Letter to My 12-Year-Old Self: The Perils of Early Sport Specialization

Dear 12-Year-Old Julie,

I know you probably won’t appreciate this note very much, but I’m writing from the future, in hindsight, to give you some advice..

You know how you play soccer almost every day, in every season, in every weather? Well, you’re doing something we like to call “sport specialization.” You might think of it as eating, breathing, and sleeping soccer. We like to think of it as “intense training in one sport at the exclusion of others.” Early sport specialization happens before puberty and late sport specialization happens later in adolescence. The creation and popularity of select, club, and travel teams over the last forty years has allowed for year-round single-sport participation, with athletes often electing to play on multiple different teams in all four seasons.

I understand the reason you have chosen to specialize in soccer. You are good at it. The soccer field is your safe haven and the one place you feel in control. You have the idea that early sport specialization will produce an elite athlete out of you – maybe even one day an olympian. But here are some facts to consider:

• Yes, athletic participation is excellent for developing good lifelong physical activity habits, learning proper socialization, gaining exposure to teamwork, building leadership skills, improving self-esteem, and having fun; However , early sport specialization is considered a significant risk factor for overtraining, overuse injury, and athletic burnout.
• Overuse injuries account for anywhere from 45-50% of all athletic injuries.
•  Nearly 70% of children discontinue organized sport after the age of 13.
• Approximately 3 to 11% of high school athletes compete at the NCAA level – with only 1% receiving scholarship of any kind.
• Only 0.03 to 0.5% of high school athletes make it to professional sport.

Now, I don’t say this to scare or deter you. You and I both know that if you truly put your mind to something, you can achieve just about anything.

However, I should inform you: Specialization in one single sport before puberty may not be the best way to accomplish your athletic goals. Did you know that of the 322 athletes invited to the 2015 NFL Scouting Combine, 87% were multi-sport athletes, while only 13% exclusively specialized in the sport of football. Athletes are also much more likely to excel athletically and continue to participate in organized sport if they participate in informal games and “deliberate play.” Deliberate play is characterized by the intentional and voluntary nature of informal games, merely designed to maximize inherent enjoyment. When highly structured activity that requires max effort and is motivated by performance enhancement heavily outweighs the kick-the-cans, capture-the-flags, and man-hunts of the world, kids start to encounter both physical, emotional, and social turmoil.

I know that the skeptical child in you will inevitably raise your eyebrow and say, “Well then, what about the gymnasts, figure skaters, and swimmers who achieve global fame and still have their baby teeth?” These technical sports are an exception to the rule, as elite level competitors often specialize before the age of 8 in order to reach peak competitive form prior to musculoskeletal maturation.

You should know that, generally speaking, specializing early in intense training of sport often leads to overuse injuries, loss of playing time, and even early retirement. I know you’ve always been the overly analytical, “prove-it-to-me” type, so I’ll leave these stats right here:

A recent study showed that high school athletes demonstrate an increased risk of injury when their training volume exceeds 16 hours per week. Another study showed that athletes who participate in organized sport compared with free play in a ratio >2:1 have an increased risk of overuse injury. This basically means that for every one hour of organized sport, there should be at least 30 minutes of free play time to decrease the risk of injury. This same study actually found that young athletes who participate in more hours of organized sport per week than their age in years also have an increased risk of overuse injury. They also found that other complications of early specialization include burnout, anxiety, depression, and/or attrition from physical activity entirely.

But pediatric injuries are unlike those of adults due to a number of anatomical and biomechanical differences. These are just big words for saying that children are not small adults. With nearly 60 million kids between the ages of 6 and 18 participating in some form of organized sport in the United States, healthcare practitioners should be cognizant of the fact that adult maladies and youth injuries vary significantly.

For example, the most common type of overuse injury in the pediatric population is fracture. While children are growing, their growth plates (or “physes”) are extremely vulnerable to injury, as they are the weakest part of the bone. An injury pattern that might result in a ruptured ACL in a mature adult, will actually result in an avulsion, or fracture, at the tibial spine in a child. Physical therapists and other sport medicine clinicians alike must err on the side of assuming growth plate injury until being proven otherwise, as misdiagnosis of these injuries can have calamitous effects, including, but not limited to, growth arrest, joint deformity, or arthritis.

Of significant note is that more than half of all pediatric overuse injuries are suspected to be preventable with simple approaches. One such approach is aptly labeled INT, or Integrative Neuromuscular Training. INT is any form of supplemental training that incorporates general or specific strength and conditioning activities, such as resistance, dynamic stability, core-focused strength, plyometric, and agility-based exercises. It has been postulated that INT should be implemented throughout childhood and adolescence, as neuromuscular training is thought to improve movement mechanics, minimizes risk of sports-related injury, and promote positive health outcomes during adulthood. (You might recall, neuromuscular training can reduce ACL injuries by as much as 50%, with non-contact ACL injuries decreased by as much as 67% in females.) Research also suggests that youths are well-advised to play any single sport for only 8 months of the year, with month-long periods of recovery and INT to prophylactically protect against injury.

Lastly, there is an increasing amount of evidence alluding to the fact that late specialization in sport (after ~15 or 16 years of age) may lead to a higher likelihood of athletic success. Late specialization allows for children to sample different sports and develop mastery of different movement patterns, while perhaps discovering unknown interests and talents. It also develops sustainable habits that support long-term athletic development that will carry well into adulthood.

While I know it may be a difficult pill to swallow, please remember to explore other hobbies and passions. Do not solely invest your identity in one sport. Remember that variety is the spice of life. Your body and mind will thank you later.

Sincerely from the Future,

27-Year-Old Julie

Guidance for the Sport-Specialized Parent (via American Academy of Pediatrics):

• The primary focus of sports for young athletes should be to have fun and learn lifelong physical activity skills.
• Participating in multiple sports, at least until puberty, decreases the chances of injuries, stress, and burnout in young athletes.
• For most sports, specializing in a sport later (ie, late adolescence) may lead to a higher chance of the young athlete accomplishing his or her athletic goals.
• Early diversification and later specialization provides for a greater chance of lifetime sports involvement, lifetime physical fitness, and possibly elite participation.
• If a young athlete has decided to specialize in a single sport, discussing his or her goals to determine whether they are appropriate and realistic is important. This discussion may involve helping the young athlete distinguish these goals from those of the parents and/or coaches.
• It is important for parents to closely monitor the training and coaching environment of “elite” youth sports programs and be aware of best practices for their children’s sports.
• Having at least a total of 3 months off throughout the year, in increments of 1 month, from their particular sport of interest will allow for athletes’ physical and psychological recovery. Young athletes can still remain active in other activities to meet physical activity guidelines during the time off.
• Young athletes having at least 1 to 2 days off per week from their particular sport of interest can decrease the chance for injuries.
• Closely monitoring young athletes who pursue intensive training for physical and psychological growth and maturation as well as nutritional status is an important parameter for health and well-being.

References:

1. Brenner JS. Sports specialization and intensive training in young athletes. Pediatrics. 2016;138(3):e20162148–e20162148.
2. 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.
3. LaPrade RF, Agel J, Baker J, et al. AOSSM early sport specialization consensus statement. Orthop J Sports Med. 2016;4(4):2325967116644241.
4. Wojciechowski, M. Not ‘Small Adults:’ Here’s What Its Need to Know About Pediatric Overuse Injuries. PT in Motion. November 2018; 1: 28-34.
5. 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;48:287-288.
6. Facts about NCAA Sports. https://www.ncaa.org/sites/default/files/Recruiting%20Fact%20 Sheet%20WEB.pdf. Accessed August 27, 2018.
7. Bergeron MF, Mountjoy M, Armstrong N, et al. International Olympic Committee consensus statement on youth athletic development. BR J Sports Med. 2015;49: 843-851.
8. Myer GD, Faigenbaum AD, Ford KR, et al. When to initiate integrative neuromuscular training
   to reduce sports-related injuries in youth? Curr Sports Med Rep. 2011;10(3): 155-166.
9. McLeod TC, Decoster LC, Loud KJ, et al. National Athletic Trainers’ Association Position Statement: Prevention of Pediatric Overuse Injuries. J Athl Training. 2011;46(2): 206-220.

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