Overuse Injuries and Burnout in Youth Sports Karin VanBaak MD Assistant Professor University of Colorado School of Medicine Department of Family Medicine Division of Sports Medicine
Objectives Review the risks and benefits of youth sports participation Identify signs and symptoms of overuse injuries and burnout in young athletes Describe strategies for prevention of these types of issues
Background: Resources AAP: Intensive Training and Sports Specialization in Young Athletes. 2000 AAP: Overuse Injuries, Overtraining, and Burnout in Child and Adolescent Athletes. 2007 Sports Specialization in Young Athletes: Evidence-Based Recommendations. Sports Health, 2012 AMSSM: Overuse Injuries and Burnout in Youth Sports: A Position Statement 2014 AAP: Sports Specialization and Intensive Training in Young Athletes. 2016 AOSSM: AOSSM Early Sport Specialization Consensus Statement. 2016
Background: Youth Sports Youth sports is good! Self-esteem, socialization, fitness, lifelong physical activity, teamwork & leadership skills Increasing pressure for high-intensity training at young ages Potential consequences of early sport specialization
Joel S. Brenner, and COUNCIL ON SPORTS MEDICINE AND FITNESS Pediatrics doi:10.1542/peds.2016-2148 2016 by American Academy of Pediatrics
Youth Sports Participation 27 million US children ages 6-18 participate in team sports 60 million US children ages 6-18 participate in some form of organized athletics (National Council of Youth Sports, 2008) 27% participate in only one sport 66% male, 34% female 12% <6 years (up from 6% in 1997) 70% drop out of organized sports by 13 years of age 7.8 million high school athletes participated in sports (National Federation of High School Sports 2013-2014) 3.3% - 11.3% of high school athletes participate at the NCAA level 0.03% - 0.5% of high school athletes ever compete professionally
Sports Specialization and Intensive Training in Young Athletes. Joel S. Brenner, and COUNCIL ON SPORTS MEDICINE AND FITNESS Pediatrics doi:10.1542/peds.2016-2148 2016 by American Academy of Pediatrics
Background: Definitions Early Sport Specialization Participation in intensive training and/or competition in organized sports greater than 8 months per year Participation in 1 sport to the exclusion of others Involving pre-pubertal children (< 7 th grade or age 12) Overuse injury Due to repetitive submaximal loading of the musculoskeletal system without adequate rest to allow for structural adaptation
Epidemiology Difficult to assess due to lack of uniform definitions Often assessed based on time loss Prevalence of overuse injuries in children and adolescents: 37% (skiing, handball) - 68% (running)
Risk factors for overuse injury Prior injury Adolescent growth spurt Higher training volume Injury specific Stress fractures history of amenorrhea Possible Poor-fitting equipment Multiple competitive events in quick succession as a marker of high ratio of workload to recovery time
Risk factors for overuse injury Risk factors for Overuse Injury Growth-related Other Intrinsic Extrinsic Susceptibility of growth cartilate to repetitive stress Adolescent growth spurt Previosu injury Previous level of conditioning Anatomic factors Menstrual dysfunction Athlete specific psychological and developmental factors Training workload (rate, intensity, and progression) Training and competition schedules Equipment/footwear Environment Sport Technique Adult and peer influences Adapted from Table 2 AMSSM: Overuse Injuries and Burnout in Youth Sports: A Position Statement DiFiori, et al. BJSM. 2014
The Elephant in the Room Does early specialization lead to success? D1 NCAA athletes are more likely to have played multiple sports in high school 2015 NFL Combine: 87% of participants had played multiple sports in high school Multiple studies of elite athletes show that intense training did not start until late adolescence Late specialization with early diversification is most likely to lead to elite status - Jayanthi
The Elephant in the Room Does early specialization lead to success? Certain sports such as figure skating and gymnastics may require early specialization Conflicting data about whether this puts these athletes at increased risk of injury Gymnasts and figure skaters achieve menarche later but still within the normal range Female athletes that participate in sports requiring early specialization are at higher risk of overuse injuries and the female athlete triad
How can we help? Look out for high-risk overuse injuries Certain stress fractures Pyseal stress injuries Osteochondritis dessecans Some apophyseal injuries Effort thrombosis
How can we help? look out for burnout Factors Related to Burnout in Young Athletes Environmental Extremely high training volumes or time demands Demanding performance expectations Frequent intense competition Inconsistent coaching practices Little personal control in sport decision making Critical rather than supportive evaluations Personal Perfectionism Need to please others Nonassertiveness Low self-esteem High anxiety Unidimensional self-conceptualization Adapted from Table 5 AMSSM: Overuse Injuries and Burnout in Youth Sports: A Position Statement DiFiori, et al. BJSM. 2014
How can we help? look out for burnout Symptoms of Overtraining Syndrome/Burnout Fatigue Depression Insomnia Loss of appetite Irritability Weight loss Bradycardia or tachycardia Agitation Lack of mental concentration Loss of motivation or interest Decreased selfconfidence Heavy, sore, stiff muscles Hypertension Anxiety Restlessness Sleep disturbances Nausea Frequent Illness Personal Perfectionism Adapted from Table 6 AMSSM: Overuse Injuries and Burnout in Youth Sports: A Position Statement DiFiori, et al. BJSM. 2014
How can we help? look out for burnout Diagnosis of Overtraining Syndrome/ Burnout History Potential Triggers Decreased performance persisting after weeks to months of recovery Disturbances in mood No other medical diagnosis Lack of enjoyment in sport Inadequate nutritional intake and hydration Increased training load with adequate recovery Monotanous training Excessive number of competitions Sleep disturbance Family life stressors Sport stressors Previous illness Adapted from Table 7 AMSSM: Overuse Injuries and Burnout in Youth Sports: A Position Statement DiFiori, et al. BJSM. 2014
How can we help? Prevention Limits on total weekly/yearly participation Limit sport-specific repetitive movements (B) Schedule rest periods (B) Individualize these modifications based on athlete s age, growth rate, readiness, and injury history (C) Monitor workload during the adolescent growth spurt (B) Preseason conditioning (B) Prepractice neuromuscular training (B) Attention to equipment fit (C) Emphasize skill development above competition and winning (C)
How can we help? Long-term athlete development programs Started in the 1990s in the US, Canada, other Focus on physical literacy fundamental movement and sports skills ABC s: Agility, Balance, Coordination, Speed Stages of late-specialization LTAD 1. FUNdamental (age 6-10) 2. Training to Train (age 10-14, 75% training, 25% competition) 3. Training to Compete (age 13-18, 50% skills development, 50% competition training) 4. Training to Win (age >/= 17, 75% competition) 5. Retirement/Retraining
How can we help? Long-term athlete development programs American Development Model: developed by USOC in 2014 from LTAD principles 1. Discover, Learn, and Play (age 0-12 years) 2. Develop and Challenge (age 10-16) 3. Train and Compete (age 13-19) 4. Excel for High Performance or Participate and Succeed (age >/= 15) 5. Mentor and Thrive (for Life) Development Model of Sport Participation Early diversification (sampling) Or early specialization
Joel S. Brenner, and COUNCIL ON SPORTS MEDICINE AND FITNESS Pediatrics doi:10.1542/peds.2016-2148 2016 by American Academy of Pediatrics
Thank You
References AAP: Intensive Training and Sports Specialization in Young Athletes. 2000 AAP: Overuse Injuries, Overtraining, and Burnout in Child and Adolescent Athletes. 2007 Sports Specialization in Young Athletes: Evidence-Based Recommendations. Sports Health, 2012 AMSSM: Overuse Injuries and Burnout in Youth Sports: A Position Statement 2014 AAP: Sports Specialization and Intensive Training in Young Athletes. 2016 AOSSM: AOSSM Early Sport Specialization Consensus Statement. 2016