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Sports Specialization and Overuse Injuries

Melanie Cole: Welcome. You're listening to Children's Health Checkup. I'm Melanie Cole. Our topic today is sports specialization and overuse injuries and our expert is Stephen LePlante. He's the Team Lead Physical Therapist at the Children's Health Andrews Institute for Orthopedics and Sports Medicine. We will discuss for families whether kids should specialize in a single sport and why doing so, could predispose your child to injuries. Stephen, thank you for joining us today. Please define for the listeners sports specialization. What is that?

Stephen LePlante: Yeah. Hey Melanie, thanks for having me. So sports specialization in its simplest term is just when an athlete or their parents kind of decide to spend a majority of their time in a given year, we'd say probably over nine or 10 months focusing on training for just one sport. It's kind of been a trend that we've been seeing over probably at least the last decade or so where I think parents have this mentality that more is better. And that if my kid plays the sport more frequently, you know, maybe they increase their chance or likelihood of getting a scholarship or reaching some elite level. There's also this kind of higher level of competitiveness in general with youth sports. And so I think a lot of parents feel that the only way to keep up is have their child in that same sport, you know, all throughout the year so they can kind of maintain their spot on a team or maintain their status in that sport.

Host: Well, it certainly is an ongoing issue. Does specializing in a sport predispose a child to injuries? What are some of the potential drawbacks of specialization? Explain for parents why kids shouldn't necessarily specialize in a specific sport at a young age and how that presents a risk of overuse injuries.

Stephen LePlante: Yeah, so that's what the research is telling us and it keeps coming out year after year. And this has been going on for a long time. That, you know, the more your kid does the same movements or the same activities over and over and over, there's an increased likelihood of overuse injuries from occurring. So you can look at like, baseball's a good example of these kids that are, you know, throwing the ball, you know, hundreds and hundreds of times a week. And they can have major injuries to their shoulder, you know, we're seeing this huge spike in ulnar collateral ligament tears in these youth baseball players, stuff that we didn't see 10 years ago. And you've got sports like soccer and basketball and volleyball. They're more lower extremity dominant, but you're seeing this up an increase in an ACL tears and just general lower extremity injuries. And the last couple of years I've seen a huge spike in like back injuries, like so really bad back injuries from like gymnastics and other rotational sports. And you know, some of these injuries are so bad they're keeping these kids out of the sport for six months to a year. And so there's a psychological component to that for the child as well. When they're not able to play the sport they love.

Host: Well, that's certainly true. Now as a sports medicine specialist, Stephen, what’s your advice for families on whether kids should specialize, when and why? So is there ever a time, I guess I'm asking when it's appropriate for them to specialize?

Stephen LePlante: Yeah. One of the rules that we've kind of been using for a while is to wait until they're skeletally mature. So that happens at different ages for boys and girls. You know, there's even some cases of people that didn't specialize until their late teens and twenties that actually went on to be very successful, you know, professional athletes. So everyone kind of peaks at different times. But we know anything kind of prior to the age of probably 13 or 14 is going to have more negative implications then positive implications. And we talk about sports specialization. I mean, if you look at the majority of pro athletes and even college level athletes, almost all of them played multiple sports growing up. There's a lot of statistics and we've seen some of the best athletes in the world. They didn't specialize in their sport till very, very late. So, you know, maybe 17, 18 years old before they actually, you know, only focused on that one sport. So, you know, we know it's good. It's good for just athletic development to do different things and not do the same thing over and over and over again. And it also helps prevent burnout as well.

Host: So let's talk about the common injuries that you see and you mentioned throwing limits, you know, for baseball players. That's certainly a common one. What other types of injuries are you seeing that can result from, you know, chronic overuse sports specialization and not really mixing it up a little bit and playing different sports?

Stephen LePlante: Yeah, I mean the ACL epidemic has gotten kind of out of hand. I mean, especially in these the female athletes, or soccer teams are, you know, there's two or three a year on every team. It seems like coming in sometimes even more than that. That's a big one. You know, anything where fatigue is a factor. Anything where they're playing these like weekend tournaments where they're, you know, playing five to six games in a two day period. I mean, that's kind of crazy to me to think that because even our college and professional level athletes, we don't require them to do that. But yet we'll take a 14 year old kid and take them to a tournament all weekend and we wonder why they get hurt. You know, it's like these kids are running, you know, a marathon plus in a soccer tournament every weekend, and then they do it weekend after weekend after weekend without the chance to recover and just kind of rebuild themselves up. Yeah, I think baseball is a bad one too. We see a lot of like elbow injuries and a lot of these are preventable. Like if we just didn't do as much, like they wouldn't occur. And that's kind of the difficult part is at least 50% of these are probably things that we could eliminate almost all of them if we just didn't play all the time.

Host: Absolutely. So for parents, for coaches, tell them what you'd like them to know about reducing those risks. When we talk about cross training, not everybody knows what that means. So explain how that works and what goes together, whether it's swimming, going together with baseball or if you're a football player, what do you do? Run on the off season. Something. Give parents some advice on what they can do to reduce those risks?

Stephen LePlante: Yeah, I mean, the first thing they need to do is actually stop monitoring the amount of time their child commits each week to their sports. Our rule is that your child should not participate in more hours than their age, in their sports. So if you have a 12 year old child, they should not be playing in their sport more than 12 hours a week. That's a big thing. Listen to your kids and kind of watch them. I think parents are pretty understanding of when a kid's kind of looking a little tired and looking like they don't want to be in the sport and you know, just respect the child and listen to what they have to say. But our biggest push is that we want to take at least three months off from their primary sport per year. And that's not, you know, every, you know, you don't have to do back to back to back. You can kind of break it up. But, you know, learning new skills, like, you know, the brain is pretty cool at how it formats things. But even just because you play soccer going and you know, picking up a basketball can actually help the different skills the way it's all set up. You know, I think we have too much what we call deliberate practice. So that's that structured, you know, coaches involved versus like what you and I are probably used to when we grew up, we had more what's called deliberate play.

So you know, we would go meet up and we would play baseball with our friends, but it wasn't, there wasn't structure, there was fun. There was still being had. I think we've kind of taken the fun out of youth sports. So I think it's important that parents find those times to participate in other activities. Like have your kid ride a bike, like you said, swimming. What a great exercise for kids. It's a way to unload their body's. Good cardiovascular exercise for them too. What we've done at Children's Health here is we have partnered with a group, EXOS, which is a great partnership for us where we have strength conditioning coaches and we put these kids in training programs to build up their foundational base where they're all, they're working on, you know, learning how to control their body in space and learning how to lift weights properly. And you know, when we have that foundation, you know, just overall athleticism gets better as well. So we're not just all about the skill, right? We're not all just about throwing and catching and hitting. Like we're going to actually develop this nice foundation that we can be, can work off, and hopefully stay healthy because of it.

Host: Absolutely. Well said. So what should parents do, if they think their child may have an injury, if they start to notice that their child is moving their arm around a lot or limping or any of these things, because not all athletes are going to tell. They don't all want to say anything because they don't want to be pulled from play.

Stephen LePlante: Yeah, that's a great point. Those are the tough ones. I mean, you know, if those kids don't want to be out, they love doing what they're doing, but it's our responsibility. I'm going to, I'm a parent, I've got three kids and you know, so when one of my kids looks like they're struggling or you know, it's my responsibility to step in and say, Hey, you know, what's going on? And you know, when in doubt, take him to like a physician that's specializing with youth athletes particularly. I think there's a big distinction between Doctors and therapists. This is what we do all the time versus people that don't do it as much. I mean, I came from a world of professional sports and college sports to a world of kids and it took me a while to adapt and change to some of that. And so you've got to find the right people for that. But you know what? Therapists do very well is we can assess the way a kid moves and try to, you know, find little areas that may be dysfunctional that could either lead to injury or causing the injury to happen. So I think getting a referral to a physical therapist or like a sports med doc, if you have any doubt like is always a good idea.

Host: Before we wrap up and I ask you for your best advice, tell us a little bit about Children's Health, Andrews Institute for Orthopedics and Sports Medicine. Tell us a little bit about your team and what you guys do there.

Stephen LePlante: Yeah, we have a fantastic team down here in Plano. Kind of built this, what I call a playground. I mean it's the most integrative system that I've ever worked in where we are all literally on the first floor of the same building and our Doctors are next door to us and our performance team is on the other side of us and rehabs kind of sandwiched in the middle. And we've got this, you know, 60 yard turf and this track outside, you know, because we wanted kids to have access to movement. But it's so integrative, like we all work together with that common goal to prevent injuries, but also to get the athlete back on the field, as fast as we can. We have some of the best technology that you can have constantly focusing on education for the staff, every year. So yeah, just, it's just an awesome place and glad to be a part of it.

Host: Give us your best advice, for parents listening about preventing those overuse injuries, preventing the risk of injuries by sports specialization for their youth athletes.

Stephen LePlante: Yeah, I mean, the biggest key to prevention is to not let it happen to begin with, right? So we need to commit ourselves to these programs of saying, Hey, we're not going to play our sport. We're going to take a month off. You know, it's Christmas time let's go do something else. You know, let's not pick up a baseball, let's just be a family and have some fun. And I think the parents are getting fed a lot of misinformation too, that they don't really know what else to do because they're being told if your kid doesn't play in this season, then they're probably not going to stay on this team or this, this club team and all this stuff. And then they're, you know, they're putting that on top of a high school team. So we have to really like monitor volumes, right? We need to make sure that like these kids and the kids have to understand too, right? That like more is not better. I deal with this all the time, like these kids that come in here and they just want to do more, like they want to be in rehab five days a week and I'm like, you don't need it. Like we need a couple of days off where you're just enjoying yourself as being a child. You know, at the end of the day, these are children that we're talking about. And even teenagers need a little bit of time to unwind and relax and the pressures and stress of life in general. You know, I think we're, we've got to take some, take a step back and kind of reevaluate what we're doing as parents and, you know, make sure that we're doing the best thing for our kids.

Host: Great advice. Thank you so much for your time with us today and to our audience for listening to Children's Health Checkup. You can find more information on the Children's Health Andrews Institute for Orthopedics and Sports Medicine at children's.com/Andrews. And if you found this podcast helpful, please rate and review or share the episode and please follow Children's Health on your social channels.