Sports medicine for single-sport athletes

Athletic trainer Shawn Cameron and a young athlete performing an exercise that builds strength, mobility, and balance.
Sports medicine physicians and athletic trainers serve an important role in helping athletes participate in sports in a safe, rewarding way. (Photos: Karen Elsner, Boston Children's Hospital)

As youth sports have become more structured and focused on results, sports medicine specialists have seen a growing number of sports injuries in younger patients. Is early sports specialization to blame?

“Specializing in a single sport is not necessarily a cause for concern,” says Andrea Stracciolini, MD, director of Medical Sports Medicine at Boston Children’s Hospital. “Athletes can benefit from being able to focus and setting and achieving goals.”

Playing a single sport year-round, however, often goes hand in hand with overtraining. Stracciolini and a team of Boston Children’s researchers found that that single-sport athletes trained almost twice as many hours per week as those who participated in more than one sport. Those who spent more time training were more likely to get injured.

What can physicians and trainers do when they see young athletes taking on adult-sized training loads? 

Here, she and injury prevention specialist Shawn Cameron offer tips to help physicians and trainers reduce athletes’ injury risk.

Understand the link between growth and injury

“Have you had any growth spurts recently?” This is one of the first questions Cameron asks injured athletes who come to The Micheli Center for Sports Injury Prevention (part of the Sports Medicine Division) as part of their recovery. 

All children and adolescents go through periods of rapid growth. For athletes, however, growth spurts can increase the risk of injury. Until their muscles, tendons, and ligaments catch up, athletes are more prone to strains and tears, even when performing moves they’ve practiced hundreds of times.

Dr. Andrea Stracciolini stands next to several orthopedic models of some of the joints that get injured by overtraining.
Andrea Stracciolini, MD: “As medical doctors, I think our job is to think about every component of the injury.”

“Often, periods of rapid growth coincide with increased training volume,” says Dr. Stracciolini. Whether it’s a school or club team, competition and training levels tend to increase in middle school and again in high school, common times for adolescent growth. “We know these are high-risk periods. We need to be watching these athletes carefully and shift the focus of their training while they’re growing.”

Signs of overtraining

  • frequent or multiple injuries
  • overuse injuries that don’t heal
  • drop in athletic performance
  • persistent fatigue

Treating the overtraining athlete

Years of caring for injured athletes has led Dr. Stracciolini to modify her clinical approach.

“Early in my career, I focused on injuries from a purely musculoskeletal point of view. Now I think much more about the whole athlete.” This includes talking with patients about things like nutrition, whether they’re sleeping enough, their emotional well-being, and if they have a supportive social group. Essentially, any factors that could have contributed to the current injury or increase the risk of future injury.

“As medical doctors, I think our job is to think about every component of the injury, especially as kids are specializing earlier and earlier.”

Education is another important component of her treatment approach. Athletes who know the finest details of their sport are often not nearly as well versed in the role of rest, proper nutrition, and hydration in their health and wellbeing.

Recommendations for safe youth sports

  • Limit participation in a single sport to less than eight months per year.
  • Participate in only one organized team or league at a time.
  • Participate in a variety of sports throughout the year.
  • Take one to two days off from training every week.
  • Make sure the number of hours of training per week does not exceed the athlete’s age (a 10-year-old child should not train more than 10 hours a week).
  • Reduce the number of hours and intensity of training during periods of rapid growth.

Training the overtraining athlete

A common myth held by athletes of all ages equates strength training with lifting heavy weights. Cameron will tell you (and his athletes) there’s a better way.

“Anyone new to strength and conditioning needs to learn proper technique first. Young or inexperienced athletes need to work on balance, coordination, fine motor skills, flexibility, and mobility. When it comes to strength training, body weight and functional resistance exercises are highly effective.”

Shawn Cameron next to a rack of training tools he uses to help athletes recover from overtraining injuries.
Shawn Cameron: “Most athletes are open to doing what it takes to get better, as long as they feel involved in the process.”

While tailoring training programs to individual athletes based on their asymmetries and strength deficits, he also looks for less visible signs of overtraining, such as lost confidence, burnout, or exhaustion. In such cases, he may refer the athlete to a mental skills specialist at The Micheli Center. Athletes whose performance has declined or who have a chronic injury probably need to take time off from their sport while they heal.

Athletes, he says, rarely push back when he recommends time off from sports. “Most athletes are open to doing what it takes to get better, as long as they feel involved in the process.”

Unfortunately, the current sports culture promotes early sports specialization and overtraining as the way to achieve sports success. As long as such mistaken beliefs prevail, athletes will remain at risk of preventable overuse injuries. Sports medicine physicians and athletic trainers serve an important role in helping these athletes participate in sports in a safe, rewarding way.

Learn more about the Sports Medicine Division and The Micheli Center for Sports Injury Prevention.

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