The Right Way to Play: The Controversy Behind Early Sports Specialization

by Robert Pagán-Rosado, MD & Walter Alomar-Jimenez, MD, JD

Sports specialization is defined as choosing a single sport and/or quitting others to focus on one sport for more than eight months per year.(1) Year-round training and focused participation in a single sport has become more common among young athletes around the world. In most cases, this type of practice is driven by the pursuit of scholarships, strong desire of talent recognition, and a goal of reaching the elite level.(2) Sports that strongly require technical skills such as diving, swimming, figure skating, and gymnastics first led to early sports specialization in Eastern Europe many years ago. This led to earlier recruitment of future champions in the primary school years, and subsequently introducing them to development programs intended to increase chances of success.(3,4) Although these programs produced world-renowned Olympians and highly-paid professional athletes, there is great controversy regarding the potential effects of early sports specialization in young athletes. Interestingly, there is still a strong debate to determine whether early sports specialization is required to become an elite athlete.(5)

One of the undesirable consequences that early sports specialization may have on young athletes is the incidence of overuse injuries due to the lack of musculoskeletal maturation and neuromuscular skills. Over-scheduling competition, lack of rest, and higher volume of intensified specialized training are some of the main factors associated with injury.(2, 5) Equilibrium, hand-eye coordination, overall muscle strength, flexibility, and rest from repetitive use of the same body segments may be acquired by diversifying physical activity at an early age, thus providing protection against overuse injuries. Specifically, literature has shown that engaging in multiple sports during childhood provides much of the above mentioned benefits as well as other cognitive and behavioral skills. But aside from physical consequences, the excessive psychological stress that specialized high-intensity training may have on a young athlete may translate to burnout, frustration, and premature sport abandonment.(6) On the other hand, one must be careful along the way and not discourage sports participation since quitting recreational sports at an early age may lead to physical inactivity that could later in life translate to preventable chronic health issues.(7)

Current evidence suggest that early specialization does not guarantee elite sport performance.(10) A study in which 35,000 young Russian athletes were selected to train in sport schools found that only 0.14% reached high-level status.(8) Another study involving NCAA Division 1 athletes found that approximately 70% did not specialize in their sport until at least age 12 years, and 88% had participated in more than one sport.(9) Moreover, these university athletes specialized at an older age compared with non-athlete students at the same university. Athletes dedicated to team sports such as baseball, basketball, and volleyball tend to have participated in different sports at younger ages and specialized later during adolescence.(10) Regarding individual sports such as tennis, gymnastics, and swimming, early specialization may be beneficial to reach the elite level.(9,10)

Among national sports organizations, new proposals are being introduced for future sport development projects.(11) These stratify an athlete’s development to direct the way they should be trained. One of the goals is to keep them participating in a safe manner, which may increase their chances of reaching a competitive level. For example, the United States Tennis Association divides sports participation in three phases:

1. Age 12 years and under: Athlete discovers the game, enjoys it, develops basic skills while he or she engages in other sports.
2. Ages 12–15: Athlete further understands the sport and the importance of specialized training to prepare for competition.
3. Ages 15–18: Athlete is fully involved in the sport, dedicates full time to training, and prepares for competition in order to become an elite player.

These phases take into account social, psychological and physical aspects that influence the transition from recreational to competitive sports in a typical young athlete. Moreover, these guides may help decrease the incidence of overuse injuries, burnout, and sport abandonment in young athletes.

In Summary, recent evidence has converged to advise the following recommendations for parents and coaches:(10)

1. Unstructured play should be provided to youth for development of motor skills throughout growing years.
2. Encouragement of participation in a variety of sports, specially those that the child enjoys.
3. Close monitoring for those children who engage in more than 16 hours per week of intense training.
4. Youth who are specialized in sports activities should be monitored for overuse injuries and burnout.
5. Strength conditioning should be included in the training regimen of all youth for competitive participation preparation, specially for those specialized in a single sport.

References:

1. Jayanthi N, Pinkham C, Dugas L, Patrick B, Labella C. Sports specialization in young athletes: evidence-based recommendations. Sports Health. 2013; 5:251–257.
2. Jayanthi NA, LaBella CR, Fischer D, Pasulka J, Dugas LR. Sports-specialized intensive training and the risk of injury in young athletes: a clinical case-control study. Am J Sports Med. 2015;43:794–801.
3. Mostafavifar AM, Best TM, Myer GD. Early sport specialization, does it lead to long-term problems? Br J Sports Med. 2013;47:1060–1061.
4. Finley B. A single goal in common. New York Times. December 17, 2006. http://www.nytimes.com/2006/12/17/nyregion/nyregionspecial2/17Rsports.Accessed November 13, 2019.
5. Myer GD, Jayanthi N, Difiori JP, Faigenbaum AD, Kiefer AW, Logerstedt D, et al. Sport Specialization, Part I: Does Early Sports Specialization Increase Negative Outcomes and Reduce the Opportunity for Success in Young Athletes Sports Health. 2015;7(5):437–42.
6. American Academy of Pediatrics. Intensive training and sports specialization in young athletes. Pediatrics. 2000; 106:154–157.
7. Biddle SJ, Pearson N, Ross GM, Braithwaite R. Tracking of sedentary behaviors of young people: a systematic review. Prev Med. 2010;51:345–351.
8. Ljach W. High-performance sport of children in Russia. Leistungssport. 1997;27:37–40.
9. Quitiquit C, DiFiori JP, Baker R, Gray A. Comparing sport participation history between NCAA student-athletes and undergraduate students. Clin J Sport Med.2014;24(2).
10. Myer GD, Jayanthi N, DiFiori JP, Faigenbaum AD, Kiefer AW, Logerstedt D, et al. Sports Specialization, Part II: Alternative Solutions to Early Sport Specialization in Youth Athletes. Sports Health. 2016;8(1):65–73.
11. Micheo, W. Especialización deportiva temprana en tenis: Riesgos y Beneficios https://www.usta.com/es/home/stay-current/caribbean/virginislands/early-sports-specialization-in-tennis--risks-and-benefits.html. Accessed November15, 2019.

Robert Pagán-Rosado is a PGY1 at Hospital Episcopal San Lucas & incoming PM&R Resident at Mayo Clinic Department of Physical Medicine and Rehabilitation. Follow him on Twitter @rdprMD.

Walter Alomar-Jimenez is a clinical lecturer at the University of Michigan Department of Physical Medicine and Rehabilitation.