sports specialization - texas children's hospital · specialization and injury • roos kg,...

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Texas Children’s Professional Education SeriesOrthopedics & Sports Medicine 2018

Sports Specialization

Scott McKay, MDOrthopedics

Why Sports for Youth?Physical Benefits

Decreasedobesity

Cardiovascularbenefits

Strength benefits

Bonehealth

Better sleep

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Selfconfidence

Why Sports for Youth?Psychosocial Benefits

Friendships

Purpose

Alternative tomore nefariousactivities


• Focus on one sport

• Year round

DEFINITION: SPORTS SPECIALIZATION

• Participation of one sport at the exclusion of other sports

• More than 8 months per year

• Prior to age 12

AOSSM has defined EARLY SPORTS SPECIALIZATION

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• Scholarship

• Win

• Improve skills

• Certain sports demand it

Why Specialize?

Certain Sports RequireSpecialization for Success

Competitivegymnastics

?Golf

?Fencing?Competitive

cheer

Ballet

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Specialization Possibly Harmful?

• Track

• Basketball

• Wrestling

• VolleyballBaseball Football Softball Soccer

Odds of Playing College

1% receivescholarship

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Sports Specialization: Why Do We Care?

• Growing body of literature to suggest thatearly sports specialization contributes to

• Injuries: Acute & Overuse

• Burnout

• Depression

Sports Specialization• The Business of Youth Sports

• Estimated $9-15 billion industry

• Families spend thousandsof dollars/year

–Travel teams

–Showcases

–High level private coaching

–Personal trainers/performance

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Studies Showing Association withSpecialization and Injury

• Roos KG, Marshall SW, Kerr ZY, et al.Epidemiology of overuse injuries in collegiateand high school athletics in the United States.Am J Sports Med. 2015;43(7):1790–1797

• Schroeder AN, Comstock RD, Collins CL,Everhart J, Flanigan D, Best TM. Epidemiologyof overuse injuries among high-school athletesin the United States. J Pediatr.2015;166(3):600–606

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MLB Pitch Smart 2014

Age

Daily Max(Pitchesin Game) Required Rest (Pitches)

0 Days 1 Days 2 Days 3 Days 4 Days 5 Days

7-8 50 1-20 21-35 36-50 N/A N/A N/A

9-10 75 1-20 21-35 36-50 51-65 66+ N/A

11-12 85 1-20 21-35 36-50 51-65 66+ N/A

13-14 95 1-20 21-35 36-50 51-65 66+ N/A

15-16 95 1-30 31-45 46-60 61-75 76+ N/A

17-18 105 1-30 31-45 46-60 61-80 81+ N/A

19-22 120 1-30 31-45 46-60 61-80 81-105 106+

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AAP/AOSSM/Pitch Smart Recommendations

• No year round pitching (<8 months preferred)

• No pitching while fatigued

• Follow pitch-count and rest guidelines

• Do not pitch on 2 simultaneous teams

• Do not catch and pitch

• No curveball until 14, slider at 16

• Appropriate strength & conditioning

• Watch yourself at showcases

• Put away the radar gun

• Age, height, multiple teams, velocity, arm fatigue

• Pitches per game for shoulder injuries

• GIRD, shoulder adduction not significant

Am J Sports Med. April 2018

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AAP/AOSSM/Pitch Smart Recommendations

• No year round pitching (<8 months preferred)• No pitching while fatigued• Follow pitch-count and rest guidelines• Do not pitch on 2 simultaneous teams• Do not catch and pitch• No curveball until 14, slider at 16• Appropriate Strength & Conditioning• Watch yourself at showcases• Put away the radar gun

PRiSM – Pediatric Research inSports Medicine

• Multidisciplinary society dedicated tofurthering knowledge to improve the careof young athletes

• Multiple ResearchInterest Groups

• Sports Specialization Group

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2017-18 Project

• Multicenter, multi-region athlete self-reportedstudy of teenage soccer specialization and itseffects on injuries

• Online survey hosted by Qualtrics. IRB approvedfor link distribution via email, social media, flyers

• 761 completed surveys by soccer players age12-18. 431 female

Specialization Correlated withKnee Injuries

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Overuse Injuries by sport

• Baseball – shoulder/elbow

Internal Impingement

Undersurface ofsupraspinatus hittingposterior superiorglenoid rim

https://link.springer.com/chapter/10.1007/978-3-319-57334-2_10

https://link.springer.com/chapter/10.1007/978-3-319-57334-2_10

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Elbow Issues

• Traction forces medially– Medial epicondyle apophysis

– Ulnar collateral ligament

• Compression forces laterally– Osteochondritis dissecans

Soccer

• ACL injuries

• Patellofemoralpain

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Prevention of Knee Injuries

• Sportsmetrics

• US club soccer “11+”

• CHOP “ready set prevent”

• Santa Monica ACL prevention project(US Soccer)

Swimmer’s Shoulder

• Repetition of badtechnique = injury

• PT & relative rest

• Prehab & maintenance

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Water Polo Shoulder Injury

• 25-80% of elite playersage 16-33

• Acute dislocation andchronic overuse pain

• Need proper swim &shot technique

Track/Cross Country

• Stress fractures– Tibia/foot/femur

• Shin splints

• Foot pain

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Lots of OrganizationsHave Position Statements

Brenner JS, Council on Sports Medicineand Fitness. Sports Specialization andIntensive Training in Young Athletes.Pediatrics. 2016;138(3):e20162148.doi:10.1542/peds.2016-2148.

AAP

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Others

• AMSSM

• AOSSM

• NATA

• European College of Sport Science

Summary

• Sports are good

• Odds of scholarship are small

• Specialize by late adolescence if at all

• Follow published guidelines to avoidpsychological and physical consequences

sports specialization - texas children's hospital · specialization and injury • roos kg,...

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