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Pediatrics at HSS

Intensive Participation in a Single Sport: Good or Bad for Kids?

Intensive Participation in a Single Sport: Good or Bad for Kids?

Few would question the benefits of athletic activities for young people. Many kids' lives revolve around their favorite sport as they build skill, form friendships and learn the value of teamwork. Competition, the goal to improve and the desire to stay on the team, often leads to intensive focus in just one sport at a young age.

But is there a downside? Yes, say many sports medicine experts, when the desire to excel leads to rigorous year-round training in just one sport. Known as "early youth sport specialization," the practice is becoming increasingly common among pre-teen and young teen athletes, according to Dr. Peter Fabricant, a pediatric orthopedic surgeon at HSS.

"We see kids as young as 10 years old on four soccer teams," Dr. Fabricant says. "The problem is that playing the same sport intensively all year round puts young athletes at higher risk of overuse injuries."

Overuse begins gradually and happens over time, and it accounts for about half of the injuries seen in young athletes. Basically, they overdo it. Excessive stress on muscles, bones, tendons and ligaments makes an injury more likely.

"We see a lot of shoulder and elbow injuries in young athletes involved in baseball, tennis and overhead sports," Dr. Fabricant notes. "Kids involved in field and impact sports often come in with stress fractures and knee problems."

About 60 million children and teens from age 6 to 18 participate in organized sports each year. Of those, about 27 percent are involved in only one sport, according to the National Council of Youth Sports. Increasingly, they're training or competing year-round, often on multiple teams. Kids as young as 7 years old may join travel leagues in addition to school-sponsored programs.

"A better, healthier alternative to single sport specialization is for kids to play a variety of sports year-round," Dr. Fabricant advises. "For example, if they love baseball, they play that sport for two seasons. The other two seasons, they participate in recreational or organized sports that don't involve overhead throwing, so they give their arm a rest."

Just this year, the American Orthopaedic Society for Sports Medicine published a consensus statement after reviewing the research on early sport specialization. A panel of experts, including a physician from HSS, declared the practice to be detrimental. They defined early specialization as participation in an activity year-round at the exclusion of other sports prior to age 12.

"There is no evidence that young children will benefit from early sport specialization in the majority of sports," the panel wrote. "They are subject to overuse injury and burnout from concentrated activity." The group proposed multisport participation as an excellent alternative to reach athletic goals and increase lifetime enjoyment of physical activity.

Despite the evidence, it's not always easy to dissuade a kid from playing his favorite sport year-round, Dr. Fabricant notes. Coaches may push kids to train intensely in a sport, and parents may see specialization as a ticket to a college scholarship or professional career. They think about the success of athletes such as the Williams sisters, who started training at a young age, and have high hopes for their children.

As the practice of early specialization becomes widespread, more medical groups are starting to weigh in. In September, the American Academy of Pediatrics published a report advising against single-sport specialization. The Academy encouraged children to play multiple sports and delay specializing until late adolescence.

Initiatives at Hospital for Special Surgery, such as the Young Athlete Program, seek to raise awareness of good practices and injury prevention. "We still want kids to be active all year. We don't want them to be couch potatoes," Dr. Fabricant says. "The key is diversification. If they play a variety of sports, they are less likely to experience an overuse injury."

Kids are often devastated when they get hurt badly enough to be sidelined, and that brings up another benefit of diversification. "If an injury prevents a young athlete from playing one sport, he or she may be still be able to participate in another athletic activity," Dr. Fabricant notes.  "For example, a kid who needs to give his shoulder a rest could still be on the track team."

Dr. Fabricant says ultimately, more research is needed to determine the ideal age for sport specialization, how to best prevent injuries in young athletes, and how to promote life-long enjoyment of athletics for good health.