“Overuse Injuries and Burnout in Youth Sports”

Karin VanBaak MDAssistant Professor

University of Colorado School of MedicineDepartment of Family Medicine

Division of Sports Medicine

Objectives

• Review the risks and benefits of youth sports participation

• Identify signs and symptoms of overuse injuries and burnout in young athletes

• Describe strategies for prevention of these types of issues

Background: Resources

• AAP: “Intensive Training and Sports Specialization in Young Athletes.” 2000

• AAP: “Overuse Injuries, Overtraining, and Burnout in Child and Adolescent Athletes.” 2007

• “Sports Specialization in Young Athletes: Evidence-Based Recommendations.” Sports Health, 2012

• AMSSM: “Overuse Injuries and Burnout in Youth Sports: A Position Statement …” 2014

• AAP: “Sports Specialization and Intensive Training in Young Athletes.” 2016

• AOSSM: “AOSSM Early Sport Specialization Consensus Statement.” 2016

Background: Youth Sports

• Youth sports is good!

– Self-esteem, socialization, fitness, lifelong physical activity, teamwork & leadership skills

• Increasing pressure for high-intensity training at young ages

• Potential consequences of early sport specialization

Joel S. Brenner, and COUNCIL ON SPORTS MEDICINE

AND FITNESS Pediatrics doi:10.1542/peds.2016-2148

©2016 by American Academy of Pediatrics

Youth Sports Participation

• 27 million US children ages 6-18 participate in team sports• 60 million US children ages 6-18 participate in some form of

organized athletics (National Council of Youth Sports, 2008)– 27% participate in only one sport – 66% male, 34% female– 12% <6 years (up from 6% in 1997)– 70% drop out of organized sports by 13 years of age

• 7.8 million high school athletes participated in sports (National Federation of High School Sports 2013-2014)

• 3.3% - 11.3% of high school athletes participate at the NCAA level

• 0.03% - 0.5% of high school athletes ever compete professionally

Sports Specialization and Intensive Training in Young

Athletes.

Joel S. Brenner, and COUNCIL ON SPORTS MEDICINE

AND FITNESS Pediatrics doi:10.1542/peds.2016-2148

©2016 by American Academy of Pediatrics

Background: Definitions

• Early Sport Specialization

– Participation in intensive training and/or competition in organized sports greater than 8 months per year

– Participation in 1 sport to the exclusion of others

– Involving pre-pubertal children (< 7th grade or age 12)

• Overuse injury

– Due to repetitive submaximal loading of the musculoskeletal system without adequate rest to allow for structural adaptation

Epidemiology

• Difficult to assess due to lack of uniform definitions

• Often assessed based on time loss

• Prevalence of overuse injuries in children and adolescents: 37% (skiing, handball) - 68% (running)

Risk factors for overuse injury

• Prior injury

• Adolescent growth spurt

• Higher training volume

• Injury specific– Stress fractures – history of amenorrhea

• Possible– Poor-fitting equipment

– Multiple competitive events in quick succession as a marker of high ratio of workload to recovery time

Risk factors for overuse injury

• Adapted from Table 2 AMSSM: “Overuse Injuries and Burnout in Youth Sports: A Position Statement …” DiFiori, et al. BJSM. 2014

Risk factors for Overuse Injury

Growth-related Susceptibility of growth cartilate to repetitive stress

Adolescent growth spurt

Other Intrinsic Previosu injury

Previous level of conditioning

Anatomic factors

Menstrual dysfunction

Athlete specific psychological and developmental factors

Extrinsic Training workload (rate, intensity, and progression)

Training and competition schedules

Equipment/footwear

Environment

Sport Technique

Adult and peer influences

The Elephant in the Room

• Does early specialization lead to success?– D1 NCAA athletes are more likely to have played

multiple sports in high school

– 2015 NFL Combine: 87% of participants had played multiple sports in high school

– Multiple studies of elite athletes show that intense training did not start until late adolescence

– Late specialization with early diversification is most likely to lead to elite status - Jayanthi

The Elephant in the Room

• Does early specialization lead to success?

– Certain sports such as figure skating and gymnastics may require early specialization

– Conflicting data about whether this puts these athletes at increased risk of injury

• Gymnasts and figure skaters achieve menarche later but still within the normal range

• Female athletes that participate in sports requiring early specialization are at higher risk of overuse injuries and the female athlete triad

How can we help?

• Look out for high-risk overuse injuries

– Certain stress fractures

– Pyseal stress injuries

– Osteochondritis dessecans

– Some apophyseal injuries

– Effort thrombosis

How can we help? look out for burnout

• Adapted from Table 5 AMSSM: “Overuse Injuries and Burnout in Youth Sports: A Position Statement …” DiFiori, et al. BJSM. 2014

Factors Related to Burnout in Young Athletes

Environmental Extremely high training volumes or time demands

Demanding performance expectations

Frequent intense competition

Inconsistent coaching practices

Little personal control in sport decision making

Critical rather than supportive evaluations

Personal Perfectionism

Need to please others

Nonassertiveness

Low self-esteem

High anxiety

Unidimensional self-conceptualization

How can we help? look out for burnout

• Adapted from Table 6 AMSSM: “Overuse Injuries and Burnout in Youth Sports: A Position Statement …” DiFiori, et al. BJSM. 2014

Symptoms of Overtraining Syndrome/Burnout

Fatigue Depression Insomnia

Loss of appetite Irritability Weight loss

Bradycardia or tachycardia

Agitation Lack of mental concentration

Loss of motivation or interest

Decreased self-confidence

Heavy, sore, stiff muscles

Hypertension Anxiety Restlessness

Sleep disturbances Nausea Frequent Illness

Personal Perfectionism

How can we help? look out for burnout

• Adapted from Table 7 AMSSM: “Overuse Injuries and Burnout in Youth Sports: A Position Statement …” DiFiori, et al. BJSM. 2014

Diagnosis of Overtraining Syndrome/ Burnout

History Decreased performance persisting after weeks to months of recovery

Disturbances in mood

No other medical diagnosis

Lack of enjoyment in sport

Inadequate nutritional intake and hydration

Potential Triggers Increased training load with adequate recovery

Monotanous training

Excessive number of competitions

Sleep disturbance

Family life stressors

Sport stressors

Previous illness

How can we help?

• Prevention– Limits on total weekly/yearly participation– Limit sport-specific repetitive movements (B)– Schedule rest periods (B)– Individualize these modifications based on athlete’s age, growth rate,

readiness, and injury history (C)– Monitor workload during the adolescent growth spurt (B)– Preseason conditioning (B)– Prepractice neuromuscular training (B)– Attention to equipment fit (C)– Emphasize skill development above competition and winning (C)

How can we help?

• Long-term athlete development programs– Started in the 1990s in the US, Canada, other– Focus on physical literacy – fundamental movement

and sports skills• “ABC’s:” Agility, Balance, Coordination, Speed

– Stages of “late-specialization LTAD”• 1. FUNdamental (age 6-10)• 2. Training to Train (age 10-14, 75% training, 25%

competition)• 3. Training to Compete (age 13-18, 50% skills development,

50% competition training)• 4. Training to Win (age >/= 17, 75% competition)• 5. Retirement/Retraining

How can we help?

• Long-term athlete development programs– American Development Model: developed by USOC in 2014 from LTAD

principles• 1. Discover, Learn, and Play (age 0-12 years)

• 2. Develop and Challenge (age 10-16)

• 3. Train and Compete (age 13-19)

• 4. Excel for High Performance or Participate and Succeed (age >/= 15)

• 5. Mentor and Thrive (for Life)

– Development Model of Sport Participation• Early diversification (sampling)

• Or early specialization

Joel S. Brenner, and COUNCIL ON SPORTS MEDICINE

AND FITNESS Pediatrics doi:10.1542/peds.2016-2148©2016 by American Academy of Pediatrics

Thank You

References

• AAP: “Intensive Training and Sports Specialization in Young Athletes.” 2000

• AAP: “Overuse Injuries, Overtraining, and Burnout in Child and Adolescent Athletes.” 2007

• “Sports Specialization in Young Athletes: Evidence-Based Recommendations.” Sports Health, 2012

• AMSSM: “Overuse Injuries and Burnout in Youth Sports: A Position Statement …” 2014

• AAP: “Sports Specialization and Intensive Training in Young Athletes.” 2016

• AOSSM: “AOSSM Early Sport Specialization Consensus Statement.” 2016