Editor’s note: This is the third of a four-part series on overuse injuries.
Dr. Aman Dhawan understands the “10,000-hour” principle, which essentially states that it takes 10 years and 10,000 hours of deliberate practice to become an expert performer at something.
But it shouldn’t happen before high school graduation.
“From a cultural standpoint, the idea of early sports specialization is becoming the new norm,” said Dhawan, an orthopedic surgeon who specializes in sports medicine with University Orthopaedic Associates in Wall. “This cultural idealogy is pretty much built from the 10,000-hours theory, and now we’re seeing children as young as 7 or 8 years old who are starting to play just one sport year-round.
“There’s a difference between athletic prowess and specialization, and to extrapolate that 10,000-hour principle and apply it to everything in life is ridiculous.”
Yet it’s becoming more common to see youngsters who have not yet reached puberty exclusively practicing and competing in one sport, or multiple similar sports which use the same muscle groups, throughout the year.
The examples are plentiful — the 10-year-old who plays baseball in the spring, summer and fall, then spends his winter at various clinics or indoor development sessions; the 12-year-old softball pitcher who plays for her middle school team in the spring, then spends her summer and fall with a travel program and goes to pitching lessons through the winter; the 11-year-old soccer player who plays in the town rec league in the fall and spring, competes with an indoor team during the winter and goes to various camps during the summer.
And with specialization comes the increased risk of overuse injury.
“If it’s an adolescent coming up in a particular sport, training and competing five days a week is adequate,” said Dr. Harry Bade, an orthopedic surgeon with Professional Orthopaedic Associates and a team physician for Monmouth and Georgian Court universities. “If the athlete is training or competing six or seven days a week, that’s usually too much. If the athlete is training with one team, that’s good. If that athlete is training with two or more teams, that’s usually not good.
“And if an athlete is playing two sports that are somewhat mutual in terms of what the activity involves during the same season, that’s definitely not good.”
‘Not a good idea’
Many medical professionals agree that the increase of youth sports specialization during the past decade has had a tremendous impact on the number of overuse injuries now being recorded on a yearly basis. And according to Dhawan, “the data is overwhelming and troubling.”
The U.S. Centers for Disease Control and Prevention (CDCP) estimates that more than 3.5 million kids under 14 receive treatment for sports injuries each year, more than half of which are preventable. Among middle and high school students, the CDCP estimates that more than half of the injuries are due to overuse.
In April, Dr. Neeru Jayanthi gave a report to the American Medical Society for Sports Medicine (AMSSM) based on a study of 1,206 athletes, ages 8 to 18, by the Loyola University Medical Center and Lurie Children’s Hospital in Chicago. Between 2010 and 2013, Jayanthi and his colleagues recorded 859 total injuries, including 564 overuse injuries.
Of the overuse injuries, 139 were deemed serious, which included such injuries as stress fractures in the back or limbs, elbow ligament injuries and injuries to cartilage and underlying bone — all injuries which can lead to recovery times of one to six months or longer.
“The numbers are becoming crazy,” Dhawan said. “Lots of kids are literally playing year-round, and the data support that it’s not a good idea.”
Colts Neck athletic trainer Eric Nussbaum, past president of the Athletic Trainers’ Society of New Jersey, helped develop the National Stress Fracture Registry — a study that involved 60 secondary school athletic trainers from 16 states who reported incidents and collected data related to the causes of adolescent stress fractures, the findings of which were presented at the National Athletic Trainers Association national meeting in 2009.
“Through the data in our stress fracture registry, we looked at the number of hours per week an athlete was normally active,” Nussbaum said. “And once an athlete got past 10 hours per week, the numbers of stress fractures increased dramatically. There was a big spike when the hours per week hit 12-15 hours.”
One recommendation Jayanthi and his team made to the AMSSM was to limit the number of hours per week an adolescent plays sports to no more than the number of his or her age. The mantra behind such a recommendation is that younger children are developmentally immature and may be less able to tolerate physical stress.
Nussbaum and Dhawan both ageed that such a recommendation is sound.
“We can’t blame parents for putting their kids into organized sports and trying to develop them as athletes,” Dhawan said. “But what some parents have to realize is that children are not mini-adults, and what their bodies can realistically handle with regard to workload is significantly different from 7 to 10, from 11 to 14, and even from 15 to 18.”
Dr. Laurie Glasser, a sports medicine specialist with the Orthopaedic Institute of Central Jersey, also believes parents need to pay close attention to what their children are doing away from organized sports practices and competition.
“Parents have to be aware of what other activities their kids are doing,” she said. “If a kid is playing a specific sport for 10 hours in a week, and then playing the same sport with his or her friends in the schoolyard for a few hours on Saturday or Sunday,” she said, “that could be too much and the kid could end up with an overuse injury.”
Still, Bade said there’s no reason for a young athlete to begin specializing in one sport until later in high school.
“You have to at least wait for puberty to set in,” he said. “For one, the strength hormones in both males and females don’t really start kicking in until 15 or 16. The second thing is they’re still growing, their bodies are changing and they’re just not that strong. All you have to do is look at the difference in physical strength between a 14-year-old and an 18-year-old. It’s huge.”
Generally, sports medicine experts suggest that athletes, at least up to the age of 15 or 16, depending on the individual athlete, play a variety of sports in an effort not just to diversify the overall physical conditioning of the athlete to alleviate the potential for overuse injury, but also to improve an athlete’s cognitive and social abilities.
“Some of the best ways to get better at your No. 1 sport is to play other sports,” said Dr. Charlie Weingroff, a physical therapist, athletic trainer and certified strength and conditioning specialist in Marlboro. “Before playing a specific sport, you have to be an athlete first. But even before that, you have to be a human being first.”
Despite the increase in numbers of overuse injuries, one-sport specialization among youth athletes continues to rise. And with such factors as potential scholarships, a culture of “being No. 1” or “winning at all cost” and pressures from adults and peers alike thrown into the mix, it’s easy to see why that is so.
“Parents really need to take charge in this area,” said Dr. Stephen Rice, a pediatric sports medicine specialist and director of the Sports Medicine Center at Jersey Shore University Medical Center in Neptune. “But sometimes it’s very hard for parents to be realistic about what their kids’ limits are. Some parents get suckered into thinking their kid is going to be great in this sport or that sport, and they really have to be careful.”
But what is a parent to do if his or her 13-year-old really enjoys playing just one sport or multiple similar sports?
In addition to limiting the number of hours played and practiced per week, medical professionals recommend that parents make sure the athlete has an offseason, when the athlete is doing nothing related to that particular activity.
If your baseball player competes and practices throughout the spring, summer and fall, make sure he has the winter off from anything related to throwing. If your girl is a cheerleader in the fall and a club gymnast in the winter and spring, be sure she has most of the summer to relax and recover. If your kid is serious about track in the spring and wants to run cross country in the fall, it might be best for him to take off during the winter season and do cardiovascular conditioning away from a running surface.
Also, parents must be on the lookout for signs of burnout. If a child is showing a lack of interest in practicing or competing in a particular sport after years of doing so, discuss other options with him or her.
“There’s tons of data showing that specialization leads to burnout,” Dhawan said. “And if a kid is burned out on a sport, he or she is at greater risk for overuse injury. But not just that, the kid is also at risk for potential psychological harm. Parents have to remember that sports should be fun. And if a kid is burnt out, it’s not going to be fun and it especially isn’t going to be fun if the kid gets hurt.”