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Athletic specialization pre-puberty can have detrimental effects

by Ryan Basen
Staff Writer, MedPage Today

Specializing in a single sport, and engaging in intensive training for it, may cause prepubescent and adolescent athletes to suffer overuse injuries and burnout, according to the American Academy of Pediatrics (AAP).
In a new clinical guideline, an AAP council advises clinicians on how to counsel young athlete patients and their parents regarding sports specialization and intensive training.
The council also called on the AAP, parents, pediatricians, and college athletic organizations to “advocate banning national ranking of athletes and college recruitments before the athletes’ high school years.”
“Current evidence suggests that delaying sport specialization for the majority of sports until after puberty will minimize the risks and lead to a higher likelihood of athletic success,” wrote Joel S. Brenner, MD, MPH, of the AAP’s Council on Sports Medicine and Fitness in Pediatrics, and colleagues.
“There is increased pressure to participate at a high level, to specialize in 1 sport early, and to play year-round, often on multiple teams. This increased emphasis on sports specialization has led to an increase in overuse injuries, overtraining, and burnout,” the authors noted.
The current report replaces a 2000 AAP policy statement, which was reaffirmed in 2014, and complements a 2007 AAP clinical report on overuse injuries, overtraining and burnout, which was reaffirmed in 2014.
In the new guideline, the council member suggested that pediatricians help counsel parents, young athletes, and coaches to understand that sports should be fun for athletes and help them develop life-long physical activity skills.
Also, participating in multiple sports at least until puberty decreases injury, stress, and burnout risk.
The authors noted that specializing beginning in late adolescence may help athletes achieve their goals in most sports, and that early sports diversification, and later specialization, makes athletes more likely to play sports and be physically fit over their lifetimes — and possibly become elite athletes.
In addition, clinicians are encouraged to discuss athletes’ goals if they are specializing, to determine if they are appropriate and realistic. Parents should be encouraged to closely monitor training and coaching within elite sports programs, and to familiarize themselves with the sport’s best practices.
While playing a chosen sport, taking 1 or 2 days off weekly can decrease injury risk, they stated.
Participants should be advised to take of 3 months annually — in 1-month increments — from their chosen sport to help with physical and psychological recovery. However, they may participate in other physical activities during that time off, the council advised.
Finally, clinicians should closely monitor the physical and psychological growth and maturation, as well as nutritional status, of athletes pursuing intensive training.
The council found that even though athletes in early entry sports, such as gymnastics and figure skating, tend to peak before full physical maturation, there are still unanswered questions about the effects of specialization on these athletes’ long-term health and well-being.
The authors also pointed out that it’s not known what the exact amount of training athletes should strive for to succeed, and that the threshold to avoid injuries, burnout, and attrition has not been established. Also, niche programs that focus on technique or conditioning have not been shown to help athletes succeed, “despite their increased time and financial investment,” they stated.
The council called for longitudinal studies of early specialization and intensive training that quantify injury and burnout rates, as well as data to confirm if and when young athletes should specialize.
Based on their literature review, the council found that “athletes who engaged in sport-specific training at a young age had shorter athletic careers…. Evidence is lacking that specialization before puberty is necessary to achieve elite status, and in fact, specialization before puberty is more likely to be detrimental.”
The guideline will likely counter the belief held by many parents, coaches, and athletes that specializing maximizes a child’s chances of becoming an elite athlete. Many parents and young athletes specialize because they want to earn college scholarships and/or become professional athletes, the council members noted, but only three to 11 in 100 high school athletes play at the National Collegiate Athletic Association (NCAA) level, while one in 100 earn scholarships to do so. In addition, from three to 50 in 10,000 ever turn pro.
They pointed out that young people who show talent for a particular sport are ranked nationally as early as sixth grade.
“As colleges start to look at middle school and early high school athletes, more pressure is created for the athlete and parent to do everything possible to succeed,” the council cautioned. “This situation may push athletes into playing year-round and possibly on multiple teams simultaneously to get more exposure and specializing in a single sport sooner for fear of missing their opportunity to impress a college coach. Given what is currently known out early sport specialization, this changing paradigm should be discouraged by society.”