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Melanie Cole: There's no handbook for your child's health, but we do have a podcast featuring world-class clinical and research physicians covering everything from your child's allergies to Zinc levels. This is Kids' Health Cast by Weill Cornell Medicine. I'm Melanie Cole, and I invite you to listen in, as we discuss early sports specialization and its effect on our kids. Joining me is Dr. Amy Skaria. She's an Assistant Professor of Clinical Pediatrics in Primary Care and Rehabilitation Medicine at Weill Cornell Medicine. And she's an Assistant Attending Pediatrician at New York Presbyterian Weill Cornell Medical Center. Dr. Skaria, I'm so glad to have you with us. This topic is so great. It's so important right now for parents to hear some of what you and I are going to discuss here today. So first start out, letting parents know what is sports specialization, how did this term come about?

Dr. Skaria: So, sports specialization is a term used to describe when someone chooses a single sport as their main sport, and they quit other sports to focus on this one. It also refers to year round training. So more than eight months out of a year in a single sport. And we define early sports specialization as when a child does this before the age of 12. And to answer your second question, how did this come about? So it's a great question because many people may not have heard this phrase before. If we think about youth sports culture, it's changed significantly in the past few decades, there's been a decrease in funding for public sports. More privatization of youth sports and youth sports are now driven by very competitive adults like parents and coaches rather than kids. So we've seen that the goal of sports participation has shifted from really enjoying the sport to becoming better at it. So now there's even more pressure for kids to participate at a high level specialize in one sport and to play year round, because of that shift in the culture, we started noticing the negative effects which is how the phrase early sports specialization came about.

Host: Yes, I've seen it so much myself as an exercise physiologist and working with so many young athletes it's certainly is pervasive. And I appreciate that you brought up that it's become such a competitive thing. Tell us about some of those injuries that you see then the drawbacks of specialization. Why are we seeing these and really explain to parents how this presents that risk of overuse injuries?

Dr. Skaria: So, specializing in a single sport does predispose your child to injuries, especially if they start at a younger age. So we know about the multitude of benefits for athletes in sports, you have decreased childhood obesity, better emotional and social intelligence, but the drawbacks of specializing in a single sport may not be as obvious to caregivers. So you can get things like acute sports injuries. So those are the bones sprains cuts that we're familiar with, but there's also a higher risk of overuse injuries in these young developing bodies. There's increased rates of burnout. So kids wanting to drop out or quit altogether, and there's also decreased overall athletic development. So if you specialize in a single sport, you tend to have a less creative player.

Host: Isn't that interesting? What great points you just made. As a sports medicine specialist, what's your advice to families that insist their kids should specialize in a single sport because they are so good and maybe they'll play college or make the pros. We've heard this in the field for so many years, but it's not really the case is it?

Dr. Skaria: That's a common belief that this early single sport participation is going to increase your chance of excelling or playing at an elite level. Because we tend to think that the more we do something, the better we're going to be at it. But now there are more and more research studies showing that early sampling of multiple different sports and activities, and developing multiple skills early is actually the key to better and happier players. But the best way to illustrate your point when parents are saying that their kids are going to play in college or make the pros is actually just to talk about the pros. So we have Michael Jordan, his first love was baseball. He only picked up basketball as a secondary sport. Abby Wambach played basketball in high school, and she only started specializing in soccer in college, and then Roger Fetter. And one of my favorites, he talks about how he thinks that his quick reflexes as a tennis player actually come from playing multiple sports as a child, he swam, he played football, and his parents really encouraged him to sample different sports.

Host: Those were great examples, Dr. Skaria when, if ever, is it appropriate for kids to specialize?

Dr. Skaria: I say the later the better and definitely waiting until after puberty.

Host: Thank you for that. And as someone who has a gymnast son who didn't start till he was in high school, but ended up winning state senior year, I can tell you that they don't have to start that early. They don't have to start at four and three years old because as you said, burnout is absolutely pervasive. So let's talk about some of the injuries that you see. So parents are aware whether it's girls in soccer or pitching arms in baseball, tell us about those injuries you're seeing.

Dr. Skaria: So, some of the factors that contribute to these injuries that I'm going to talk about are playing too many hours, not getting enough rest and then poor form or technique. So some common injuries in younger players. First, we have those acute sports injuries I was talking about. One common one is ACL injuries, female athletes who are soccer and basketball players have a high risk of an ACL injury at some point in their career. And for males it's really football that predisposes to that ACL injury. In terms of overuse injury, I want to just talk a little bit about what that means. So it's basically injuries on a muscle or joint that occurred due to repetitive trauma. And it usually occurs when you're taking on too much physical activity too quickly or not getting enough rest. So some of these overuse injuries and throwing athletes like baseball players, you can get conditions called little league shoulder, or little league elbow if you're throwing too much and not getting enough rest. Sports with a lot of jumping or running, you can get knee injuries such as Osgood schlatter, and these injuries will eventually force kids out of competition and out of practice.

Host: They certainly do. So let's talk about the ways to prevent some of these injuries. What can families do to reduce those risks? What can coaches do? Because we hear about equipment is one thing that some parents and even the athletes themselves may feel that the equipment is going to protect them from some of those injuries you're discussing. But tell us a little bit about what we can do and if we are taking off from that particular sport, if they're working with their kids on cross training, doing other things, how long should they do that? So I know it's a lot in one question, but tell parents about prevention.

Dr. Skaria: Yeah, that's several great points. So with equipment, proper fitting equipment is always important to help prevent certain injuries, but it's not going to help if you're over-training and not resting enough. So proper equipment is not going to protect you from overuse injuries. So that's just something that parents and coaches should keep in mind. What parents and coaches can do to really prevent these sports injuries, coaches can look for proper technique and form many times these overuse injuries are worsened by poor technique. And so addressing that's actually going to be part of the recovery plan for the athlete. But I think that the most important thing to do is really just shift that mindset. So it's the responsibility of the adults, the coaches, and the parents to ensure that kids are getting enough rest days, that they're not spending too much time on a single sport or that they're not playing on multiple teams at the same time or the same season.

And then the second part of your question. So how long should a young athlete takeoff from a particular sport? I have some good rules of thumb to use. So the first is that kid shouldn't really play one sport for more than eight months out of the year, they should take at least four months off. They shouldn't participate in more hours of organized sport per week than their age. So for example, a 12 year old shouldn't participate in more than 12 hours per week of an organized sport. And then they shouldn't participate in multiple leagues at the same time.

Host: What great guidelines you just gave us Dr. Skaria, that's excellent for parents to hear and really just so important. So are there some recommendations that you can make for that cross training? Are there certain sports that compliment each other? And then include in there working out, yoga? Do these kinds of things count as cross training?

Dr. Skaria: Yes. To address the multiple sports. So I do encourage kids to play multiple sports during their middle school, high school years, because there's so many benefits, you develop more athletic skills, you're a more creative player, it builds your confidence. And then importantly, you're changing up your routine. So you're not always stressing the same body parts, so you have less injuries. And then of course there's less burnout when you're changing up that routine. So you have a better athlete. You have a happier athlete. Just keep in mind, not to play in more than one team at the same time or in the same season. And then you mentioned cross training. So cross training is a very similar idea that as adults we're more familiar with. So it's training your body with different forms of exercises and movements, adding variety to your fitness routine, which is great for adults and for kids as well. I love low impact activities, ones that focus on improving flexibility and your range of motion while also strengthening. So things like yoga, Pilates, and I also love activities like swimming, water aerobics, and biking. Those are all great for overall conditioning and they don't put a lot of stress on your joints. So yes, I encourage multiple sports and I also encourage cross training in our younger kids.

Host: I think one important question, Dr. Skaria is what should parents do if they think their children may have a chronic overuse injury, as someone who saw that with shoulders, wrists and elbows of a gymnast, we were constantly icing trying to wrap things, doing massage, dry needling, all these different things to try. Are there some things you can recommend for parents if they're starting to notice that their kids are having some of these chronic overuse injuries and when do you feel it's important that they contact a sports medicine specialist?

Dr. Skaria: Yeah. So I think the first thing to do, you mentioned some great things that you can try at home. One thing to do is to always check your gear and make sure that it's fitted properly. Just keeping in mind that kids in middle school and high school are going through these growth spurts. And if, for example, their soccer cleats are too tight or too loose, they can develop pain, but if there's actual real concern for an overuse injury or anything else, that's really just not getting better with some rest and some ice. Then I do highly suggest that they're seen by someone like me, a sports medicine specialist, we treat children pretty differently than we treat adults because their bodies are still growing and their bones, muscles, tendons, ligaments are also still growing. So they're more at risk for getting injured. So we want to make sure we see them as early as we can to start treatment and also to make sure that the problem is not getting any worse.

Host: This is such an informative episode, Dr. Skaria, as we wrap up, give parents, coaches, anyone listening, your best advice about sports specialization, the importance of kids playing sports, because we know that helps to build self-esteem and develop a love for fitness and activity, but not concentrating on only one sport as a young athlete.

Dr. Skaria:  I think that the magic of children is really in their flurry potentiality. So they have an ability to pick up new skills so quickly and they have so much potential. So why extinguish that magic sooner than we have to? So my best advice really is early sport diversification rather than early sports specialization, with the goal of having fun. And like you said, staying healthy,

Host: Absolutely great information. Thank you so much. And families share this show with friends and family that you know, on social media, because we are learning from the experts at Weill Cornell Medicine together. And this is one of those shows where everybody can learn something from this episode. And Weill Cornell Medicine continues to see patients in person as well as through video visits. And you can be confident of the safety of your appointments at Weill Cornell medicine. Thank you so much, Dr. Skaria for joining us today and to our listeners, that concludes today's episode of Kids Health Cast. Please remember to subscribe, rate, and review this podcast and all the other Weill Cornell Medicine podcasts. For more health tips and updates such as this, please follow us on your social channels. I'm Melanie Cole.

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