Commentary by Dr. Joseph Hui
Participating in sports provides many positive benefits for youth. It promotes peer socialization, self-esteem, lifelong physical activity skills, teamwork and leadership skills and, of course, fun.
In children, the cartilage growth plates of bones and tendinous attachments between muscle and bone are particularly at risk for overuse since they are still developing. As more and more children are choosing to specialize in a specific sport at an earlier age, overuse injuries can become a bothersome barrier to well-being and success.
In a study about children specializing in one sport, those who participated in an organized sport versus free-play were at a greater risk for experiencing an overuse injury. In another study done with high school athletes, there was an increased risk of overuse injuries if training and competition demands were greater than 16 hours per week. Another guideline suggests training more than the age of the athlete in hours per week may also increase the risk of injury.
Playing only one sport year-round also appears to be a risk factor for overuse injuries. There are some sports, including gymnastics, figure skating and diving, where peak performance takes place before the participants are completely mature physically. The athletes involved in these types of sports typically focus on their single sport in order to be successful. In general, however, I recommend avoiding early specialization of a sport. It’s also encouraged by most medical societies, including the American Academy of Pediatricians and the American Medical Society for Sports Medicine, to promote a diversified athletic skill set in order to decrease overuse injuries and reduce burnout.
The female athlete triad, which is decreased energy availability, menstrual dysfunction and low bone mineral density, is also a modifiable risk factor for overuse injury and should be screened for in all female athletes. This trifecta often leads to stress injuries and/or stress fractures in bones.
Coaches and parents are the first line of defense against overuse injuries and should be vigilant in monitoring for signs of stress, burnout and physical symptoms. Shifting the emphasis from pushing through the pain to being prepared to reduce the frequency and intensity of training can go a long way to minimize overuse injuries in our children.