Risk of Overuse Injury and Burnout as Consequences of Early Specialization in Youth Sports

Purpose: In the US, 60 million children participate in organized youth sports yearly and there is a growing emphasis on athletes specializing in a particular sport and developing their skill. Sports Specialization has been defined as participation in a single sport, which entails quitting all other sports, while also participating in year-round training (>8 months per year). The consequences of specializing in one sport at an early age including risks of overuse injuries, greater susceptibility to early burnout, and lack of social development. The purpose of the present study is to explore the literature related to youth sports specialization and its relationship to burnout and overuse injuries. Methods: A literature review was conducted using electronic databases, and the reference list of the relevant articles was screened for titles and abstracts containing the keywords. The keywords used included specialization, youth athletics, burnout, adolescence, children, organized sport, overtraining syndrome, awareness, prevention. The retrospective search was limited to: articles in English; studies in the US; articles including athletes in high school or younger; articles including overuse injury, burnout, specialization in the title or abstract. Based on above criteria, the search yielded 28 articles that included case studies, qualitative and quantitative studies, and systematic reviews. Results: Specializing in a single sport as well as participating in many hours per week training can lead to overuse injuries. Youth athletes who participated in more hours of training or specialized early were more likely to report history of injuries, particularly in lower extremities. Early sports specialization was associated with an increased risk of developing anterior knee-pain pathologies compared to their multi-sport counterparts. Compared to healthy athletes, injured athletes spent more hours per week in sports and there was an independent risk of injury and overuse injury in athletes specializing in a single sport. Burnout and dropout are positively correlated in youth athletes. Main factors contributing to sports dropout were lack of support from school friends, lack of support from teammates, and pressure from parents. Additionally, players that dropped out began their training at a younger age and participated in more hours per year training between ages 12-13. One study used an athlete burnout questionnaire and found that, compared to multi-sport athletes, specialized athletes reported higher levels of burnout, a reduced sense of accomplishment, sport devaluation, and exhaustion. Conclusion: These findings indicate that levels of specialization are related to psychological burnout and increased rate of overuse injuries in youth athletes, primarily through time spent in sports. Yet there is a further need for more research into whether multisport athletes are at a decreased risk of injury due to engagement in a broader set of movements and thus overall muscle strength and stability, or whether it is due to less hours spent overtraining one muscle group. Overall, educational programs should be developed to educate parents and coaches about risks of overtraining, early signs of overuse injuries, and positive ways to build a youth athlete’s confidence in their ability to play sports to avoid injury and burnout.