sports specialization - texas children's hospital · specialization and injury • roos kg,...
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Texas Children’s Professional Education SeriesOrthopedics & Sports Medicine 2018
Sports Specialization
Scott McKay, MDOrthopedics
Why Sports for Youth?Physical Benefits
Decreasedobesity
Cardiovascularbenefits
Strength benefits
Bonehealth
Better sleep
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Texas Children’s Professional Education SeriesOrthopedics & Sports Medicine 2018
Selfconfidence
Why Sports for Youth?Psychosocial Benefits
Friendships
Purpose
Alternative tomore nefariousactivities
Sports Specialization
• Focus on one sport
• Year round
DEFINITION: SPORTS SPECIALIZATION
• Participation of one sport at the exclusion of other sports
• More than 8 months per year
• Prior to age 12
AOSSM has defined EARLY SPORTS SPECIALIZATION
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Texas Children’s Professional Education SeriesOrthopedics & Sports Medicine 2018
• Scholarship
• Win
• Improve skills
• Certain sports demand it
Why Specialize?
Certain Sports RequireSpecialization for Success
Competitivegymnastics
?Golf
?Fencing?Competitive
cheer
Ballet
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Texas Children’s Professional Education SeriesOrthopedics & Sports Medicine 2018
Specialization Possibly Harmful?
• Track
• Basketball
• Wrestling
• VolleyballBaseball Football Softball Soccer
Odds of Playing College
1% receivescholarship
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Texas Children’s Professional Education SeriesOrthopedics & Sports Medicine 2018
Sports Specialization: Why Do We Care?
• Growing body of literature to suggest thatearly sports specialization contributes to
• Injuries: Acute & Overuse
• Burnout
• Depression
Sports Specialization• The Business of Youth Sports
• Estimated $9-15 billion industry
• Families spend thousandsof dollars/year
–Travel teams
–Showcases
–High level private coaching
–Personal trainers/performance
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Texas Children’s Professional Education SeriesOrthopedics & Sports Medicine 2018
Sports Specialization
Studies Showing Association withSpecialization and Injury
• Roos KG, Marshall SW, Kerr ZY, et al.Epidemiology of overuse injuries in collegiateand high school athletics in the United States.Am J Sports Med. 2015;43(7):1790–1797
• Schroeder AN, Comstock RD, Collins CL,Everhart J, Flanigan D, Best TM. Epidemiologyof overuse injuries among high-school athletesin the United States. J Pediatr.2015;166(3):600–606
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Texas Children’s Professional Education SeriesOrthopedics & Sports Medicine 2018
MLB Pitch Smart 2014
Age
Daily Max(Pitchesin Game) Required Rest (Pitches)
0 Days 1 Days 2 Days 3 Days 4 Days 5 Days
7-8 50 1-20 21-35 36-50 N/A N/A N/A
9-10 75 1-20 21-35 36-50 51-65 66+ N/A
11-12 85 1-20 21-35 36-50 51-65 66+ N/A
13-14 95 1-20 21-35 36-50 51-65 66+ N/A
15-16 95 1-30 31-45 46-60 61-75 76+ N/A
17-18 105 1-30 31-45 46-60 61-80 81+ N/A
19-22 120 1-30 31-45 46-60 61-80 81-105 106+
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Texas Children’s Professional Education SeriesOrthopedics & Sports Medicine 2018
AAP/AOSSM/Pitch Smart Recommendations
• No year round pitching (<8 months preferred)
• No pitching while fatigued
• Follow pitch-count and rest guidelines
• Do not pitch on 2 simultaneous teams
• Do not catch and pitch
• No curveball until 14, slider at 16
• Appropriate strength & conditioning
• Watch yourself at showcases
• Put away the radar gun
• Age, height, multiple teams, velocity, arm fatigue
• Pitches per game for shoulder injuries
• GIRD, shoulder adduction not significant
Am J Sports Med. April 2018
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Texas Children’s Professional Education SeriesOrthopedics & Sports Medicine 2018
AAP/AOSSM/Pitch Smart Recommendations
• No year round pitching (<8 months preferred)• No pitching while fatigued• Follow pitch-count and rest guidelines• Do not pitch on 2 simultaneous teams• Do not catch and pitch• No curveball until 14, slider at 16• Appropriate Strength & Conditioning• Watch yourself at showcases• Put away the radar gun
PRiSM – Pediatric Research inSports Medicine
• Multidisciplinary society dedicated tofurthering knowledge to improve the careof young athletes
• Multiple ResearchInterest Groups
• Sports Specialization Group
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Texas Children’s Professional Education SeriesOrthopedics & Sports Medicine 2018
2017-18 Project
• Multicenter, multi-region athlete self-reportedstudy of teenage soccer specialization and itseffects on injuries
• Online survey hosted by Qualtrics. IRB approvedfor link distribution via email, social media, flyers
• 761 completed surveys by soccer players age12-18. 431 female
Specialization Correlated withKnee Injuries
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Texas Children’s Professional Education SeriesOrthopedics & Sports Medicine 2018
Overuse Injuries by sport
• Baseball – shoulder/elbow
Internal Impingement
Undersurface ofsupraspinatus hittingposterior superiorglenoid rim
https://link.springer.com/chapter/10.1007/978-3-319-57334-2_10
https://link.springer.com/chapter/10.1007/978-3-319-57334-2_10
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Texas Children’s Professional Education SeriesOrthopedics & Sports Medicine 2018
Elbow Issues
• Traction forces medially– Medial epicondyle apophysis
– Ulnar collateral ligament
• Compression forces laterally– Osteochondritis dissecans
Soccer
• ACL injuries
• Patellofemoralpain
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Texas Children’s Professional Education SeriesOrthopedics & Sports Medicine 2018
Prevention of Knee Injuries
• Sportsmetrics
• US club soccer “11+”
• CHOP “ready set prevent”
• Santa Monica ACL prevention project(US Soccer)
Swimmer’s Shoulder
• Repetition of badtechnique = injury
• PT & relative rest
• Prehab & maintenance
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Texas Children’s Professional Education SeriesOrthopedics & Sports Medicine 2018
Water Polo Shoulder Injury
• 25-80% of elite playersage 16-33
• Acute dislocation andchronic overuse pain
• Need proper swim &shot technique
Track/Cross Country
• Stress fractures– Tibia/foot/femur
• Shin splints
• Foot pain
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Texas Children’s Professional Education SeriesOrthopedics & Sports Medicine 2018
Lots of OrganizationsHave Position Statements
Brenner JS, Council on Sports Medicineand Fitness. Sports Specialization andIntensive Training in Young Athletes.Pediatrics. 2016;138(3):e20162148.doi:10.1542/peds.2016-2148.
AAP
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Texas Children’s Professional Education SeriesOrthopedics & Sports Medicine 2018
Others
• AMSSM
• AOSSM
• NATA
• European College of Sport Science
Summary
• Sports are good
• Odds of scholarship are small
• Specialize by late adolescence if at all
• Follow published guidelines to avoidpsychological and physical consequences