How sports specialization can hurt

Sports for children and adolescents have changed drastically over the last several decades, with many young athletes working intensely to reach specific goals-whether that is playing professionally or as a way to earn a scholarship. However, this intensity comes at a price, and it can be dangerous both physically and mentally, according to a new report.

The report, published in Pediatrics, aims to help pediatricians counsel young athletes and parents on the risks of early sports specialization and intensive training. It also supports a previous clinical report from the American Academy of Pediatrics (AAP) on overtraining, burnout, and sports-related injuries.

“Sports should be about having fun and learning lifelong physical activity skills. In order to accomplish these goals and any other an athlete may have-like playing in college-young athletes should play multiple sports; have scheduled time off throughout the week and year; engage in more deliberate play; and delay specialization until late adolescence or even later,” says Joel S. Brenner, MD, MPH, FAAP, medical director of sports medicine at Children’s Hospital of The King’s Daughters in Norfolk, Virginia, immediate past-chair of the AAP Council on Sports Medicine and Fitness, and lead author. “You do not need to specialize to be a successful athlete.”

Brenner says sports are a great way for adolescents to learn valuable lessons about teamwork, leadership, and self-esteem, and develop friendships, but moderation and common sense must come into play as well.

Gone are the “pick-up” games of the past. Instead, sports participation has been replaced with organized sports driven by parents and coaches, who often have different goals for the game than the players. Young athletes are also increasingly likely to play 1 sport at a high level, all year-sometimes on multiple teams-rather than participating in multiple sports throughout the school year.

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According to a 2008 report from the National Council of Youth Sports, participation in organized sports among children aged 6 to 18 years rose by about 25% in a decade-from 45 million participants in 1997 to 60 million in 2008. More than a quarter-27%-of those playing organized sports in 2008 participated in just 1 sport, but 70% of children dropped out of organized sports by age 13 years, and burnout could be a factor. Overuse is another risk in this trend, with an estimated 46% to 50% of all athletic injuries resulting from overuse.

Sports specialization has increased as an overall trend, the report points out, and can begin as early as age 7 years-typically in leagues that are independent of school-sponsored programs and that run year-round. Although many of these athletes, or their families, may pursue specialization to try and earn athletic scholarships, the report reveals that just 1% of high school athletes go on to earn athletic scholarships, and only 3.3% to 11.3% even get a chance to compete at the National Collegiate Athletic Association (NCAA) level. A mere 0.03% to 0.5% make it to playing at the professional level, the report notes.

Whereas students might hold aspirations of scholarships or professional careers-despite the odds-Brenner notes that parents are the strongest influences on starting a sport, and coaches influence an athlete’s decision to train intensely or specialize.

“Parents need to look at the big picture in terms of their child’s schedule. If they are overscheduled there will be a higher likelihood of stress, anxiety, and burnout, which will affect all aspects of their life,” he says.

There are many benefits to moderation and diversity. Brenner says in the report that athletes who participate in a variety of sports have fewer injuries and play longer than those who specialize in a single sport before reaching puberty.

Intensive training in young athletes can have many negative, unintended consequences, ranging from physical to psychological problems. Physical problems mainly involve overuse and malnutrition based on the level of physical activity. Psychological problems can stem from social isolation resulting from the amount of time spent training rather than building relationships with friends and family.

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In terms of determining how much is too much, Brenner says some research has shown that the risk of injury increased when training exceeded 16 hours per week, and others have suggested that training hours per week should not exceed the athlete’s age in years.

Despite agreement among sports authorities that early specialization leads to increased success, Brenner says it is now becoming clear that the timing of specialization can play a key role in its efficacy.

“Studies have shown that Division 1 NCAA athletes are more likely to have played multiple sports in high school and that their first organized sport was different from their current one,” Brenner writes. “Many examples exist of professional athletes who have learned skills that cross over to their sport by playing a variety of sports into high school and even college. There were 322 athletes invited to the 2015 National Football League Scouting Combine, 87% of whom played multiple sports in high school and 13% of whom only played football.”

Other success stories reveal specialization that did not occur until late adolescence, with the athletes participating in multiple sports in the years prior to specialization. Current evidence suggests that delaying sports specialization until after puberty may minimize the risk of injury and increase an athlete’s chances of success.

Brenner also suggests that the culture of early college recruitment be amended, as it may push athletes into year-round and intensive training out of fear that they may lose an opportunity.

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“Given what is currently known about early sport specialization, this changing paradigm should be discouraged by society,” Brenner says. “The AAP, NCAA, pediatricians, parents, and other stakeholders should advocate banning national ranking of athletes and college recruitment before the athletes’ later high school years.”

Pediatricians can play a key role not only in advocating for these changes, but also in monitoring the intensity and risks involved in early specialization and intense training.

“Hopefully the pediatricians will be able to counsel young athletes and parents at their well visits and visits for injuries about prevention strategies. It can be a great conversation starter. Most parents are hungry for this information and oftentimes just want to be told that it is OK for their child to take a break or do other activities,” Brenner says. “The bigger issue is the culture of youth sports and the pressure that the athlete and parent may feel. The parent, coach, league, national governing body, NCAA, National Federation of State High School Associations, state high school leagues, and other stakeholders can play a vital role in changing the paradigm.”

Pediatricians should share with young athletes and their families the following key messages, says Brenner.

1. The focus of sports for young athletes should be on fun and learning lifelong physical skills.

2. Participating in multiple sports-especially before puberty-can lower the risks of injury, stress, and burnout in young athletes.

3. Delaying sports specialization until late adolescence is more likely to increase an athlete’s success.

4. Early diversification and later specialization increases the chances of lifelong sports involvement, physical fitness, and elite participation.

5. Athletes who wish to specialize early should be counseled on their goals, to distinguish whether they are truly the athlete’s goals and not those of a parent or coach, and to determine whether those goals are appropriate and realistic.

6. Parents should monitor training and coaching in “elite” sports programs closely to be sure they are in line with best practices.

7. Athletes should have a total of 3 months off from their sport of interest each year, in increments of 1 month.

8. The risk of injury is lower in young athletes who have at least 1 to 2 days off from their sport of interest each week.

9. Physical and psychological growth, as well as nutritional status, should be closely monitored in young athletes who pursue intense training.

An infographic created as a part of the clinical report is available as an educational tool for families and athletes, Brenner says.