Developing Physically Active and Sporty Kids - Overuse Injuries and Burnout

Original Editor - Jess Bell based on the course by Tracy Prowse
Top Contributors - Jess Bell, Kim Jackson and Naomi O'Reilly
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Introduction[edit | edit source]

A large number of children participate in organised sports every year. In the US alone, more than 46.5 million children play sports.[1] While the benefits of physical activity are clear,[2] involvement in organised sport can also lead to injuries and burnout. There were, for instance, 1.2 million injuries recorded for high school athletes in the US in 2015 to 2-16.[3]

Each year, more than 10 percent of children aged under 14 are treated for sports injuries in the US. Half of all sports injuries in children aged over 10 years are overuse injuries.[4][5]

However, despite these high rates, 70 percent of children who participate in sports will actually drop out by the age of 13.[6] The reasons for this are explored in here, but they may be due in part to the influence of pushy parents and coaches.[5]

Growing Need For Intervention[edit | edit source]

Children may be at more risk of injury for a number of reasons. These are discussed in more detail here LINK, but the following factors should be considered:[5]

  • Immature bones[7][8]
  • Insufficient rest after an injury
  • Poor training or conditioning / muscle strength[8]
  • Specialisation in just one sport
    • Young athletes are specialising in sports (and positions) at earlier ages, which is known to increase injury risk[9] [10][7]
  • Year-round participation[11]
    • Training schedules are often regimented and repetitive, which has increased the number of overuse injuries in children
  • Changes in society[5]
    • Shrinking backyard
    • Perceived danger
    • Technology
    • Less play time, more drill time

Overuse Injury and Burnout Prevention[edit | edit source]

A child’s history of injury is:[5]

  • A risk factor for future injury (during both adolescence and adulthood)
  • A contributor to long-term degenerative diseases, such as osteoarthritis

As shown in Table 1, which is based on the work of DiFiori and colleagues,[10] risk factors can be divided into intrinsic and extrinsic risk factors.

Table 1. Intrinsice and extrinsic risk factors. Key: +++ = strong predictor of future injury / burnout; ++ = moderate predictor; + = mild predictor; 0 = poor evidence, not considered a predictor of injury
Intrinsic Risk Factors Extrinsic Risk Factors
Prior injury +++ Higher training volumes ++
Growth spurt +++ Overscheduling+ (recovery time ++)
History of amenorrhea +++ Poor-fitting equipment +
Joint hypermobility + (especially during adolescence) Sport specialisation + (see below)
Readiness + (physical and psycho-social, not age)
Anatomic malalignment, flexibility, functional control of movement 0
Sufficient strength to withstand forces and range of motion +

It has been found that diversified sports training during early and middle adolescence may be more effective in developing elite-level skills.[10] Specialisation can be delayed until late adolescence.[5]

Jayanthi and colleagues[12] found that the following factors had an increased odds of serious overuse injury:

  • Young athletes participating in more hours of sports per week than their age in years (i.e. > 9 hours for 9 years)
  • Young athletes whose ratio of organised sport to free play was >2:1 hours per week

References[edit | edit source]

  1. ↑ Safe Kids Worldwide. Preventing sports-related injuries. Available from: https://www.safekids.org/preventing-sports-related-injuries (accessed 7 November 2021).
  2. ↑ Janssen I, LeBlanc AG. Systematic review of the health benefits of physical activity and fitness in school-aged children and youth. Int J Behav Nutr Phys Act. 2010;7(40).
  3. ↑ Welton KL, Kraeutler MJ, Pierpoint LA, Bartley JH, McCarty EC, Comstock RD. Injury recurrence among high school athletes in the United States: a decade of patterns and trends, 2005-2006 through 2015-2016. Orthop J Sports Med. 2018;6(1):2325967117745788.
  4. ↑ American Academy of Pediatrics. Preventing overuse injuries in young athletes. Available from: https://www.healthychildren.org/English/health-issues/injuries-emergencies/sports-injuries/Pages/Preventing-Overuse-Injuries.aspx (accessed 7 November 2021).
  5. ↑ 5.0 5.1 5.2 5.3 5.4 5.5 Prowse T. Developing Physically Active and Sporty Kids - Overuse Injuries and Burnout Course. Physioplus, 2021.
  6. ↑ Gadient W, Hawili R, Strand B. Athlete drop outs, sport specialization, and sport diversification: an argument for late specialization in youth sport. 2020.
  7. ↑ 7.0 7.1 Bergeron MF, Mountjoy M, Armstrong N, Chia M, Côté J, Emery CA et al. International Olympic Committee consensus statement on youth athletic development. Br J Sports Med. 2015;49(13):843-51.
  8. ↑ 8.0 8.1 Patel DR, Yamasaki A, Brown K. Epidemiology of sports-related musculoskeletal injuries in young athletes in United States. Transl Pediatr. 2017;6(3):160-166.
  9. ↑ Ahlquist S, Cash BM, Hame SL. Associations of early sport specialization and high training volume with injury rates in National Collegiate Athletic Association Division I Athletes. Orthop J Sports Med. 2020;8(3):2325967120906825.
  10. ↑ 10.0 10.1 10.2 DiFiori JP, Benjamin HJ, Brenner J, Gregory A, Jayanthi N, Landry GL, Luke A. Overuse injuries and burnout in youth sports: a position statement from the American Medical Society for Sports Medicine. Clin J Sport Med. 2014;24(1):3-20.
  11. ↑ Hawkins D, Metheny J. Overuse injuries in youth sports: biomechanical considerations. Med Sci Sports Exerc. 2001;33(10):1701-7.
  12. ↑ Jayanthi NA, LaBella CR, Fischer D, Pasulka J, Dugas LR. Sports-specialized intensive training and the risk of injury in young athletes: a clinical case-control study. Am J Sports Med. 2015;43(4):794-801.
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