Have you ever wondered if your kids are training too much? Are they attending too many practices, or at risk for injuries? Are they playing too many sports simultaneously? Is there such a thing as too much practice? The latest research provides some answers to these questions. To avoid overuse injuries, current research suggests parents and coaches focus on four things: a thorough pre-participation physical exam during which risk factors and predisposing musculoskeletal conditions can be identified; maintaining their athlete’s strength, endurance, and flexibility before, during and after the season; limiting practice time to no more than five days a week (with at least 1 to 2 days off each work) and monitoring total activity time; and cross-training during between-season and summer breaks to allow injuries to heal, refresh their minds, and work on strength, conditioning, and proprioception.
What the research says:
As busy parents with active kids, we all realize that children playing high-level sports are asked to practice more frequently for more hours throughout more months of the year. In addition, many children participate in multiple sports simultaneously. Thus the number of cumulative practice hours have led to increased concern of overuse injuries, with “overuse injuries, overtraining, and burnout among child and adolescent athletes … a growing problem in the United States ”. What is an overuse injury exactly? The technical definition is “microtraumatic damage to a bone, muscle, or tendon that has been subjected to repetitive stress without sufficient time to heal or undergo the natural reparative process ”. That’s an elaborate way of saying overuse injuries are caused by doing too much to the muscles or joints without sufficient rest. Overuse can be caused by exacerbated growth-related disorders, such as Sever’s Disease and Osgood-Schlatter’s Disease, or mechanical overloading, such as stress fractures. Whatever the biological cause, though, overuse injuries affect the lives of too many young athletes and is projected to account for as much as 50% of pediatric sports medicine injuries .
What can you do to avoid overuse injuries in your child? The National Athletic Trainers’ Association and the American Academy of Pediatrics have both released position papers recently focused on the prevention of pediatric overuse injuries [3, 6]. Their position statements have the following recommendations for parents, coaches, and doctors of young athletes:
1. Don’t skip the Pre-participation Physical Exams
The pre-participation physical exam is thought to be foundational to decreasing overuse injuries, as it is important for detecting injuries, identifying risk factors, and surveying biomechanical and musculoskeletal conditions that could predispose your child to injury or illness . It also provides an opportunity to discuss nutrition, burnout and other topics with a medical professional. Although the pre-participation physical exam is often required for high-school sports, it may not be required for recreational or club sports, and when done, may be done incompletely or inconsistently. An example of a thorough pre-participation physical exam form can be found by clicking on this link to the North Dakota High School Activities Association’s Pre-participation Physical Evaluation Form.
2. Help your player get in shape BEFORE they start a sport
Young athletes should get in shape before starting a sport. That may sound counterintuitive, but it’s based on the fact that strong muscles and joints are less susceptible to injury. “All pediatric athletes should begin by establishing a good general-fitness routine that encompasses strengthening, endurance, and flexibility, and this training should precede the start of sport-specific training .” Results have shown that injuries decrease when athletes participate in strengthening and flexibility regimens [9-11], which supports the need for sustained athleticism and cross-training prior to, during, and after the season.
3. No more than 5 in 7
“The American Academy of Pediatrics Council on Sports Medicine and Fitness recommends limiting practices to a maximum of 5 days per week with at least 1 day off from any organized physical activity .” Your child’s team probably doesn’t practice more than five times a week, so you’re probably thinking, “we’re fine there”. But does your child play on multiple teams? Or is he or she participating in multiple sports simultaneously? Is your son playing basketball during his winter soccer season? Or does your daughter play lacrosse while participating in the fencing team? If so, your child may be practicing more than 5 days a week.
You may also want to consider the total number of hours your child spends participating in sports each week. “Some data suggest a general guideline of no more than 16 to 20 hours per week of vigorous physical activity by pediatric athletes .” This guideline is based on a study examining the relationship between hours of vigorous activity and incidence of stress fractures in girls younger than 17 years old. The study found “there is a threshold over which the risk of stress fracture increases significantly among adolescent girls”, and this number was found to be more than 16 hours per week of vigorous physical activity . In a similar study, the activity levels of both boys and girls were correlated to the incidence of bone fractures, and the results again showed that “daily or more episodes of vigorous physical activity increases fracture risk in children” . Although the results of these studies are specific to their particular study designs, they do provide evidence that parents should also consider the total number of hours their children spend participating in vigorous activity.
Parents are also encouraged to limit their athlete’s participation to only 1 team during a season. If the athlete is also a member of a traveling or select team, then the parent is advised that cumulative participation time should be meet the 5-in7 guidelines mentioned above.
4. Every kid needs a break from the action
“Pediatric athletes should take time off between sport seasons and 2 to 3 nonconsecutive months away from a specific sport if they participate in that sport year round .” If you’re like me, you’re probably thinking that 2 to 3 months off would negate all of the hard work that your child has put in during the season. It would be tantamount to the brain drain that many kids suffer over the summer. But the recommendations really suggest your child focus on other sports or skills during inter-seasonal and summer breaks (hence the word nonconsecutive in the recommendation). Experts recommend pediatric athletes use these breaks to allow injuries to heal, refresh their minds, and work on strength, conditioning, and proprioception in hopes of reducing injury risk. This harkens back to point #2 above and reinforces the benefit of maintaining overall physical health, flexibility, endurance, and athleticism while providing a physical and mental break from their sport-of-choice.
What does this all mean to you?
If you’ve ever asked yourself the question “are they doing too much”, you now have a framework for an answer. Each child will be different, and each parent has different things to consider. But in general, if your child follows the recommendations above, it is likely that they will be able to participate in sports injury-free.
1. Sports-related injuries in youth athletes: is overscheduling a risk factor? Luke A, Lazaro RM, Bergeron MF, Keyser L, Benjamin H, Brenner J, d'Hemecourt P, Grady M, Philpott J, Smith A. Clin J Sport Med. 2011 Jul;21(4):307-14.
2. Pediatric overuse injuries in sports. Hoang QB, Mortazavi M. Adv Pediatr. 2012;59(1):359-83.
3. National Athletic Trainers' Association position statement: prevention of pediatric overuse injuries. Valovich McLeod TC, Decoster LC, Loud KJ, Micheli LJ, Parker JT, Sandrey MA, White C. J Athl Train. 2011 Mar-Apr;46(2):206-20. doi: 10.4085/1062-6050-46.2.206.
4. Aetiology and prevention of injuries in elite young athletes. Maffulli N, Longo UG, Spiezia F, Denaro V. Med Sport Sci. 2011;56:187-200. doi: 10.1159/000321078. Epub 2010 Dec 21. Review.
5. Evaluation of overuse injuries in children and adolescents. DiFiori JP. Curr Sports Med Rep. 2010 Nov-Dec;9(6):372-8. doi: 10.1249/JSR.0b013e3181fdba58.
6. Overuse injuries, overtraining, and burnout in child and adolescent athletes. Brenner JS; American Academy of Pediatrics Council on Sports Medicine and Fitness. Pediatrics. 2007 Jun;119(6):1242-5. Review.
7. Overuse injuries in adolescent athletes. Dalton SE. Sports Med. 1992 Jan;13(1):58-70. Review.
9. Effectiveness of a home-based balance-training program in reducing sports-related injuries among healthy adolescents: a cluster randomized controlled trial. Emery CA, Cassidy JD, Klassen TP, Rosychuk RJ, Rowe BH. CMAJ. 2005 Mar 15;172(6):749-54.
10. Prevention of soccer injuries: a prospective intervention study in youth amateur players. Junge A, Rösch D, Peterson L, Graf-Baumann T, Dvorak J. Am J Sports Med. 2002 Sep-Oct;30(5):652-9.
11. The FIFA 11+ program is effective in preventing injuries in elite male basketball players: a cluster randomized controlled trial. Longo UG, Loppini M, Berton A, Marinozzi A, Maffulli N, Denaro V. Am J Sports Med. 2012 May;40(5):996-1005.
12. Correlates of stress fractures among preadolescent and adolescent girls. Loud KJ, Gordon CM, Micheli LJ, Field AE. Pediatrics. 2005 Apr;115(4):e399-406.
13. Vigorous physical activity increases fracture risk in children irrespective of bone mass: a prospective study of the independent risk factors for fractures in healthy children. Clark EM, Ness AR, Tobias JH. J Bone Miner Res. 2008 Jul;23(7):1012-22.