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 sports specialization, or repetitive stress, injuries are increasing 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 literature to show over the last five to 10 years that the chance of serious muscular and skeletal injury is increased as it relates to the shoulder, elbow and knee (due to sports specialization),” Dr. Jones said. “The literature shows us this is a problem.”

Dr. Jones defines sports specialization injuries as those caused by overuse of a particular muscle or joint, such as the recurring motion of a baseball pitcher.

“A lot of the focus on sports specialization has been on baseball, just because of the number of ulnar collateral ligament reconstructions that we saw happening recently to 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 L.A. Dodgers) pitcher Tommy John, when he was well into his 30s. We were never seeing ulnar collateral ligament injuries in children because kids at that time weren't specializing in overhead sports."

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 kids 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 force to the inside of the elbow on a consistent basis, the ligaments become overused," explained Dr. Jones. "That will cause the ligament to fail. Not only will that ligament fail, but when the ligaments stretch out, secondary stabilizers in the elbow are feeling more force and stress than they should.”

Dr. Jones added that with the progression of sports specialization injuries, we can expect to see more children with ligament damage. Major League Baseball is trying to do its part to curb the injuries by providing a pitch count guide on its website to help coaches and parents track how many pitches their athletes can throw daily.

Shoulder and knee injuries are common in football.

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.

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

“I see it all the time with our women’s gymnastics team,” he said. “So many of them are riddled with injury because they start so young and they put such high forces on parts of the body that weren't meant to be load-bearing, such as the arms."

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 the kid's side, they see the heightened sense of fame and celebrity that comes with being a famous athlete. From the coaches’ side, you have coaches who just want to win and see the potential in a kid. They want that kid to develop and provide a winning edge to the team. Finally, the parents are just like, ‘I want my kid to get a college scholarship,’” Jones said.

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 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 injury,” 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 of injury for different age groups,” Dr. Jones said. “We need specific pitch counts for kids who play Little League Baseball so we can prevent these injuries. We then need to translate those guidelines for basketball, football, track and other sports.”


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