Student Athletes Who Specialize Early Are Injured More Often, Study Finds

Jul 25, 2017
Originally published on July 25, 2017 6:38 pm

If you're involved in high school athletics, you know the scene. There's increasing pressure to specialize in a single sport and play it year-round.

The upside? Focusing on one sport can help give kids the edge they need to compete on elite club teams — or travel teams. Many athletes hope to attract the attention of college recruiters, or be offered a sports scholarship. This emphasis on competitive success has become widespread throughout the U.S., according to a consensus statement from the American Medical Society for Sports Medicine.

And, the downside? The "increased emphasis on sports specialization has led to an increase in overuse injuries, overtraining, and burnout, according to a 2016 report from the American Academy of Pediatrics .

Now, comes a study, published this week in The American Journal of Sports Medicine, that adds to the evidence that specialization may increase the risk of a range of injuries for high school athletes.

"We found that kids who had higher levels of specialization were at about a 50 percent greater risk of having an injury," says study author Timothy McGuine, a senior scientist and research coordinator at the University of Wisconsin Health Sports Medicine Center. The injuries McGuine and his colleagues noted included ankle sprains, knee tendonitis, and stress fractures.

The researchers determined specialization by asking athletes in the study these questions: Have you quit one sport to focus on another? Do you consider your primary sport more important? Do you train more than eight months a year for your primary sport? (Students who answered yes to all three questions were considered highly specialized.)

Until now, a lot of what was known about these kinds of injuries has been anecdotal.

To get more hard evidence, McGuine and his colleagues asked athletic trainers to record injuries as they happened during games and practices. The trainers tracked about 1,500 players from 29 high schools in Wisconsin during the 2015-2016 school year.

"We then reported into a database the type of injury, and how it occurred," McGuine explains. They also recorded information on whether the athlete went to the doctor, whether they had X-rays or MRI's, whether they had surgery, and how long the injury kept them from playing their sport.

In total, 235 students, of the roughly 1,500, sustained an injury that was serious enough to take them out of the game for a week.

McGuine's finding underscores the recent advice from a growing number of pediatric and sports medicine groups.

In a clinical report published last year, the American Academy of Pediatrics concluded that current evidence "suggests that delaying sport specialization for the majority of sports until after puberty (late adolescence — around 15 or 16 years of age) will minimize the risks and lead to a higher likelihood of athletic success."

And a consensus statement from the American Orthopaedic Society for Sports Medicine concluded that "there is no evidence that young children will benefit from early sport specialization in the majority of sports," given the risk of overuse injury and burnout.

That group recommends several measures to prevent burnout and injury including "avoiding overscheduling and excessive time commitments."

As a rule of thumb, McGuine says, kids should limit the number of hours they participate in organized sports each week to the number of years they've been alive — or less. "So a 10-year-old should not play or practice more than 10 hours a week," he says.

Still, not all sports medicine experts are convinced by the new evidence.

"Sport specialization may simply be a marker for a larger volume of training and competition," Dr. John DiFiori, Chief of the Division of Sports Medicine at UCLA told us by email. In other words, kids who focus on one sport and train year-round may simply be on the field more competing and practicing compared to kids who don't specialize. He'd like to see more research to answer that question.

In the meantime, there's one conclusion everyone seems to agree on: Parents, clinicians, and coaches need to work together with the leagues to ensure healthy play.

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For kids who are serious about playing sports, there's increasing pressure to pick one sport and specialize in it. That can mean year-round intensive training. It can make kids better, but a new study finds specialization has a downside when it comes to the risk of injury. NPR's Allison Aubrey has the report.

UNIDENTIFIED MAN: Let's go, baby. Let's go. Let's go.

ALLISON AUBREY, BYLINE: It's not football season yet, but for these football players training on a high school field in Washington, D.C., practice has been in full swing all summer.

UNIDENTIFIED BOY: All right, Riley (ph), you're up.

AUBREY: As the boys line up for drills, I talk to one of the moms, Michelle Wilson (ph). She's got two sons on the field. And she says when it comes to football, they're all in.

MICHELLE WILSON: Absolutely. We're practicing year-round. We're going to tournaments year-round. It's definitely different from when I grew up.

AUBREY: Specializing in one sport has become increasingly common. Kids don't just play for their school teams. They're striving for elite-level travel teams and even college scholarships. However, a new study published in the American Journal of Sports Medicine finds focusing on one sport can lead to more injuries among high school players. Here's study author Timothy McGuine of the University of Wisconsin.

TIMOTHY MCGUINE: We found that kids that had higher levels of specialization were at 50 percent greater risk of having an injury, you know, like ankle sprains, knee tendonitis, stress fractures in their foot.

AUBREY: Until now, many reports about these kinds of injuries have just been anecdotal. That's why McGuine and his collaborators did this new study. They had athletic trainers on the field record injuries as they happened during games and practices. They tracked about 1,500 players from 29 high schools in Wisconsin for an entire school year.

MCGUINE: We had reported into a database the type of injury, how it occurred, and eventually we'd get information on did they need to go to the doctor, if - did they have surgery, how long they were out from their sport. We collected all that data.

AUBREY: In total, 235 students - about 15 percent - sustained an injury that was bad enough to take them out of the game for a week. And it makes sense. Kids are putting stress on the same joints over and over again and training at a high level during years when they're still growing. McGuine's new findings bolster previous position papers issued by the American Academy of Pediatrics and the American Orthopaedic Society for Sports Medicine. Both point to the potential risk of overuse injuries and burnout in student athletes who specialize. McGuine says to reduce the risk of injury, a general rule of thumb is this - each week, the number of hours a kid trains and competes should not exceed their age.

MCGUINE: So a 10-year-old should not play or practice more than 10 hours a week.

AUBREY: And for kids in high school, there's evidence that training more than 16 hours a week can increase the risk of injury. Now, back at the football practice, mom Michelle Wilson says she hopes that sports may give her younger son a shot at a scholarship.

WILSON: So for us, it's not - the opportunity isn't the football. It's using football for an opportunity we may not have been able to afford or get otherwise.

AUBREY: But she says she and her boys' coaches think a lot about injury prevention. They train off the field to vary the workouts, and they take plenty of time to rest. She says if going forward it gets too intense, she would pull them out.

WILSON: We don't pressure them. And if my boys did not like it, we would stop.

AUBREY: She says when it comes to sports, it's all about weighing the potential risks and rewards. Allison Aubrey, NPR News.