Youth sports bring physical, mental and social benefits any parent can cheer for, and on the surface, the popularity of sports among children and teens warrants a standing ovation: In 2019, before COVID-19 sidelined some, 56% of U.S. kids ages 6-17 participated in organized sports. But a UCLA orthopedic surgeon who specializes in sports-related injuries warns about the perils of too much of a good thing. When children focus on a single sport at too young an age and overdo it, they risk both physical and psychological damage.
Kristofer Jones, a team physician for UCLA Athletics and head team physician for the Los Angeles Lakers, is troubled by evidence of a rise in youth sports specialization, which he defines as intensive training in a single sport for more than eight months per year, typically to the exclusion of other sports. “Youth sports has evolved from a child-driven sense of fun, recreational play to a highly structured, adult-driven practice focused on skill development,” Jones says. “We place a high regard on the achievements of elite athletes, and consequently, children, parents and coaches alike think the road map to that type of success is linked to concentrating earlier on mastering these skills.”
Youth who specialize in a sport are prone to overuse injuries because of their musculoskeletal and physiologic immaturity. “Simply put, the body isn’t fully developed and is more susceptible to injury with repetitive physical activity,” Jones says. The still-developing musculoskeletal tissue of children and adolescents can translate to less-than-optimal biomechanics, increasing the risk of overuse injury. Such injuries are especially common in high-velocity sports, such as baseball, where young pitchers who throw too much often develop “Little League shoulder” or “Little League elbow;” basketball (“jumper’s knee”); gymnastics; swimming; and hockey. “But it’s not about the particular sport so much as the fact that these young athletes are placing repetitive loads on their bodies,” Jones explains.
His worries about sports specialization go beyond the physical. “Burnout is real,” Jones says. “You see kids who start out playing in a park rec league on Tuesdays and Thursdays, then all of a sudden they’re picked out for a travel team and being driven all over the place every weekend for all-day tournaments. It’s too much pressure on someone that young.”
Jones acknowledges that every case is different. But for the parents of children who are inclined to push themselves to excel in a single sport, he offers the following general advice:
Watch for Waning Enthusiasm
The drive to specialize in a sport often starts with the child, and well-intentioned parents might naturally feel it’s their place to support that decision. But, particularly with young children, Jones urges caution. “Kids’ interests can be fleeting, and as parents, we should introduce them to as many things as possible,” he says. For children who immerse themselves in a single sport, parents should pay close attention to signs of stress and burnout. When it’s time to leave for practice, do they look as excited as they were the first time, or has this become more of a burden than a fun pursuit? “There is clearly increased pressure in intense, adult-driven, specialized training,” Jones says. “Children and adolescents need to enjoy the activities. Inherent motivators are vital.”
Allow the Body to Develop
Jones says the specific age at which risk of overuse injury becomes less of a concern is uncertain, but he suggests using the point of skeletal maturity and peak physical development of muscle strength as a guide. “When the adolescent’s body is a bit more developed, theoretically they’re at less risk,” he says. “But the truth is, even as a physician at the NBA level, I see very specific overuse injury patterns.”
Young athletes specializing in a sport should heed early signs of an overuse injury.
Don’t Overdo It
For those who choose to specialize, Jones advises limiting the overall volume of training in both frequency and duration. “Higher training volumes have a direct correlation with higher overuse injuries,” he says. He advises scheduling a clear period of complete rest from the sport for at least one month for every two months of focused training. “You have to build in those rest periods because we now know that over time, as you start to engage in these activities over and over, it’s the repetitive load on a particular body part that leads to injuries,” Jones says.
Heed the Warning Signs
Young athletes specializing in a sport should heed early signs of an overuse injury, seeking medical evaluation for any pain, soreness or discomfort that doesn’t subside with rest, ice and anti-inflammatory medications. Unfortunately, Jones notes, the sports medicine field lacks specific metrics to pinpoint exactly what threshold of symptoms signals that an overuse injury is imminent and it’s time to take a break. “You just have to listen to what your body is telling you,” he says. “But a lot of kids are pushing through injuries because they feel they need to in order not to get left behind in their development or not to lose a position. It’s incumbent upon parents and coaches to listen to children when they say they’re having symptoms.”
Ensure Proper Biomechanics
One key prevention strategy: Work with a coach who has expertise, and make sure the child’s mechanics are optimal. When an overuse injury occurs, seek an evaluation from a sports medicine physician and physical therapist to determine whether any altered biomechanics contributed to the injury. “We have so many great tools now with motion capture and video analysis, where you can use software programs to look at, for example, the athlete’s landing mechanics from a jump to see what the hips are doing relative to the knees, relative to the ankles,” Jones says. “When you look at those mechanics and you know basic anatomy and what muscles do, you can identify where corrections are needed.”
Waiting Is Winning
In his blockbuster book Outliers, Malcolm Gladwell popularized the 10,000-hour rule — the notion that mastering any complex skill set requires that intensive investment of time. But before you encourage your 10-year-old to log 500 jump shots a day, consider this: “While research suggests the 10,000-hour rule may be true for a discipline like music, where the mastery of an instrument can predictably be tied to early, full-time commitment, there is not a lot of research to suggest that this is true in sports,” Jones submits. In fact, he notes, there’s some evidence to suggest that late specialization may result in better athletic achievement.
Read more from UCLA Magazine's January 2022 issue.