Injuries, Sports

Overuse Injuries – Carl W. Nissen, M.D.

Issues concerning sports specialization have increased significantly over the course of the past decade. Unfortunately, it is true that un-trained athletes and athletes returning back to their sport after a layoff, do improve rapidly if they specialize.  This rapid improvement in ability in these situations is used to justify continued single sport specialization. From a medical point of view what is concerning is that specialization leads to a lack of the whole-body exercises and a very specific repetitive set of motions are utilized at the expense of more healthy practices. Though not uniformly problematic, the risk of overuse injuries in specialized athletes is dramatically higher than multisport athletes.

Overuse injuries are common especially in younger athletes whose bodies have not yet matured to the point where repetitive stresses can be tolerated regularly. These young athletes aspire and attempt to mimic the stars in their respective sports often attempting to perform exactly the same maneuvers and actions that they are older roll models do. Examples of this can be seen everywhere. Young gymnasts use the same apparatus that national and Olympic level gymnast use. Similarly, adolescent baseball pitchers throw from the same distance that Major League Baseball pitchers do.

One of the issues that often leads overuse injuries to the point of becoming long-term and perhaps even permanent problems is that young athletes often believe and are told that pain and discomfort are normal. It is very difficult for young athletes to differentiate between muscle soreness and joint discomfort. Joint discomfort or bone pain are not normal and should not be ‘played through’. In a recent AOSSM consensus meeting and publication it was found that many young athletes continued to play despite having pain and feeling fatigued. Even more concerning is that these young athletes went to hold that this would significantly increase the risk of injury they seem to disregard the information and continued to participate. This is often reinforced by their coaches and parents.

Overuse injuries, sometimes referred to as overtraining syndrome, have some definitive symptoms and symptomatology and should be understood and watched out for. The presence of constant fatigue or waning interest in sports is a problem often seen and even discussed at the dinner table but rarely acted upon. These young athletes also will show more than the usual amount of irritability or moodiness, perhaps some loss of appetite, chronic specific joint and/or muscle pain, may begin to feign injuries, and have the inability to get a good night’s sleep. When the signs and isolation occur and certainly when they occur in combination should be noted recognized in a period of rest instituted.

One of the interesting findings of recent studies on sport specialization and overuse injuries is that there is an inverse relationship between the number of contest a young athlete will participate in and their ability to participate in either college or professional sports. In one specific study, it was noted that 88% of NCAA Division I male and female athletes participated in 2 or more sports until the middle of their high school careers. (Difiori – presented at The Annual Meeting of the AMSSM, New Orleans Apr 5-9, 2014)

Perhaps even more compelling from a societal health perspective is that studies have shown when high school students participate in 2 or more sports the likelihood that they will have healthier behaviors later in life are better. These behaviors include a lower incidence of smoking, higher levels of regular activity, better sleeping hygiene, and lower levels of loneliness and mental health problems. (DiFiori JP,Benjamin HJ, Brenner JS,et al. Br J Sports Med 2014;48:287–288.)

While there is no absolute answer for when an individual can safely specialize in a single sport it is certainly true that the trend for doing so at younger and younger ages is not healthy. Long-term studies and more in-depth evaluation of these young athletes will certainly help support the medical concerns that now exist. However, at this point-in-time individuals involved in sports organizations including coaches and administrators should all do what they can to educate young athletes and their parents as to the concerns that sport specialization may lead to. It may be helpful as well to explain and perhaps even obtain a local sports expert to discuss these issues. Most high-ranking coaches when evaluating young athletes and deciding at the college level whether or not to recruit the athlete place a lot of stock in overall athletic ability and not their ability in a specific sport.

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