5 Questions with Dr. John DiFiori, AMSSM President

Screen Shot of AMSSM
Infographic on
Youth Sport and Burnout

January represents the new year here at CJSM, as it does of course for all of you in the blogosphere.  But what really excites us is not the opportunity to set new year’s resolutions:  it’s  the new issue of the CJSM, and that’s what I want to share with you today.

There is a lot on offer in this issue, including studies exploring treatments of articular cartilage pathology, a study of functional ankle instability, and a journal club exploring the relative of benefits of PRP and ESWT on chronic patellar tendinopathy.

The lead study is a systematic review and position statement on the issue of youth sports, with an evidence-based  focus on the phenomena of overuse injuries.  This blog reviewed the statement in an earlier post.  It’s an important study, and we want to make sure as many people as possible get a chance to read it.

And so, we feel fortunate to have had the chance over the holidays to chat with the lead author of the paper, Dr. John DiFiori, and ask him ’5 questions’ about his recent work.

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1) CJSM: Dr. DiFiori, you are the lead author of the new American Medical Society for Sports Medicine (AMSSM) position statement on ’overuse injuries and burnout in youth sports.’  Can you tell us a bit about the genesis of this statement?  When was it first conceived?  How long did it take to go from initial conception to publication?  How did you gather together the group of experts who are authors on this statement?

JD: Given all of the issues currently surrounding youth sports, the AMSSM leadership felt that a position statement focusing on overuse injuries and burnout would be timely, and would help to address many of the concerns held by sports medicine professionals, as well parents, coaches, and the young athletes themselves. In late 2011, a nominating process was completed, and I was asked by AMSSM to lead this project. The six outstanding members of the writing group were identified through a similar process, based on their clinical expertise, and their record of educational and scholarly contributions in this area.

We began to develop the content areas and search strategy in early 2012. We endeavored to have the paper be as evidenced-based as possible. To this end, we utilized a systematic search process, followed by author review, to identify relevant literature. The writing process, multiple re-writes and editing to ensure accurate information, took about 1 year. Because of the length of the process, we performed another systematic literature search in mid 2013 to ensure the paper would be as up to date as possible. The draft then underwent critical review by several expert external reviewers, who provided some very valuable suggestions. Following this, the paper underwent another round of review by the AMSSM Board of Directors. And then it was off to CJSM. So, all in all it was a very thorough process. Hopefully the result is a document that will be a solid resource for the sports medicine community.

2) CJSM: The statement is a comprehensive review of some of the major phenomena in the world of youth sport:  overuse, early specialization, over scheduling, burnout. What do you think are some of the underlying forces driving these phenomena?  Are there different pressures being brought to bear on the modern youth athlete we didn’t see a generation ago?  And if so, what are they?

JD: This is an important question. I think the factors involved are many, and vary somewhat from one young athlete and family to the next. Obtaining a collegiate athletic scholarship is frequently a driving force. Other aspirations that may coincide such as  regional, national or Olympic team selection, and ultimately professional careers may play a role. Certainly the idea that a champion athlete can be developed simply by applying a plan of early sport introduction and accumulating a specific number of hours or years or preparation can be part of the picture and is concerning. This stems not only from some examples of famous individuals whose success was seemingly a result of that sort of process, but peer pressure both at the adult level and among young athletes themselves. The objective of gaining an edge using this approach, can lead to the hiring of personal coaches not only for sport technique, but also strength and conditioning, and even psychological “training.”

In some circles, young adolescents may be home schooled in order to provide more time for training and competition. The explosion of information sources via the internet has likely played a large role, because parents and young athletes can easily gather information and procure such services. All this has resulted into what can be referred to as the youth sports industry. The youth sports economy, which in the past was mostly tied to equipment, has now become a multi-faceted big business. The marketing employed by these various services is now another factor that influences parents and children. Brion O’Conner, of the Boston Globe, referred to all this as part of the “hostile takeover” of youth sports by adults.

With all this in mind, it creates the very concerning prospect that youth sports may be becoming more and more an opportunity limited to only those with the resources to participate. Given our nation’s serious problems with adolescent obesity and diabetes, if this becomes a reality, youth sports would become very costly indeed.

3) CJSM:  you have to compose a 140 character tweet on twitter about keeping kids healthy, active, and safe.  What does the tweet say?

JD:  The first thing would be to stop reading tweets and put the phone down! I am not very familiar with texting lingo, but something such as: “Play every day. Trade your screen time for green time. Keep your texting short, so you can enjoy sport.”

(CJSM: Great tweet John.  Though we spend a lot of time oureselves on social media and the blog, we couldn’t agree any more when it comes to youth:  trade screen time for green time!  Love it!)

4) CJSM: As many of our readers know,  you are the current president of the AMSSM.   What have been some of the highlights of your tenure to date?

JD:  It has been quite a busy and productive year so far. Our Annual Meeting, scheduled for April 5-9^th in New Orleans looks to be fantastic. AMSSM First Vice President, Chris Madden, M.D. and Program Chair, Steven Paul, M.D. have assembled an outstanding group of speakers to present on a number of hot topics spanning the spectrum of sports medicine.

I am also proud to announce that AMSSM has now established its first Traveling Fellowship Program. I am very excited about this program in which AMSSM will host renowned leaders in sports medicine, and will also have distinguished AMSSM members and promising young clinicians and researchers travel abroad to learn from international colleagues and share their knowledge.  Our inaugural Traveling Fellow is Peter Brukner, OAM, MBBS.  As you know, Dr. Bruckner is an internationally recognized sports medicine physician and the founding partner at the Olympic Park Sports Medicine Centre in Melbourne .  As part of his travels in the U.S., Dr. Bruckner will be a featured speaker in New Orleans.

Dr. John DiFiori ministering
to injured athlete on the field.
GO BRUINS!

5) CJSM:  On the other hand, many of our readers may not know you are the Chief of the UCLA Division of Sports Medicine and Non-Operative Orthopaedics, Head Team Physician for the Bruins and Co-Director of the Primary Care Sports Medicine Fellowship Program at UCLA.  What are the chief professional joys these positions bring to you?  What are the challenges?

JD:  I am very fortunate to be part of a medical center that offers  opportunities to participate in clinical, teaching, administrative and research roles. Our clinical program includes the care of more than 650 collegiate athletes, which challenges us on a regular basis to be at the top of our game. More importantly, the  colleagues with whom I share these responsibilities, the fellows that we work with,  and our coaching and athletic department staff create a wonderful environment that results in lasting personal and professional relationships – which is incredibly rewarding.

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John, thanks so much for fitting us in to your busy schedule.  We’re looking forward to seeing you in New Orleans in a few months.  Until then, all of us enjoying the current polar weather will be California Dreamin’. Enjoy the sun for us!