Sports Medicine. Br J Sports Med. 2014;48(4):287-288.
Hergenroeder AC. Prevention of sports injuries. Pediatrics. 1998;101(6):1057-1063.
Health NIo. Conference on Sports Injuries in Youth: Surveillance Strategies, 1991. In: National Institutes of Health Bethesda, MD; 1992.
Logan K, Cuff S. Organized Sports for Children, Preadolescents, and Adolescents. Pediatrics. 2019.
Merkel DL. Youth sport: positive and negative impact on young athletes. Open Access J Sports Med. 2013;4:151-160.
Brettschneider W-d. Effects of sport club activities on adolescent development in Germany. European Journal of Sport Science. 2001;1(2):1-11.
Jayanthi NA, LaBella CR, Fischer D, Pasulka J, Dugas LR. Sports-specialized intensive training and the risk of injury in young athletes: a clinical case-control study. Am J Sports Med. 2015;43(4):794-801.
Jayanthi N, Pinkham C, Dugas L, Patrick B, LaBella C. Sports spe- cialization in young athletes: evidence-based recommendations. Sports Health. 2013;5:251-257
Jayanthi N, Kleithermes S, Dugas L, Pasulka J, Iqbal S, LaBella C. Risk of Injuries Associated With Sport Specialization and Intense Training Patterns in Young Athletes: A Longitudinal Clinical Case-Control Study. Orthop J Sports Med. 2020;8(6):2325967120922764. Published 2020 Jun 25.