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Intense, Specialized Training in Young Athletes Linked to Serious Overuse Injuries

MAYWOOD, Ill. - Young athletes who specialize in one sport and train intensively have a significantly higher risk of stress fractures and other severe overuse injuries, even when compared with other injured athletes, according to the largest clinical study of its kind.

For example, young athletes who spent  more hours per week than their age playing one sport – such as a 12-year-old who plays tennis 13 or more hours a week – were 70 percent more likely to experience serious overuse injuries than other injuries.

Loyola University Medical Center sports medicine physician Dr. Neeru Jayanthi presented findings during an oral podium research session April 19 at the American Medical Society for Sports Medicine (AMSSM) meeting in San Diego. The study is titled “Risks of Specialized Training and Growth in Young Athletes:  A Prospective Clinical Cohort Study."

"We should be cautious about intense specialization in one sport before and during adolescence,” Jayanthi said. “One of the recommendations we can make, based on our findings, is that young athletes should not spend more hours per week in organized sports than their ages."

Between 2010 and 2013, Jayanthi and colleagues at Loyola and Lurie Children’s Hospital of Chicago enrolled 1,206 athletes between the ages of 8 to 18 who had come in for sports physicals or treatment for injuries. Researchers are following each athlete for up to three years.

There were 859 total injuries, including 564 overuse injuries, in cases in which the clinical diagnosis was recorded. The overuse injuries included 139 serious injuries such as stress fractures in the back or limbs, elbow ligament injuries and osteochondral injuries (injuries to cartilage and underlying bone). Such serious injuries can force young athletes to the sidelines for one to six months or longer.
The study confirmed preliminary findings, reported earlier, that specializing in a single sport increases the risk of overall injury, even when controlling for an athlete’s age and hours per week of sports activity.

Among the study’s other findings:

  • Young athletes were more likely to be injured if they spent more than twice as much time playing organized sports as they spent in unorganized free play – for example, playing 11 hours of organized soccer each week, and only 5 hours of free play such as pickup games.
  • Athletes who suffered serious injuries spent an average of 21 hours per week in total physical activity (organized sports, gym and unorganized free play), including 13 hours in organized sports. By comparison, athletes who were not injured participated in less activity – 17.6 hours per week in total physical activity, including only 9.4 hours in organized sports.
  • Injured athletes scored 3.3 on researchers’ 6-point sports-specialization scale. Uninjured athletes scored 2.7 on the specialization scale. (On the sports specialization scale, an athlete is given a point for each of the following: Trains more than 75 percent of the time in one sport; trains to improve skill or misses time with friends; has quit other sports to focus on one sport; considers one sport more important than other sports; regularly travels out of state; trains more than eight months a year or competes more than six months per year.
  • Jayanthi offers the following tips to reduce the risk of injuries in young adults:
    Do not spend more hours per week than your age playing sports. (Younger children are developmentally immature and may be less able to tolerate physical stress.)
  • Do not spend more than twice as much time playing organized sports as you spend in gym and unorganized play.
  • Do not specialize in one sport before late adolescence.
  • Do not play sports competitively year-round. Take a break from competition for one to three months each year (not necessarily consecutively).
  • Take at least one day off per week from training in sports.

Jayanthi and colleagues at Loyola and Lurie Children’s Hospital are planning a follow-up study to determine whether counseling recommendations on proper sports training can reduce the risk of overuse injuries in young athletes. The study is called TRACK – Training, Risk Assessment and Counseling in Kids.
“We will be testing our hypothesis that many of these serious injuries are potentially preventable,” Jayanthi said.

The current study was funded by two research grants from the American Medical Society for Sports Medicine. Jayanthi is a member of an AMSSM committee that is writing guidelines on preventing and treating overuse injuries in young athletes.

Jayanthi is medical director of Primary Care Sports Medicine at Loyola. He is an associate professor in the Departments of Family Medicine and Orthopaedic Surgery & Rehabilitation at Loyola University Chicago Stritch School of Medicine.
Co-authors of the study Lara Dugas, PhD, of Loyola’s Department of Public Health Sciences; Cynthia LaBella, MD; and Brittany Patrick of Lurie Children’s Hospital. Loyola medical students and research assistants who assisted in the study are Dan Fischer, Courtney Pinkham, Erin Feller and Peter Linn.

The study was originally supported by Stritch School of Medicine's Student Training in Approaches to Research (STAR) program.

Loyola University Health System (LUHS) is a member of Trinity Health. Based in the western suburbs of Chicago, LUHS is a quaternary care system with a 61-acre main medical center campus, the 36-acre Gottlieb Memorial Hospital campus and more than 30 primary and specialty care facilities in Cook, Will and DuPage counties. The medical center campus is conveniently located in Maywood, 13 miles west of the Chicago Loop and 8 miles east of Oak Brook, Ill. The heart of the medical center campus is a 559-licensed-bed hospital that houses a Level 1 Trauma Center, a Burn Center and the Ronald McDonald® Children's Hospital of Loyola University Medical Center. Also on campus are the Cardinal Bernardin Cancer Center, Loyola Outpatient Center, Center for Heart & Vascular Medicine and Loyola Oral Health Center as well as the LUC Stritch School of Medicine, the LUC Marcella Niehoff School of Nursing and the Loyola Center for Fitness. Loyola's Gottlieb campus in Melrose Park includes the 255-licensed-bed community hospital, the Professional Office Building housing 150 private practice clinics, the Adult Day Care, the Gottlieb Center for Fitness, Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park.

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