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Dangers of Sports Specialization
Marc Kowalsky, MD Shoulder & Elbow Surgery, Sports Medicine
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Dangers of Sports Specialization
Marc Kowalsky, MD October 3, 2017
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Orthopaedic & Neurosurgery Specialists
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The Epidemic
• 30 million children (75%) participate in organized sports
• 30% of youth athletes are highly specialized
• Young athletes specialize in sports and positions at an earlier age
• 3.5 million children under age 14 treated annually for sports injuries
• Overuse injuries account for half of all sports injuries in middle school and high school
Safe Kids USA
National Federation of State High School Associations
Jayanthi et al. AJSM, 2015
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Sport Specialization: Definition
• Participation in intensive training and/or competition in organization sports > 8 months per year
• Participation in 1 sport to the exclusion of participation in other sports
• Involvement of prepubertal children (seventh grade, or 12 years old)
• Limited overall free play
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Motivation
• Ability to compete at the next level
• College admissions
• Collegiate athletic scholarships
• National, Olympic team selection
• Professional contract
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Motivation
• Success
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Motivation
• Success
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Drivers
• Athletes
• Parents
• Coaches
• Media
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Drivers
• Eastern European olympic development • Sports in which peak performance occurs early
– Figure Skating – Gymnastics – Swimming – Diving
• Early selection • High-volume training • Rigorous coaching
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Rationale
• “10 Year / 10,000 Rule” – Simon & Chase. “Skill in
Chess”. American Scientist. 1973
• 10K to 50K hours of practice to become a master.
– John Hayes. “10 Years of Silence”.
• 500 works of classical music between 1685 – 1900
• None were composed before 10 years of “practice”
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Rationale
• Deliberate Practice – “The role of deliberate
practice in the acquisition of expert performance”
– Ericsson and colleagues, 1993
– Relevant to performance improvement
– Level of performance directly related to deliberate practice
– Early deliberate practice benefit over peers
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Questions
• Is early sport specialization safe? Does early
sport specialization increase the risk of injury in youth athletes?
• Is early sport specialization effective or necessary in achieving elite performance?
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Concern: Skeletal Maturity
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Concern: Skeletal Maturity
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Concern: Skeletal Maturity
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Concern: Psychosocial Maturity
• Need to enjoy activities of their domain
• Need to have sense of control over their lives
• Do not respond favorably to isolation
• Less able to participate with others outside peer group
• Less prepared to deal with stress / anxiety
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Risk: Year-round Participation
• Year-round training is a key component of sport specialization
• Important risk factor for injury – pitching > 8 months / year – no break for one sport season / year
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Risk: Repetitive Technical Skills
• Repetitive high risk mechanics in skeletally immature athlete
– Introduction of kick serve < 13 years old
increased shoulder/elbow injury
– Repetitive impact in gymnasts with volume of training and skill level
wrist pain
– Pitch type, volume and poor mechanics in young pitchers
elbow injury
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Risk: Overscheduling
• Competitive demands higher for specialized athlete
• More frequent and intense formal competition
• Competition is associated with increased risk of injury
• Inadequate rest & recovery associated with increased risk of injury
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Effect of Early Sport Specialization
• Execute less age-appropriate sport skills
• Do not develop protective neuromuscular patterns
• Increased organized play over free play doubles injury risk
• Specializing before age 12 years increases injury risk
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Effect: Overuse Injury
• Early specialization associated with injury – hockey hip labrum injury – tennis femoroacetabular (hip) impingement – baseball shoulder / elbow injury
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Effect: Psychological Burnout
• Adult-driven specialized training
• Characteristics – Loss of (intrinsic) motivation
– Lack of enjoyment (younger)
– High perceived stress, anxiety
– Ineffective stress coping strategies
– Fear of reinjury at young age
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Effect: Psychological Burnout
• Manifestations
– Mood disturbances
– Social isolation
– Eating disorders
– Dropout
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Effect: Psychological Burnout
• Swimming – decreased time on national
team – earlier retirement from
sport • Hockey
– increased off-ice training time
– earlier initiation of participation
– more prone to dropout
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10 Year / 10,000 Hour Rule
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Nature Versus Nurture
• Elite athletes are more likely to have parent or sibling who played collegiate or professional sports
• Pushing a child to specialize early WILL NOT compensate for lack of athletic genetics
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Evidence: Early Specialization
• Of 35,000 highly qualified young Russian athletes in sport school, only 0.14% reached high level status
• Among German athletes chosen for early specialization, only 0.3% achieved elite status
• Among US high school athletes, only 0.2 – 0.5% achieve professional level
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Evidence: Later Specialization
• Elite athletes pursued intensive trainer later in adolescents than their near-elite peers
• 2004 Olympians initiated sports at average age 11.5 years
• 1500 German Olympic national athletes initiated training in primary sport later
• Among NCAA athletes, 70% did not specialize in their sport until age 12 years
• No difference in training profiles of experts and nonexperts in field hockey, soccer, and triathlon until ages 13, 15, and 20.
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Evidence: Diversification
• 1500 German Olympic national athletes on average participated in 2 other sports
• Among NCAA athletes, 88% participated in more than one sport
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Benefits of Early Diversification
• Enhance physical literacy
• Motor skill development
• Psychosocial and cognitive skills
• Protective neuromuscular patterns
• Crossover effect of multiple sports
• Accommodates psychological well-being
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Development Model of Sport
Early diversification does not hinder elite sport participation
Early diversification is linked to a longer sport career and has positive implications for long-term sport involvement
Early diversification allows participation in a range of contexts that most favorably affects positive youth development
High amounts of deliberate play during sampling years builds a solid foundation of motivation through involvement in activities that are enjoyable
High amounts of deliberate play during sampling years establishes a range of motor and cognitive experiences that children bring to their sport of interest
Toward end of primary school (age 13), children should have the opportunity to choose to specialize in their favorite sport or continue with recreational sport
Late adolescents (age 16) have the physical, cognitive, social, emotional and motor skills to become highly specialized in one sport
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Protective Strategies
• Provide opportunities for free, unstructured play
• Ratio of weekly hours in organized sport to weekly hours in free play should remain below 2:1
• Weekly hours of sports participation should not exceed child’s age, or total 16 hours
• Avoid specialization before age 13 years
• Structured strength & conditioning program
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Sport-Specific Policies
• Tennis
– Minimum 12 year-old junior tournament player
– < 12 hours / week of organized tennis
– < 12 tournaments / year
– Consider another sport during “off-season”
– 2 hours / week injury prevention training
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Sport-Specific Policies
• Observe pitch counts and rest periods • No overhead throwing for 2-3 months per
year • No competition for 4 months per year • No pitching > 100 innings per year • Avoid pitching for multiple overlapping teams • No pitcher / catcher combination • Avoid radar guns • Avoid showcases
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Aspen Institute
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Aspen Institute
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