To Play or Not to Play

Are the benefits of sports specialization worth the potential risks?

Jeff Amberg

The United States of America is a nation in love with sports. Each year millions of Americans spend billions of dollars both as spectators and participants in their favorite athletic events. The history of sports extends as far back as recorded history and marks the foundation of military training. Competition was used to determine which individuals were most fit and combat ready as well as to develop the ability to work together as a team in the army. Today, the benefits of sports for America’s youth are clear: fitness, self-esteem, and peer socialization. With our nation’s growing epidemic of obesity, youth sports have never played a bigger role in the future health of our children.

Today, 27 million American youth ages 6 to 18 play organized team sports, 60 million participate in some form of organized sport, and 44 million play more than one sport. For many Americans, the emphasis on excelling in competitive sports is a major focus as kids –– and their parents –– dream of following in their favorite athlete’s footsteps. Whether the goal is to make the elite travel team in soccer, earn a sports scholarship to college, win a gold medal in the Olympics, or become a professional athlete, many families make enormous sacrifices in time and money to help their son become the next Michael Jordan or their daughter the next Serena Williams.

The little leagues have grown up. Over the past three decades, sports specialization for children and teens has exploded, becoming more focused, intense, and expensive than ever before. Sports specialization, which is defined as intense, year-round training in a single sport with the exclusion of other sports, has infected most all athletics. Many experts caution against specialization, asserting that the only certainty in this model is that it generates enormous profits for people in the youth sports industry, including the medical profession.

Indeed, youth sports is big business. A privatization of sport has occurred over the past 20 years, where athletes are now able to access their sport of choice through private enterprise and programming outside of school. IMG Academy is one of many new business models that generates billions of dollars annually planning, funding, and developing young athletes with year-round opportunities to excel in their chosen sport.

To keep up with the Joneses, families spend thousands of dollars each year on club fees, travel expenses, and equipment. Recent trends indicate more and more young athletes ages 9 and up are specializing in their chosen sport year-round — training and competing at the highest levels available with the hope that one day the hard work and dedication to one sport will pay off.

However, more doesn’t necessarily mean better, as the increased intensity can damage the child’s interest in the sport or even their physical well-being, in addition to the high cost and time. Some question whether the current structure of America’s youth sports system, tailored to identify and develop its most elite athletes, does so at the expense of participation, fun, and life skills. But aiming high is the American way, and there is no questioning America’s place in the world’s sports hierarchy. “Winning isn’t everything, it’s the only thing!” quipped UCLA Football Coach Red Sanders, and this mentality is undeniably ingrained in U.S. culture.

But success at the peak doesn’t speak for the system as a whole. The structure of organized youth sports is designed to serve just the five or 10 percent of the population who might play varsity athletics. Many American youths miss out on the benefits of team sports because the system is designed to identify and promote only the top performing athletes.

For proof, look no further than attrition rates in youth athletics, as 70 percent of kids drop out of sports by age 13. While sports are definitely not for everyone, 70 percent is a disturbing trend.

Sports psychologists have found three main reasons kids compete in youth sports: to have fun, learn skills and acquire competency, and make friends. Yet, instead of focusing on skills and enjoyment, the attention is all too often on advancement through wins and losses. Indeed, in American youth sports today, both athletes and parents are pressured to “win at all costs.” It appears that sports specialization, year-round training, and travel might be the cost of competing in today’s sports climate. A spot on the freshman team could depend on the level of preparation players received at an age that is growing younger and younger.

One parent reported a disturbing trend highlighting the increased emphasis on winning at all costs when their child’s club team asked them to sign contracts promising that their child will not play any other sport. As they focus on one discipline, kids supplement their team activities with private lessons from trainers, further increasing the pressure that a young athlete is never going to make the high school or travel team unless they participate in the sport year-round.

Is it worth it? How do parents and their children decide whether to play multiple sports versus specializing in one sport year-round? Examining the risk-benefit ratio of the single sport model requires a careful and objective analysis of the research, something many athletes (and their parents) are incapable of doing. The key variables to consider include: is the risk of injuries increased, what is the risk of psychological burnout, and most importantly, does sports specialization and the enormous sacrifice it requires guarantee success?

The American College of Sports Medicine position statement on overuse injuries and burnout in youth sports states that injury risk, both acute and overuse, is 70 percent greater in single-sport athletes versus multi-sport athletes. Overuse injuries are defined by the ACSM as “injuries that occur from repetitive submaximal loading of the musculoskeletal system when insufficient recovery time is allowed for structural adaptation.”

A 2015 survey in the American Journal of Sports Medicine found that 60 percent of all Tommy John surgeries in the United States are for patients ages 15 to 19 — startling, considering that professional baseball player Tommy John himself was 31 when the surgical-graft procedure was invented to repair his damaged elbow ligament in 1974. In 2010, the American Orthopedic Society for Sports Medicine launched the STOP (Sports Trauma and Overuse Prevention) Sports Injuries campaign to combat the worrisome trend.

Overuse injuries were not as common when young athletes participated in more diverse sports, according to research and expert opinions. Overall estimates of overuse versus acute injuries range from 45.9 percent to 55 percent and vary by specific sport, from as low as 37 percent (skiing) to as high as 68 percent (running). Injuries include muscle-tendon strains, ligament sprains, bursitis, neurovascular insults, and bone stress fractures. Physical stress exceeds a young athlete’s ability to adapt and recover.

Physicians increasingly need to perform surgery to repair serious athletic injuries, but corrective surgery doesn’t guarantee that athletes will remain in the game, especially as return trips to the operating room grow more frequent, especially with anterior cruciate ligament (ACL) repairs. Experts caution that these injuries are not reversible, and they predict former athletes will increasingly need joint replacements (hip, knee, etc.) at younger ages.

Psychological burnout is another risk factor to consider when deciding to play one versus multiple sports. Burnout, defined as chronic stress that causes the young athlete to cease participation in a previously enjoyable activity, is part of a spectrum of conditions that includes overreaching and overtraining. Data suggests that sport specialization increases risk for burnout. Children apparently experience more of a psychological component to burnout and attrition with adult-supervised activities.

There are four stages of burnout described by the ACSM: (1) the young athlete is placed in a situation that involves varying demands; (2) the demands are perceived as excessive; (3) the young athlete experiences varying physiological responses; and, (4) varying burnout consequences develop (i.e. withdrawal). The more fun and satisfaction children perceive, the less anxiety they experience.

Low self-esteem, low personal performance, worry about failure and adult expectations, and increased parental pressure to participate are associated with increased anxiety. Excessive athletic stress can lead to loss of appetite and sleep, decreased fun and satisfaction, physical injury, decreased performance, and subsequent withdrawal from the sport.

Stress in appropriate levels is beneficial in learning coping strategies; however, in excess it can lead to burnout and sports attrition. It should come as no surprise that one of the biggest risk factors for psychological burnout in athletics is the year-round sports specialization/intensive training model, especially in young athletes.

Ultimately, the question becomes, “Is it worth it?” Does all the sacrifice in time, money, and effort coupled with the increased risk of injury and burnout associated with playing one sport year-round at the expense of almost everything else improve performance to a level that maximizes each young athlete’s ultimate goal of achieving elite status in their chosen sport? The data is inconclusive and certainly depends on several factors.

There is no consensus regarding the degree of sports specialization required to develop elite-level skills. Is early specialized and intensive training necessary to achieve high level sports skills or do young athletes benefit more from holding off specialization until late adolescence? Experts generally agree that the number of hours spent in deliberate practice and training positively correlates with level of achievement in both individual and team sports; whether this intense practice must begin during early childhood and to the exclusion of other sports is a matter of debate. While professional medical organizations, such as the ACSM, have published position statements on sports specialization and intense training in young people, they have limited data upon which to base their recommendations and thus rely on expert opinion.

Most experts agree that early specialized training is necessary in technical sports that require elite-level competition prior to full maturation. This includes sports such as gymnastics, figure skating, and swimming/diving. This type of early specialized training typically occurs before the age of 12 and frequently as young as 5 or 6 years of age. Two recent studies demonstrated that accomplished elite athletes in women’s rhythmic gymnastics were more likely to initiate intense training in early and middle childhood. In gymnastics, peak performance occurs before full maturation, requiring intense training before puberty.

In contrast, elite athletes in team sports such as football, basketball, and soccer are more likely to initiate intense training later in adolescence. World-class athletes are more likely to have started competing at a later age and in other sports, and they are typically selected for a sports federation program at an older age than those at the national level. For most sports, early diversification is more likely to lead to success.

Experts state that among high-level athletes in sports such as basketball, soccer, and football, the greater the number of activities that the athletes experienced and practiced in their developing years (ages 0 to 12 years), the less sports-specific practice was necessary to acquire expertise in their sport. This transfer-of-pattern-recall skills from one sport to another is most pronounced during the early stages of involvement. Early diversification followed by specialization may lead to more enjoyment, fewer injuries, and longer participation, thus elevating chances of success.

To illustrate, a stat was released after this year’s NFL draft reporting that 224 out of the 256 players selected (87.5 percent) played multiple sports in high school. Does this indicate that the sport specialization/intensive training model — with the increased risk of overuse injury and burnout — isn’t necessary to achieve elite athletic status? And, does it mean that sport diversification, like a financial portfolio, increases the chance for success? Not so fast.

While playing multiple sports is the way to go for the majority of young athletes, I have watched sports long enough to realize that the athletes we see on television in our favorite sports are one in a million. No amount of training, coaching, or sacrifice can transform most young athletes into that rare, genetically gifted athlete that is 6-foot-4, 250 pounds, and runs the 40-yard dash in 4.3 seconds. If you are investing large amounts of dollars to get your child top of the line opportunities in a single sport with the hopes of a scholarship or pro career, you’re wasting your money. The natural-born athletes we see in the NFL or NBA will leave your highly trained child in the dust. So keep sports in perspective and keep it fun. The goal is for everyone to win.

Paul Lomas, who earned his Bachelor of Science degree in exercise physiology and associate degree in physical therapy, is a certified strength and conditioning specialist. He has 30 years experience in physical therapy, cardiac rehabilitation, weight management, risk intervention, and corporate medicine.

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