Overuse injuries and burnout in youth sports: a position statement from the American Medical Society for Sports Medicine

Abstract

BackgroundYouth sport participation offers many benefits including the development of self-esteem, peer socialisation and general fitness. However, an emphasis on competitive success, often driven by goals of elite-level travel team selection, collegiate scholarships, Olympic and National team membership and even professional contracts, has seemingly become widespread. This has resulted in an increased pressure to begin high-intensity training at young ages. Such an excessive focus on early intensive training and competition at young ages rather than skill development can lead to overuse injury and burnout. PurposeTo provide a systematic, evidenced-based review that will (1) assist clinicians in recognising young athletes at risk for overuse injuries and burnout; (2) delineate the risk factors and injuries that are unique to the skeletally immature young athlete; (3) describe specific high-risk overuse injuries that present management challenges and/or can lead to long-term health consequences; (4) summarise the risk factors and symptoms associated with burnout in young athletes; (5)provide recommendations on overuse injury prevention. MethodologyMedical Subject Headings (MeSHs) and text words were searched on 26 March 2012 from MEDLINE, CINAHL and PsycINFO. The search yielded 953 unique articles. Additional articles were found using cross-referencing. The process was repeated on 10 July 2013 to review any new articles since the original search. Screening by the authors yielded a total of 208 relevant sources that were used for this article. Recommendations were classified using the Strength of Recommendation Taxonomy (SORT) grading system. Definition of overuse injuryOveruse injuries occur due to repetitive submaximal loading of the musculoskeletal system when rest is not adequate to allow for structural adaptation to take place. Injury can involve the muscletendon unit, bone, bursa, neurovascular structures and the physis. Overuse injuries unique to young athletes include apophyseal injuries and physeal stress injuries. EpidemiologyIt is estimated that 27 million US youth between 6 and 18 years of age participate in team sports. The National Council of Youth Sports survey found that 60 million children aged 6-18 years participate in some form of organised athletics, with 44 million participating in more than one sport. There is very little research specifically on the incidence and prevalence of overuse injuries in children and adolescents. Overall estimates of overuse injuries versus acute injuries range from 45.9% to 54%. The prevalence of overuse injury varies by the specific sport, ranging from 37% (skiing and handball) to 68% (running). Overuse injuries are underestimated in the literature because most of the epidemiological studies define injury as requiring a time loss from participation. Risk factorsPrior injury is a strong predictor of future overuse injury. Overuse injuries may be more likely to occur during the adolescent growth spurt. The physes, apophyses and articular surfaces in skeletally immat...

Long-Term Athletic Development- Part 1

“…The development of movement compe-tency is characterized by an early bias towards enhancing fundamental movement skills with a transition over time towards a greater emphasis on sport-specific skills. Early exposure to resistance training is supported by research, which shows that muscular strength development from resistance training can enhance physical performance (29), improve markers of health and well-being (such as insulinsensitivity (47) and levels of adiposity (8)) in active and inactive youth, and reduce the risk of sports-related injury ( 17,35,38,55). Additionally, movement skill competency is associated with physical activity engagement and improved measures of health and well-being in both normal and over-weight/obese youth (11,28,32).…”

“…Consequently, despite global physical activity recommendations and the existence of models of talent identification and development, the numbers of youth displaying substandard levels of physical fitness, muscular strength, and motor skill competency is increasing globally (12,37,43,45,49,52,56). A contemporary corollary of reduced levels of physical fitness in modern day youth is an increase in the number of youth experiencing sports-and physical activity-related injuries (1,7,9), overtraining and nonfunctional overreaching ( 3 3), burnout (17), and eventual dropout from their chosen sport(s), which remains a concern for practitioners.…”

Athlete Return-to-Play Decisions in Sports Medicine

“…However, the long-term health of the athlete must be the primary factor guiding medical decision making. Particularly in youth sports, the pressure to specialize and perform at a high level may increase risk for overuse injuries and burnout [2].…”

Until it hurts? Epidemiology of musculoskeletal pain in youth sports

“…The benefits of participation in multiple sports should be examined in future prospective studies 30) . In addition, to prevent overuse injuries, limiting the weekly and yearly participation time in sports is recommended by the American Medical Society for Sports Medicine 31) . A systematic review showed that multi-intervention training programs (e.g., balance training, structured warm-ups) effectively prevented sports injuries 32) .…”