Youth Sports And The Injuries That Come With It

We tend to think of adolescents as a physically-resilient bunch and that they can play/partake in an activity for an extensive amount of time and be able to do it repeatedly, with no ill effects. That is partly true.

Over the years, as the lucrative allure of professional sports increases, there is an increasing amount of adolescents who are playing a particular sport all year-round. The premise behind this is that early sport specialization will help improve their performance in their respective sports. As a result, there is an increasing amount of acute and overuse injuries as well as burnout that have come about. There are roughly “27 million youngsters between the age of 6-18 yrs of age that partake in team sports”. Of that number, roughly 45.9% experience overuse injuries versus 54% experience acute injuries.

Between the two, overuse injuries tend to be overlooked due to the lack of a traumatic event prior to the injury occurring. Overuse injuries tend to be the injury that is more preventable because there are some factors we can control. Can parents and coaches be educated in order to help decrease these alarming percentages even though they are part of the problem? Enlightenment in regards to “normal development and signs of readiness for certain tasks, physically and psychosocially” may help to reduce the amount of annual overuse injuries seen in youth

Overuse injuries in adolescents present themselves in the soft tissue manner (ligaments, tendons etc), but also tend to occur in the apophyseal and physeal aspects of the bone. Why? During the adolescent growth spurt, these aspects of the bone tend to be immature and are less resistant to tensile, shear and compressive forces. The physeal allows the bones to grow in length and is weaker than ligaments. So with tensile stress, the bone may give way before the ligament. Aside from the physeal plate, the apophysis is another common site of injury. The apophysis is a normal developmental outgrowth of bone. Apophyseal injuries typically occur at the tibia tubercle (Osgood Schlatter disease), calcaneal apophysate (Sever’s disease) and the medial epicondylar apophysis of the elbow (Little Leaguer’s elbow).

So what are some risk factors to look out for and address? The risk factors are composed into two categories: intrinsic and extrinsic. There are several intrinsic risk factors that can be addressed:

  • A history of previous injuries may point to the need for a prehab/strength and conditioning program being implemented in order to decrease the risk of re-injury.
  • Anatomical alignment is another subcategory that can be altered. With the feet, abnormalities such as pes planus/pes cavus can be addressed by working to enhance foot intrinsic strength in order to improve lower limb alignment. Another anatomical deficiency is excessive lumbar lordosis, which can lead to lumbar impairments such as spondylolysis and spondylolisthesis. Improving core strength and neuromuscular control of the lumbo-pelvic area will aid in decreasing the incidence of these lower back injuries.
  • In females, amenorrhea is something that has to be kept track of because this may lead to fractures due to decreased bone density.
  • Sports have been widely regarded as mentally taxing as it is physically. Improving the psychological/cognitive component of competing will help to decrease the rate of burnout, which is thought of as a summation of psychological/hormonal changes. Swapping out sports throughout the year will also help reduce burnout rates.

Extrinsic variables that have to be managed include:

  • Training workload. Excessively high training volumes and intensities are directly correlated with overuse injuries. “In a study of 2721 high school athletes…training more than 16 hours/week was associated with a significantly increased risk of injury requiring medical care.” Workload is a tough thing to manage because there is no one-size fits all rule due to individual characteristics having to be accounted for.
  • Scheduling is another variable that has to be accounted for. There is concern that year-round training in a single sport or being involved in multiple teams in the same sport is part of the problem. “One study evaluating the relationships between seasonal patterns of athletic participation and overuse injury demonstrated a 42% increase in self-reported overuse injuries in HS athletes who participated all year versus 3 or less seasons per yr.” Adequate recovery is needed to help decrease the rate of overuse injuries.
  • In regards to training workload and scheduling, the American Academy of Pediatrics Council recommends limiting 1 sporting activity to a maximum of 5 days a week with at least 1 day off from physical activity. In addition, athletes should have at least 2-3 months off per year from their particular sport.

If sport specialization is considered the devil on our shoulder, sport sampling should be considered the angel on the opposite shoulder. Sport sampling is encouraged to “promote physical literacy and fundamental movement skill competency.” Not all sports have the same physical requirements. Some may require more power/strength while others may place more emphasis on stability/endurance. Sampling sports helps to train the whole paradigm of athleticism and neuromuscular control.

A particular study hypothesized that athletes who participated in one sport during the previous year would demonstrate higher scores on the Landing Error Scoring System (LESS). A score higher than 5 was considered poor, and meant the individual demonstrated poor neuromuscular landing control. This is a valid and reliable clinical movement analysis tool using cameras in the frontal and sagittal planes to evaluate specific lower extremity movements during a jump landing.

  • There was significant correlation between neuromuscular control and sport participation groups as seen in the above pie graphs.
  • Regardless of elite vs recreational status, athletes who sampled more sports exhibited lower LESS scores.

The tug of war between sport specialization and sport sampling is one that will continue to go on but in my opinion, one reigns supreme. Sport sampling is the clear winner due to the fact it will help to reduce the amount of overuse injuries in youth athletes, develop a more well-rounded athlete and reduce burnout rates. Some of the best athletes in the NBA and NFL, played multiple sports during their younger years. Michael Jordan (basketball and baseball), Lebron James (basketball and football), Odell Beckham Jr. (football, soccer and track).

If the information presented doesn’t urge you to promote sport diversity to our youth, then take a page out of some of the best athletes to walk the face of this earth.

In good health,
Bernard Boakye, PT, DPT

  1. Difiori, John P, et al. “Overuse Injuries and Burnout in Youth Sports: a Position Statement from the American Medical Society for Sports Medicine.” British Journal of Sports Medicine, vol. 48, no. 4, 2014, pp. 287–288., doi:10.1136/bjsports-2013-093299.
  2. Distefano, Lindsay J., et al. “Sport Sampling Is Associated With Improved Landing Technique in Youth Athletes.” Sports Health: A Multidisciplinary Approach, vol. 10, no. 2, 2017, pp. 160–168., doi:10.1177/1941738117736056.
  3. Brenner, J. S. “Overuse Injuries, Overtraining, and Burnout in Child and Adolescent Athletes.” Pediatrics, vol. 119, no. 6, 2007, pp. 1242–1245., doi:10.1542/peds.2007-0887.

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