Making a Good Thing Better — The Healthy Sport Index & Youth Sports

I have the great privilege of taking care of many outstanding young athletes in my sports medicine clinics

Youth sports is of special interest to me — I practice pediatric sports medicine at Nationwide Children’s Hospital, and perhaps 90% or more of the patients I see regularly participate in youth sports.

The topic is of great interest to this journal as well:  for example, CJSM will publish later this year a themed issue on topics in youth sports medicine, guest edited by my friend and colleague, pediatrician Alison Brooks M.D. of the American Medical Society for Sports Medicine (AMSSM).

Youth sports has long been recognized as a valuable activity for the individuals and families who choose to participate.  An abundance of evidence points to the health benefits — physical, mental, academic — that can be achieved by children and adolescents engaging in sports.

There has been growing concern over the last decade or two (or three), however, of the potential and possibly growing risks of youth sports.  The concerns range from early youth sports specialization and overuse injuries to early professionalism. The concerns include the youth sports culture itself – a culture manifest in nightmare form by the myriad incidents of abuse seen in USA Gymnastics or Swimming.

On April 12 2019, the AMSSM will be hosting a pre-conference prior to their annual meeting, entitled the Youth Early Sports Specialization Summit (YESSS!)   Among many of the subjects up for discussion is the “Healthy Sport Index (HSI),” an instrument developed by the Aspen Institute’s Project Play initiative and made public in October 2018. The HSI was designed to help kids and families answer the important question:  what sport is right for my child?  As a physician caring for thousands of these athletes a year, I can’t tell you how often I’m posed that question.  Now there is a tool to help.

One of the physicians who served on the Advisory Group for the development of the HSI was Michele LaBotz, M.D. She is a pediatrician and sports medicine physician in a large multi-specialty group in southern Maine, who serves on the American Academy of Pediatrics’ Council on Sports Medicine and Fitness (COSMF) and is a member of the AMSSM.  She kindly volunteered to give an overview on the HSI for the CJSM blog, and we’re delighted we can share her thoughts in the run up to YESSS!



Michele LaBotz MD FAAP

As health care providers, we rightfully emphasize safety and injury risk when discussing sport participation in young athletes.  We recognize the potential risks of sports that are contact vs. non-contact, or those that are high impact vs. low impact.   But, sport selection and participation is about more than just injury risk, and there is under-recognition that different sports exert a variety of influences on young athletes.  The Healthy Sport Index (HSI) presents this information in an appealing format and is a valuable resource for families and other stakeholders when considering sport-related issues in children and adolescents

HSI aggregates evidence-based data on physical activity, psychosocial effects, and safety on the 10 most popular high school sports for boys and girls in the U.S. A tool on the HSI website allows families to prioritize these areas to create a unique ranking system that identifies which sports are the best match for their child. The tool was developed by Aspen Institute’s Project Play initiative in partnership with Hospital for Special Surgery, and with guidance from an advisory group of physicians, academics, and other experts related to sports health. This information has the potential to significantly expand the way athletic participation is considered in children and adolescents.

Mental health in young athletes is a bona fide hot topic in sports medicine, and HSI does a “deep dive” into this area by examining sport-specific components of psychosocial well-being in young athletes.  Data on psychological health, academic achievement, and risk-taking behavior are presented for each sport.  Overall, team sports are generally associated with higher psychosocial benefit than individual sports, but there is a great deal of variability between sports, and this data is going to be eye-opening for many.

Families (and health care providers) often assume that sport participation assures sufficient physical activity for optimal health and development, and may be surprised at HSI’s activity profiles. For example, female cheerleaders and softball players spend less than 20% of practice time performing vigorous physical activity.  Only 29% of practice time in baseball, and 39% in football, is spent in vigorous activity.  High school athletes in many sports are not meeting current recommendations for one hour of moderate to vigorous activity per day.

HSI safety data is based largely on High School RIO, and takes into account overall injury rates, as well as injury type and severity.  While many sports medicine providers are familiar with this data, HSI provides a mechanism for broader dissemination of this information to anyone making decisions regarding sport participation for children and adolescents. The website also includes a wealth of sport-specific resources and recommendations on safety, performance, and athlete development.

HSI’s website is a useful adjunct to the counseling I provide to patients, families, and friends on youth sport participation.  In my clinical practice, families have found this to be a valuable resource, and particularly helpful as they are exploring sport opportunities for their young children, or considering sport change as a result of injury.


Thank you Dr. Labotz!

Sports for children and adolescents has provided so many benefits to the athletes and families who have participated over the years.  The HSI and the upcoming YESSS! summit are tools aimed to ensure youth sports can still deliver on the promise of health and well-being in the coming decades.  Learn more by checking out the HSI and other resources from The Aspen Institute’s ‘Project Play,’ or attending YESSS!

About sportingjim
I work at Nationwide Children's Hospital in Columbus, Ohio USA, where I am a specialist in pediatric sports medicine. My academic appointment as an Associate Professor of Pediatrics is through Ohio State University. I am a public health advocate for kids' health and safety. I am also the Deputy Editor for the Clinical Journal of Sport Medicine.

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