Overuse Injuries and Burnout in Youth Sports

10,000 hours of practice, and
he might make the Red Sox?*

We’re very pleased at CJSM to open the New Year with a shout:  a fantastic systematic review and position statement on the subject of youth sport, from the American Medical Society for Sports Medicine (AMSSM).

The focus of the paper–in the January 2014 issue, which has just published–is on overuse injuries, which are thought to represent roughly half of all the injuries youth athletes sustain.

All readers of the journal, and of this blog, will find this a worthwhile read.  I have a selfish interest in the subject, as I am currently practicing pediatric sports medicine, and in my professional life I live and breathe the issues discussed in the paper. Moreover, I know several of the authors of this paper, and I think highly of them all.

But this is not about ’eminence based’ medicine.  No, it’s evidence-based all the way.  The paper is both a systematic review and the AMSSM position statement on the subject of “Overuse Injuries and Burnout in Youth Sports”.  The authors conducted a thorough review of the literature, identifying 953 papers and citing 208 unique references in their comprehensive analysis of this broad subject.  They go on to review what is known, and then make recommendations, classified using the Strength of Recommendation Taxonomy (SORT) grading system.

The paper is broadly organized into the following subsections:  epidemiology; risk factors (intrinsic and extrinsic); discussion of high-risk overuse injuries;  discussion of several concepts mentioned frequently in the literature of youth sports (readiness for sport; sport specialization; burnout); and prevention.

The study is so very comprehensive, I cannot do better justice to it than encourage you to read it yourself.  I thought I might here mention some of what stood out for me.

Drs. Andrew Gregory and Greg Canty
at ACSM 2013 in Indianapolis
Dr. Gregory is one of the authors of the
AMSSM Youth Sport Statement

I learned a tremendous amount from the discussion of intrinsic risk factors in overuse injuries.  Specifically, the authors spend some time looking at the evidence that exists for/against  ‘anatomic alignment’ and ‘flexibility’ as risk factors for overuse injury.  They conclude that “the significance of osseous alignment abnormalities versus soft tissue alignment abnormalities in relation to injury is complex, poorly understood, and likely sport specific;” regarding the issue of flexibility, they note that “….several recent studies have not shown any relationship between growth and inflexibility in boys or girls.”   Since I spend a considerable amount of my time in the examination room looking at issues such as femoral anteversion and measuring the popliteal angle in my patients, such evidence gives me pause.  I may need to rework the focus of my history and examination.

I also learned more about ‘effort thrombosis,’ also known as Paget-Schroetter syndrome, a complication of thoracic outlet syndrome.  Though I am aware of this entity, I have never seen it directly.  It always helps to read the journals, of course, as a prepared mind is more apt to identify an unusual clinical case presenting in one’s office.  As the saying goes:  I hope it (effort thrombosis)  has never seen me because, as I have said, I have never knowingly seen it!

There is an important section on sport specialization, and a reference to an insightful study published in the 2011 CJSM AMSSM abstracts on the risks of sport specialization in young athletes that I would recommend to you (there are at least 17 CJSM references in the document; we publish frequently on the topic of youth sports).  The AMSSM funded this research.  That organization, one of our affiliated societies, is a major force in keeping kids safe and ‘in the game.’

I most definitely recommend sport diversification to my young athletes, and their parents, and I think the evidence is mounting for the benefit of that approach over early sport specialization.  I have taken to referencing a 2012 study from Belgium that demonstrates, I believe, the potential advantages to avoiding early sports specialization.  The authors of that study found that early sports diversification had a positive effect on strength, speed, agility,  endurance, and gross motor coordination in the group of boys aged 10-12 years.  I’ll start quoting the AMSSM statement as well when being asked advice on this matter from families.

Finally, I enjoyed the brief discussion at the end of the paper on prevention, most especially the review of the evidence for preseason conditioning (level of evidence: B) and for regular participation in resistance training in mitigating the potential for overuse injuries.  Our colleague Dr. Avery Faigenbaum has published frequently on the safety and benefits of youth resistance training, most recently in another position statement:  “Position statement on youth resistance training:  the 2014 international consensus.”  Get those kids under some supervised resistance training!

We’ll be discussing the AMSSM paper more this month of January and beyond.  I have planned a digital ‘sit-down’ discussion–“5 Questions with CJSM”–with the lead author Dr. John de Fiori, who also happens to be president of the AMSSM.  We’re looking forward to it!  That organization is, as well, a major force in keeping kids safe and ‘in the game.’

So…..Happy New Year!  Enjoy the January CJSM and the AMSSM position statement.  And, as ever, let us know what you think.

*p.s. Thanks to my good friend and sports medicine doc, Peter Kriz, M.D., who donated the photo of his son Jack throwing out the first pitch at a Pawtucket Red Sox game.  The PawSox are the AAA affiliate of the MLB Boston RedSox.