The other day, a 17-year-old patient came to my office. He was there because of pain in his right shoulder — his pitching arm. He was frustrated because the pain had started just weeks after he’d returned from a baseball hiatus following surgery performed on his right elbow the previous winter. With this new injury, he felt cursed. How would he make it to the major leagues like pitching giants Matt Harvey and Jacob deGrom, currently in the midst of the MLB World Series? He wondered why his luck was so bad.
I wondered if luck had anything to do with it. I asked him if any other kids on his team had had injuries. Sure, he said. Every one of the pitchers on his high school team had not only been injured but also had undergone surgery for one injury or another. In fact, one of those players was another patient of mine. It seemed like maybe more than just bad luck was happening here.
Over the last quarter-century, there has been a startling shift in how children are coached and trained in youth sports programs. Gone are the days when kids played multiple sports with breaks both during and between seasons. Today, kids specialize in one sport from increasingly young ages. At the same time, they are asked to perform at increasingly higher levels: USA gymnastics offers structured competition as early as age 4; Little League Baseball has training programs that start at age 5.
Playing one sport (typically, baseball, swimming, gymnastics or soccer) on multiple teams throughout the year and often on more than one team during the same season, is now common practice. As a result, pediatric sports surgeons like myself have seen dizzying increases in the number of sport-related injuries in child and adolescent athletes. In New York state alone, the rate of ACL reconstructions performed on children aged 3-20 more than doubled from 1990 to 2009.
Researchers have confirmed the connection. One recent study found that junior elite tennis players who specialized in tennis had a 50% higher rate of injury than those who played other sports . Another group of researchers determined that the rate of anterior knee pain among adolescent female athletes who specialize in one sport (e.g., basketball, soccer or volleyball) is 1.5 times greater than those who play multiple sports. Young baseball pitchers who pitch more than 100 innings per year have been reported to have an injury rate 3.5 times greater than those who pitch less.
Ironically, the combination of early specialization, playing on multiple teams during the same season, marathon weekend travel tournaments, and year-round participation, is unlikely to achieve the desired outcome: elite athletes who get accepted for college scholarships and professional careers.
Quite the contrary, there is evidence demonstrating that kids who play multiple sports while they’re young and wait to specialize until the early teenage years are actually better athletes.
For example, one recent study described survey results from 376 female Division I intercollegiate athletes. Of these elite-level athletes, 83% had participated in multiple sports as youngsters (three sports per athlete) and the average age of sport specialization was 13 years.
Popular culture abounds with examples of elite athletes who waited until their teenage years to specialize in just one sport. Former world No. 1 tennis player Roger Federer (basketball, badminton), women’s U.S. national soccer team player Alex Morgan (basketball, softball), and five-time NBA champion Tim Duncan (swimming) each competed in other sports before choosing to focus solely on one.
Of course, there are athletes who have reached elite status after specializing in one sport early and dedicating untold hours to training. Golfer Tiger Woods and tennis phenomenon Serena Williams are examples of this. But how likely is it that all those hours of training will result in the attainment of “elite” status?
According to recent data from the National Collegiate Athletic Association, the chances that a male athlete participating in popular high school sports such as basketball, baseball, football and soccer will play at the collegiate level is well under 10%. Furthermore, less than 1% — in fact, less than half of one percent — of these high school athletes will go on to play their chosen sport at the professional level.
There are additional reasons to take pause. Physical injury, overtraining and burnout may manifest in young athletes as depression, anxiety, fatigue, sleep disturbance and chronic pain. Burnout may affect a young person’s performance in athletic, academic and social realms. In fact, the rate of depression among current Division I collegiate athletes has been reported to be higher than 20%. If the goal is to produce healthy young athletes who perform at elite levels with some degree of longevity, then sports training for kids in its current iteration is not the way to achieve it.
The existing methods of youth sport participation must be revised, both to protect children from unnecessary sports-related injuries and to ensure that they are able to reap the lifelong benefits of athletics and physical activity in a safe, positive way. Some initial steps have already been taken. In 2007, Little League Baseball instituted limits on the number of pitches a young pitcher could make in a given time frame with the goal of reducing overuse injuries of the shoulder and elbow among its young pitchers.
To date, however, guidelines such as these have proven inadequate in stemming the tide of sports-related injuries. What is needed is a cohesive, evidence-based approach that shifts our current sport-training paradigm. All of us who are involved with child and adolescent athletes — coaches, athletic trainers, school administrators, parents and health care providers — must work together to change the current culture of youth sport. If we work as a team, this is a winnable problem.
