Kids and sports: How specialization can lead to overuse injuries


A teenage patient and her mother during a follow-up exam after surgery.

If it takes 10,000 hours of “deliberate practice” to truly master a skill, as author Malcolm Gladwell contends, it would make sense that the earlier you specialize in an activity, the better you will be. While this may be true, it’s not without consequences. Kids who start specializing in one sport early may put their health at risk.

More kids than ever are playing sports these days, leading to more sports injuries in general. But we’re also seeing – especially in larger cities such as Dallas – kids at younger ages specializing in one sport, which leads to more overuse injuries that can plague them into adulthood.

I get it. We want our kids to do the best they possibly can. We want them to get scholarships and play at an elite level. The competition for playing time can be fierce, especially in larger schools, and we fear they will fall behind if they don’t specialize. But I know from experience that kids can excel at one sport while still enjoying others.

I grew up playing several sports. In high school, I began to focus solely on basketball, got a scholarship, and had a wonderful college basketball career at the University of Massachusetts. I wouldn’t trade it for the world. Nor would I trade the skills I gained and experiences I had playing sports other than basketball when I was younger.

You may be thinking, “Well, only one or two kids on my child’s team have an overuse injury.” But when it’s one or two kids on every team in Dallas, and in Texas, and in the United States, that’s a big problem. Our community needs to recognize this issue and learn the facts about sports specialization and overuse injuries so we can continue to foster a love of sports in our children while keeping them safe.

What are overuse injuries?

There are two main types of sports injuries: acute and overuse. Acute injuries usually are the result of a single incident, such as dislocating your shoulder or twisting an ankle or knee on the basketball court. Overuse injuries are caused by repetitive trauma to the tendons, bones, or joints. These injuries can be subtle and happen over time. Examples include shoulder pain in young throwing athletes, shin splints, and stress fractures.

Adolescents are more susceptible to overuse injuries because their bodies are still developing. They typically have open physes (where the bones grow), meaning the muscles and tendons are stronger than the bone itself. This can lead to overuse injuries to the growth plate and long-term problems down the road, such as chronic pain, the inability to perform, femoroacetabular impingement (FAI, in which the bones of the hip are abnormally shaped), and, although unusual, growth plate disturbance (such as limb length inequality).

We also see some overuse injuries in kids who don’t use the proper techniques for certain movements. Some of the more common overuse injuries we treat for different sports include:

  • Baseball and softball: Elbow and shoulder injuries from repetitive throwing. Many fans have heard of professional pitchers having Tommy John surgery on their elbows, but we’re seeing younger and younger players having it.
  • Hockey: Hip injuries are common because of the mechanics of the skating stride.
  • Gymnastics: This is a sport with historically early specialization, and wrist and elbow injuries from overuse are common.

Many overuse injuries aren’t treated surgically, but they can take a long time to heal. Often we’ll use braces or physical rehabilitation to target the area of the injury. It’s important to diagnose them early to prevent long-term problems and help get the athlete back on the field sooner and performing at their maximum ability.

How can we prevent overuse injuries?

While we can’t prevent injury 100 percent, there are some guidelines to follow to help your child avoid overuse injuries:

  • Age vs. hours: Don’t let your kids spend more hours per week than their age playing sports. For example, 9-year-olds shouldn’t be spending 10 hours a week at soccer practice.
  • Take breaks: You should have a day or two off each week and longer breaks throughout the year.
  • Cross-training: Playing other sports or doing other exercises gives some muscle groups a much-needed rest while developing others.

Some sports organizations have specific rules to help prevent injuries in teens, such as USA Cycling’s gear ratio restrictions and USA Swimming’s practice limits. For baseball and softball, pitch counts have proven especially beneficial in reducing injuries.

Make sure your children understand how important it is to tell an adult right away when something doesn’t feel right. Overuse injuries develop over time, and we want to address them as quickly as possible so they can keep playing.

I saw a 13-year-old who had been experiencing elbow pain for about four months. He wanted to keep playing baseball, so he had just dealt with it, but it had gotten to a point where he couldn’t throw anymore.

He was upset when I told him he would have to stop playing for a time. I told him, “I know you love sports. I do, too. I’m not trying to keep you from baseball; in fact, I want you to play at your highest level. But I would rather see you stop playing now, get the appropriate treatment, and be able to play in your more important games later in the season.”

With some physical therapy and strength training, he got back to baseball. And that’s what we want.

You know your children and you can recognize if something is off. Listen to them when they tell you something hurts. Obviously, there will be times when your 8-year-old tells you his foot hurts because he wants to get out of practice. But if it’s a prolonged complaint, they’re asking to take medication such as ibuprofen, or it’s affecting their performance, get it checked out. I’d rather you err on the side of caution than push them to continue playing.

Does specializing in one sport as a child increase their chances to go pro?

Studies show that specializing early in a sport does not increase the chances of becoming an elite athlete. It’s really not until the teen years where specialization begins to show a benefit.

A 2013 American Medical Society for Sports Medicine survey found that 88 percent of college athletes played more than one sport as children, and 70 percent didn’t specialize until they were older than 12.

Even hockey, another popular sport in Dallas-Fort Worth, doesn’t appear to benefit from early specialized play. A 2003 study showed that while, on average, professional hockey players did spend 10,000 hours in sports practice before they were 20,only 3,000 of those hours were spent practicing hockey. And of those 3,000 hours, only 450 came before they were 12.

Meanwhile, sports specialization has been shown to lead to injuries. According to a 2013 study, adolescents who spent more hours per week than their age playing one sport were 70 percent more likely to experience overuse injuries than other injuries. For example, 15-year-old who played one sport 16 or more hours a week would be at increased risk for an overuse injury.

Another study showed that kids who play one sport for eight months out of the year are nearly three times more likely to experience an overuse hip and/or knee injury.

What are the benefits to playing multiple sports?

Playing multiple sports can make you a better athlete overall. In doing this, you train more parts of the body and increase your agility. It may be funny to think about NFL players doing yoga, but many of them do because it helps make their play on the football field better.

There’s also a social aspect to consider. When your children play multiple sports, they’re exposed to different groups of people, and there’s value to that.

It’s great to dream of playing in college or in the pros, but we need to remember that only a small percentage of high school athletes will play in college, and even fewer in the pros. Above all, we want our children to learn teamwork, become good citizens, and avoid overuse injuries that potentially could have long-term consequences.

And as for Malcolm Gladwell’s 10,000 hour rule, a 2014 study found that deliberate practice only accounted for an18 percent variance in performance for sports. So sign your child up for several sports – there’s plenty of time for them to get that scholarship!

If you have questions about overuse injuries and your child’s involvement in sports, request an appointment or call 214-645-8300.