Sports specialization and injury risk for young athletes

Kocher sports specialization Thriving blog

In recent years, sports specialization has become a hot topic amongst both parents of young athletes and medical professionals. There are a lot of questions swirling around early specialization: When should my child begin to focus on just one sport year-round? Are there injury risks associated with specialization? Does specializing in one sport provide a significant benefit for their skill development?

While answers to these questions aren’t always straightforward, in a recent study Dr. Mininder Kocher, an orthopedic surgeon and associate director of the Boston Children’s Hospital Sports Medicine Division, found some compelling evidence of the risks of early sports specialization.

Specialization and activity levels

Kocher’s study looks at the link between youth sports specialization and increased injury risk. This study assessed data from the Growing Up Today Study (GUTS) — a prospective analysis of youth throughout the United States, done by Brigham and Women’s Hospital, involving almost 12,000 youth and their injury history completed by their mothers, who were all registered nurses.

Sports specialization is defined as playing a sport for multiple seasons at the exclusion of other sports.

Kocher wanted to determine whether increased injury risk was associated with sports specialization, or if it was a result of a greater volume of physical activity that typically goes hand-in-hand with a specialized athlete. “Prior studies looking at sports specialization haven’t been able to separate the two because they haven’t measured the hours per week of the vigorous activity,” Kocher explains.

After adjusting for activity levels — as well as separating individuals by both specific sports and gender — the results showed an increased injury risk for boys who specialized in baseball or gymnastics. Kocher believes this is likely due to the repetitive throwing motion used in baseball and the repetitive impact that gymnasts experience. For girls, there were no individual sports associated with increased injury risk once Kocher adjusted for the total hours per week of vigorous activity.

“The fundamental question, and the main reason we did this study, is because we’ve seen a lot of concern in the media about early sports specialization and increased risk of injury,” says Kocher. “We wanted to delve deeper and see if this is due to early specialization or if it’s just that specialized youth athletes are more active.”

Given the study’s findings — particularly with female athletes — it seems that the biggest factor for increased injury risk is the total hours of vigorous activity. “Early specialization really reflects a paradigm change in youth sports,” says Kocher. “Kids are playing at greater competitive levels and focusing on a single sport at a younger age. There’s a lot more involved in terms of travel teams, competitive play and tournaments — the whole landscape has changed.”

We have this group of young athletes who are overdoing it at high rates physically, and are risk for burnout psychologically.” ~Dr. Mininder Kocher

Athletes at risk of burnout

One of the concerns about early sports specialization is that there really isn’t much evidence to suggest that focusing on one sport at a young age actually results in more athletic success. “There are a fair number of data looking at college and professional athletes showing that those who played multiple sports were more likely to end up playing sports in college and at professional levels,” explains Kocher. “The ones who focused on a single sport were more likely to burn out or to get injured.”

Both injuries and burnout are a major concern. By age 14, about 70 percent of children have dropped out of sports. There could be several factors behind this statistic: they aren’t able to make the team, they’ve developed other interests, the sport is no longer fun and rewarding, or they’ve become burnt out after focusing on it for so long. “This is a really concerning statistic,” says Kocher. “We want to keep kids active, and being involved in sports is beneficial for both their physical and psychosocial health.”

Sports give kids the opportunity to be part of a peer group, develop self-confidence and stay physically fit. But it appears that the more we push our kids to focus on one sport, the higher the likelihood that they’ll stop playing at an early age.

“Our children are getting very dichotomized,” says Kocher. “We have a group of kids who aren’t active enough, and childhood obesity is truly an epidemic with future health consequences. But on the other hand, we have this group of young athletes who are overdoing it at high rates physically, and are risk for burnout psychologically.”

Recommendations for young athletes

While there isn’t a definitive answer to this problem, Kocher does have recommendations for the appropriate activity level of young athletes: “Our current recommendation is that the number of hours of vigorous sports activity per week should correlate to their age,” explains Kocher. “This means that if the child is 12 years old, we recommend 12 hours or less of vigorous sports during the week.”

Kocher’s recommendations are only for vigorous sports activity, such as organized practices or games. He is planning further research in order to refine the recommendations as we learn more about youth sports and injury risks.

For both parents and caregivers, the ultimate goal is to keep young athletes safe and having fun. Sports can provide great benefits to children and adolescents, but they will always carry the risk of injury. It’s important that we continue to look for ways to mitigate these risks while creating a safe and competitive environment for young athletes.

Learn more about Boston Children’s Sports Medicine Division.