New clinical report provides guidance on overuse injuries and burnout in young athletes

As an emphasis on competitive success in youth sports has led to intense training, frequent competition and early single sport specialization, overuse injuries and burnout have become common. Given these concerns, the American Medical Society for Sports Medicine (AMSSM) has released a new clinical report that provides guidance to physicians and healthcare professionals who provide care for young athletes.

"Not only are overuse injuries in young athletes likely much more common than is realized, these injuries can require lengthy recovery periods, and in some cases, they can result in long-term health consequences," says lead author John P. DiFiori, M.D., Chief of Sports Medicine and Non-Operative Orthopaedics at UCLA, and AMSSM President.

For the 60 million U.S. children and adolescents between 6-18 years who participate in some form of organized athletics (1), youth sports can be an enjoyable and beneficial experience, offering opportunities to increase self-esteem, peer socialization and general fitness. However, an emphasis on competition, collegiate scholarships and elite-level success has led to increased pressure to begin high-intensity training at young ages, often in only one sport. Consequently, overuse injuries and burnout are affecting many young athletes.

In light of these issues, the AMSSM convened an expert writing group of seven sports medicine physicians to review the latest data and provide recommendations for the sports medicine community.

The full report, entitled, Overuse Injuries and Burnout in Youth Sports: A Position Statement from the American Medical Society for Sports Medicine, was developed through a systematic literature search initially yielding nearly 1,000 articles, followed by author analysis. The findings reveal that the current literature, which reports overuse injuries comprise 50 percent of sports injuries, underestimates the burden of these injuries, since many do not result in time loss from sport.

In addition, this new report highlights several specific higher-risk overuse injuries that may result in prolonged recovery and have the potential to endanger future participation. Although infrequent, some may lead to long-term complications.

The paper also emphasizes that there are several unique risk factors for overuse injuries and burnout in children and adolescents. Social, emotional, cognitive and physical factors all play a role.

"Children grow and mature at different rates, making chronologic age a poor barometer for parents and coaches to set expectations and gauge progress," said Dr. DiFiori, Head Team Physician at UCLA. "Understanding this can be critical to a child's self-esteem and motivation to continue participating."

Other notable findings and recommendations include:

• A history of prior injury is an established risk factor for overuse injuries that should be noted as part of each injury assessment, and pre-participation examination.
• Adolescent female athletes should be assessed for menstrual irregularity as a predisposing factor to bone stress injuries.
• Early sport specialization may not lead to long-term success, and may increase risk for overuse injury and burnout. With the possible exception of early entry sports such as gymnastics, figure skating and swimming/diving, sport diversification should be encouraged at younger ages.
• Limiting weekly and yearly participation time, limits on sport-specific repetitive movements (e.g. pitching limits), and scheduled rest periods are recommended
• Careful monitoring of training workload during the adolescent growth spurt is recommended, as injury risk seems to be greater during this phase.
• Pre-season conditioning programs and pre-practice neuromuscular training can reduce
injury rates.

Source: American Medical Society for Sports Medicine