As sport specialization at the youth and high school levels becomes increasingly popular, parents, coaches, and medical professionals are encouraged to understand and help prevent the risk of injury among young athletes. Orthopaedic surgeons are increasingly finding themselves on the front line of the competition, needing to recognize injury, psychological fatigue, and burnout.
A literature review published in the Journal of the American Academy of Orthopaedic Surgeons (JAAOS) takes a deep dive into the impact of early sport specialization, exploring the adverse health and social effects on young athletes.
“Sports are a great way for kids to exercise, have fun, and learn about teamwork,” said lead author Charles A. Popkin, MD, from Columbia University Department of Orthopedic Surgery and NewYork-Presbyterian/Columbia University Irving Medical Center.
“However, the days of sandlot play and street pick-up games are waning and we’re witnessing the professionalization of youth sport. Parents and coaches are increasingly focused on developing elite athletes and believe that if more focus is placed on deliberate practice and early specialization, young athletes will have a better chance at college-level play or even Olympic standings. That’s not usually the case.”
Early sport specialization is defined as the intensive training or competition in organized sport by prepubescent children (under the age of 12) for more than 8 months of the year, with a focus on a single sport to the exclusion of other sport and free play.  Although trends in early sport specialization vary across individual and team sport and by sex, the lack of diversified activity in youth leads to increased risk of injury and burnout. The authors of the JAAOS review article note that early sport specialization may not be necessary for elite athletic achievement; instead, early diversification of sports leads to superior results.
“The merits and timing of cross-training versus specialization are evident,” said Dr. Popkin. “Not only are talented young athletes able to transfer cognitive and physical skills learned from one sport to another, but they also demonstrate more enjoyment in sport and a lower frequency of dropout. In addition, there are fewer signs of chronic stress, higher levels of motivation, and a gradual independence.”
According to the American Academy of Orthopaedic Surgeons (AAOS), overuse injury in children can have a lifetime effect on their game and quality of life. The AAOS launched a public service campaign with the American Orthopaedic Society for Sports Medicine called OneSport to educate parents, physicians, young athletes, and coaches about the dangers of sport specialization:
- When a young child repeatedly participates in 1 type of athletic activity, their body – which is still growing and developing – does not have enough time to heal properly between resting and playing.
- Intense and repetitive training can lead to pediatric trauma and may require surgery to young shoulders, knees, elbows, and wrists.
- Although most experts agree that some degree of sports specialization is necessary, there is much debate about how early intense training should begin. 
Orthopaedic surgeons need to be prepared to identify an injury, treat it, and help the athlete get back in the game. The JAAOS review article highlights the importance of advocating on behalf of athletes’ health, too. By guiding discussions about early sport specialization and noting that there is no strong evidence that it is a requirement to achieve elite athletic status, orthopaedic surgeons can help open dialogue about ways in which parents and coaches can promote enjoyable, lifelong physical activity without the psychological and social risks of early sport specialization.
“The debate over the optimal age to start sport specialization will likely continue as parents, coaches, and developing athletes look for a competitive edge,” Dr. Popkin said.
“In a perfect world, however, specialization would be part of a natural progression driven by the athlete, and not their parents or coaches.”
Save the Date!
The 5th Annual Baseball Sports Medicine: Game-Changing Concepts will be held November 19-20, 2020, in New York City, with Christopher S. Ahmad, MD, and Anthony A. Romeo, MD, once again serving as course chairs. More information will be available next year.
Popkin CA, Bayomy AF, Ahmad CS. Early sport specialization. J Am Acad Orthop Surg. 2019 Nov 15;27(22):e995-e1000. doi: 10.5435/JAAOS-D-18-00187.
- LaPrade RF, Agel J, Baker, et al: AOSSM early sport specialization consensus statement. Orthop J Sports Med 2016; 4:2325967116644241.
- Jayanthi N, Pinkham C, Dugas L, Patrick B, LaBella C. Sports specialization in young athletes: evidence-based recommendations. Sports Health. 2013 May;5(3):251-7. doi: 10.1177/1941738112464626.