Injuries among youth athletes are on the rise – but why?

UCLA Health’s Dr. Kristofer Jones explains the trend and its link to ‘sports specialization.’

Ulnar collateral ligament injuries are increasing among youth baseball players.

“Sports specialization” may be an unknown term to many, but for doctors treating young athletes, it has become all too familiar, a reference to specialization in a single sport that can lead to serious injury.

Recent data shows that youth sports specialization can be detrimental both physically and emotionally. This trend has led to increased injuries among athletes under age 18, according to Kristofer Jones, MD, orthopedic surgeon at Ronald Reagan UCLA Medical Center and head team physician for the Los Angeles Lakers.

“Now, we have the studies to show that the chance of serious musculoskeleltal injury from repetitive microtrauma is increased at a time when, due to normal adolescent growth, the body may be particularly vulnerable (due to sports specialization),” Dr. Jones said. “The literature shows a clear correlation between training volume and intensity and injury risk.”

Dr. Jones defines sports specialization as intensive, year-round training in a single sport at the expense of participation in other sports. The problem with this trend is that developing children are focusing on the improvement of specific athletic skills, such as pitching, as opposed to training to improve core physical principles such as flexibility and balance.

Gymnasts often experience sports specialization injuries due to starting at such a young age.

“A lot of the focus on injuries and their relationship to sports specialization has occurred in Little League and high school baseball, just because the number of ulnar collateral ligament (UCL) reconstructions that we were performing was starting to trend upward in kids who are under 18,” Dr. Jones stated.

“The first ulnar collateral ligament construction surgery, or ‘Tommy John’ procedure, was done decades ago by Frank Jobe on the (then Dodgers) pitcher Tommy John, when he was well into his 30s. It was almost unheard of to see UCL injuries in children at that time because kids weren't playing baseball on a year-round basis."

Times were different then, with more middle school and high school athletes participating in seasonal sports such as football or soccer in the fall, basketball or wrestling in the winter, and then in the spring kids were playing baseball.

Now, when young athletes throw consistently throughout the year without giving their arm a break by playing other sports, they become more susceptible to injury.

“When you're throwing year-round, because of the significant force imparted to the inside of the elbow, the ligaments gradually begin to fail," explained Dr. Jones. “Not only will that ligament fail, but when that primary elbow stabilizer is not functional, secondary stabilizers in the elbow begin to experience abnormal loads, leading to bone and cartilage injuries.”

Dr. Jones added that general guidelines to avoid overuse injuries are limiting overall weekly and yearly sports participation time, staying away from repetitive movement, and providing scheduled rest periods. Major League Baseball is trying to do its part to curb these injuries by providing a pitch count guide on its website to help coaches and parents track how many pitches their athletes can throw daily.

High contact sports result in frequent sports specialization injuries

Repetitive stress injuries also are common in other high-velocity sports. In basketball, many players get “jumper’s knee,” or tendinopathy. Common football-related injuries include shoulder and knee ailments and runners are not exempt either. Plenty of cross-country and track and field athletes end up with bone stress injuries from the constant heel strike on the pavement or from jumping.

Dr. Jones also cited gymnastics as a sport in which just about every athlete experiences some kind of sports specialization injury.

“I see it all the time with our women’s gymnastics team,” he said. “So many of them enter the collegiate level with complex injury histories because it is such a physically demanding sport and the culture is one in which they focus on developing an elite skill set when they are almost 5 or 6 years old.”

The exact cause of sports specialization injuries may vary, but the underlying theme is the relentless drive and desire for the athlete to be great – whether that’s generated by the athlete, a parent or a coach.

“From a cultural view, we have created an environment in youth sports where the definition of success is focused on the development of elite skills and winning as opposed to focusing on the development of basic physical health,” Dr. Jones said. “From the kid's side, they see the heightened sense of fame and celebrity that comes with being a famous athlete. From the parent and coaches’ side, they are often focused on developing the athletic potential they see through their selective lens, and the attainment of success is often measured by winning, or obtaining a college scholarship or professional contract.”

With the improvement of training programs, a better understanding of nutrition, and advancements of training technology, younger athletes are generally bigger, faster and stronger in today's sports world. However, Dr. Jones worries there may be a detrimental long-term effect attached to that reality.

“We’re seeing kids with bigger and more developed athletic bodies and better skill sets, but we have to find that balance so that we can allow them to train in a way that makes them better without placing them at such a high risk for overuse injury. Additionally, we have to take into account the mental toll that comes along with specializing, as data shows it can lead to burn out as well,” he said.

“From a sports medicine standpoint, we need to look at the data we’ve been able to collect and look at the risk for overuse injury for different age groups based on their individual sports and physical demands,” Dr. Jones said. “With proper education and use of a multidisciplinary approach, we can ultimately help all stakeholders find an appropriate balance for training that continues to help develop athletic skills but maintains a safe and enjoyable environment.”


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