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The Specialized Youth Sport Athlete from a Physiological Perspective

Madisen Keim, LAT, SCAT, ATCUniversity of South Carolina

Troy Royal, MS, SCAT, ATCPalmetto Health USC Orthopedic Center

Outline

• Background on youth sports• Specialization • Effects on the body

• Physiological • Biomechanical• Overuse

• Prevention

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Youth Sports Participation

• Estimated 27 million youth in the US between the ages of 6 and 18 participate in team sports annually

• Estimated 60 million participate in organized athletics of any form

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What is Sports Specialization?

• ‘The active participation in a single sport through the developmental years with the intention of improving skills.’

• Also involves a focused, intense participation all year-round, with the exclusion of other sports.

Cote Model: 3 Stages

• Sampling Years: 6-12 (Recreational)• Playing multiple sports at a time; no in-depth practice of just one

• Specializing Years: 13-15• Balance between deliberate practice, low amount of deliberate play and

one sport only

• Investment Years: 16+• Almost all deliberate practice, low amount of deliberate play and one sport

only

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Prominence of Specialization

• More than 60% of athletes between the ages of 7 and 18 were considered specialized (Jayanthi et al.)

• Noting that they specialized before the age of 12

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Physiological Effects of Sports Specialization

“Overuse or repetitive trauma injuries represent approximately 50% of all pediatric sport-related injuries” -- National Athletic Trainers’ Association

• Physiological Immaturity• Tissue and Bone

• Altered Biomechanics• Overuse

Physiological Immaturity• Tissues of adolescents do not mature in the same predictive

manner as adults• Injuries affecting the growth plate may have long-term physical

consequences and affect normal growth and development.• Baseball: Repetitive throwing stresses or positioning of the lower extremity

(catchers)• Running, soccer, tennis, baseball, and gymnastics: Lower extremity physeal

injuries

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Altered Biomechanics

• Can alter normal biomechanics in adolescent athletes, increasing risk of overuse injuries

• Baseball pitchers: Youth vs Adult• Youth pitchers tend to depend on rotator cuff musculature and

trunk rotation to throw a baseball, which in combination with excessive humeral torque, underdeveloped musculature, and open epiphyseal plates predisposes these athletes to rotator cuff tendinitis, shoulder instability, and humeral epiphysiolysis (Little League Shoulder).” --Gowan et al, Keeley et al, Sabick et al

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Overuse

• Main cause of UCL injuries• Increases in year-round baseball has skyrocketed rates of injuries in kids• Tommy John Surgery

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Overuse

• In FEMALE basketball, soccer, and volleyball players, there is an increase in patellofemoral pain in those athletes who specialized in a single sport vs multiple amongst middle and high school age groups

Overuse• Swimming

• Elite swimmers swim between 4-9 miles per day, 11 months per year, often beginning at the age of 10 to 12 years old

• Young swimmers are at a greater risk of external impingement and developing general laxity due to increased external and internal rotation

• In a study looking at 80 elite swimmers between the ages of 13 and 25 years old, 91% reported shoulder pain, 84% had positive impingement

signs, and 70% had MRI evidence of supraspinatus tendinopathy

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Overuse

• “Stress fractures are likely the most common youth overuse injury and are often overlooked as ‘growing pains,’ bone bruises, and normal wear and tear.” --Freely et al

• Risk factors• Overuse

• Decreased caloric intake• Overtraining

Wrap-Up

• Early sport specialization occurs nationwide, even though it has proven to be detrimental to athletes • Higher rates of injury • Nutritional & sleep inadequacies • Psychological stress or socialization issues

• Burnout rates are greater, quitting sports occurs sooner

• The reality is that few athletes achieve the elite or professional level

Less than 1% of young athletes 6 to 17 years of age achieve elite

status in basketball, soccer, baseball, softball, or football

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Prevention

• An estimated 50% of overuse injuries in adolescents may be preventable.

• Pediatric athletes should take time off between sport seasons and 2

to 3 non-consecutive months away from a specific sport if they participate in that sport year-round.

• Take note of recommendations and rules for safe play, ie pitch counts, mileage, training hours, etc.

What are the odds?

“For most sports, there is no evidence that intense training and

specialization before puberty are necessary to achieve elite

status.” --Jayanthi et al 2003

• 3-11% of high school athletes compete at the college level.

• Only 1% of high school athletes receive any scholarships.

• Between only 0.03-0.5% of high school athletes reach professional

level sports.

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“These problems might be avoided with a balanced lifestyle and a strong support system made up of parents, friends, coaches, and health care providers.” -- National Athletic Trainers’ Association

Is It Worth It?

References• Cote, J., Baker, J., & Abernethy, B. (2007). Practice and Play in the Development of Sport Expertise Handbook of Sport Psychology (pp. 184-202): John Wiley &

Sons, Inc.• Jayanthi, N., Pinkham, C., Dugas, L., Patrick, B., & Labella, C. (2013). Sports specialization in young athletes: evidence-based recommendations. Sports

Health, 5(3), 251-257. doi:10.1177/1941738112464626• McLeod, T., Laura C. Decoster, Keith J. Loud, Lyle J. Micheli, J. Terry Parker, Michelle A. Sandrey, and Christopher White (2011) National Athletic Trainers'

Association Position Statement: Prevention of Pediatric Overuse Injuries. Journal of Athletic Training: Mar/Apr 2011, Vol. 46, No. 2, pp. 206-220.• Meister K, Day T, Horodyski M, Kaminski TW, Wasik MP, Tillman S. Rotational motion changes in the glenohumeral joint of the adolescent/Little League

baseball player. Am J Sports Med. 2005;33(5):693-698.• Gowan ID, Jobe FW, Tibone JE, Perry J, Moynes DR. A comparative electromyographic analysis of the shoulder during pitching: professional versus amateur

pitchers. Am J Sports Med. 1987;15(6):586-590.• Keeley DW, Hackett T, Keirns M, Sabick MB, Torry MR. A biomechanical analysis of youth pitching mechanics. J Pediatr Orthop. 2008;28(4):452-459.• Sabick MB, Kim YK, Torry MR, Keirns MA, Hawkins RJ. Biomechanics of the shoulder in youth baseball pitchers: implications for the development of proximal

humeral epiphysiolysis and humeral retrotorsion. Am J Sports Med. 2005;33(11):1716-1722.• Bruce JR, Andrews JR. Ulnar collateral ligament injuries in the throwing athlete. J Am Acad Orthop Surg. 2014;22(5):315-325.• Dugas JR. Valgus extension overload: diagnosis and treatment. Clin Sports Med. 2010;29(4):645-• Ahmad CS, Grantham WJ, Greiwe RM. Public perceptions of Tommy John surgery. Phys Sportsmed. 2012;40(2):64-72.• Hall R, Barber Foss K, Hewett TE, Myer GD. Sports specialization is associated with an increased risk of developing anterior knee pain in adolescent female

athletes. J Sport Rehabil. 2015;24(1):31-35.• Hibberd EE, Myers JB. Practice habits and attitudes and behaviors concerning shoulder pain in high school competitive club swimmers. Clin J Sport Med.

2013;23(6):450-455.• Sein ML, Walton J, Linklater J, . Shoulder pain in elite swimmers: primarily due to swim-volume-induced supraspinatus tendinopathy. Br J Sports Med.

2010;44(2):105-113.Padaki, A. S., Popkin, C. A., Hodgins, J. L., Kovacevic, D., Lynch, T. S., & Ahmad, C. S. (2017). Factors That Drive Youth Specialization. Sports Health, 9(6), 532–536. https://doi.org/10.1177/1941738117734149

• Jayanthi NA, LaBella CR, Fischer D, Pasulka J, Dugas LR. Sports-specialized intensive training and the risk of injury in young athletes: a clinical case-control study. Am J Sports Med. 2015;43:794-801

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