Overuse Injuries and Burnout in Youth Sports: A Position Statement from the American Medical Society for Sports Medicine

Abstract

Executive Summary BACKGROUND Youth sport participation offers many benefits including the development of self-esteem, peer socialization, and general fitness. However, an emphasis on competitive success, often driven by goals of elite-level travel team selection, collegiate scholarships, Olympic and National team membership, and even professional contracts, has seemingly become widespread. This has resulted in increased pressure to begin high-intensity training at young ages. Such an excessive focus on early intensive training and competition at young ages rather than skill development can lead to overuse injury and burnout. PURPOSE To provide a systematic, evidenced-based review that will: ∘ Assist clinicians in recognizing young athletes at risk for overuse injuries and burnout. ∘ Delineate the risk factors and injuries that are unique to the skeletally immature young athlete. ∘ Describe specific high-risk overuse injuries that present management challenges and/or can lead to long-term health consequences. ∘ Summarize the risk factors and symptoms associated with burnout in young athletes. ∘ Provide recommendations on overuse injury prevention. METHODOLOGY Medical Subject Headings (MeSHs) and text words were searched on March 26, 2012, for MEDLINE, CINAHL, and PsychINFO. Nine hundred fifty-three unique articles were initially identified. Additional articles were found using cross-referencing. The process was repeated July 10, 2013, to review any new articles since the original search. Screening by the authors yielded a total of 208 relevant sources that were used for this paper. Recommendations were classified using the Strength of Recommendation Taxonomy (SORT) grading system. DEFINITION OF OVERUSE INJURY Overuse injuries occur due to repetitive submaximal loading of the musculoskeletal system when rest is not adequate to allow for structural adaptation to take place. Injury can involve the muscle-tendon unit, bone, bursa, neurovascular structures, and the physis. Overuse injuries unique to young athletes include apophyseal injuries and physeal stress injuries. EPIDEMIOLOGY It is estimated that 27 million US youth between 6 to 18 years of age participate in team sports. The National Council of Youth Sports survey found that 60 million children aged 6 to 18 years participate in some form of organized athletics, with 44 million participating in more than 1 sport. There is very little research specifically on the incidence and prevalence of overuse injuries in children and adolescents. Overall estimates of overuse injuries versus acute injuries range from 45.9% to 54%. The prevalence of overuse injury varies by the specific sport, ranging from 37% (skiing and handball) to 68% (running). Overuse injuries are underestimated in the literature because most epidemiologic studies define injury as requiring time loss from participation. RISK FACTORS Prior injury is a strong predictor of future overuse injury. Overuse injuries may be more likely to occur during the adolescent growth spurt. ∘ The physes, apophyses, and articular surfaces in skeletally immature athletes in a rapid phase of growth are less resistant to tensile, shear, and compressive forces than either mature bone or more immature prepubescent bone. ∘ A decrease in age-adjusted bone mineral density that occurs before peak height velocity may also play a role. ∘ Other factors that may contribute are a relative lack of lean tissue mass, an increase in joint hypermobility, and imbalances in growth and strength. ∘ Physeal stress injuries appear to be more during rapid growth and may be to a of of There is little to a between overuse injury and or A of is a risk for stress training to increase the risk of overuse injury in sports. Other factors that may contribute to overuse injury lack ∘ when not for in ∘ as competitive in the or This may be as a for a of for is to the between a of growth and development and the of the competitive sport. age is not a on to sport because and at of and may lack development and of for and ∘ This can in that children and to as are not in sport. ∘ children may and from the sport. may be as training in a sport at the of sports. There is that early sport may increase of overuse injury and sport this has to be training during early and may be more in elite-level in the sport due to skill OVERUSE overuse injuries are that can in loss of time from sport and/or future sport participation. include stress physeal stress some apophyseal and stress ∘ The of the the of the the the the the the the of the and the ∘ A of be for athletes of at the of high-risk bone stress injuries including the or and of the Physeal stress injuries can occur at the and the ∘ most physeal stress injuries with some may in growth and joint in athletes occurs as a of ∘ A of in as of ∘ in a to ∘ for an is of a of that and It has to occur as a of stress that a young to participation in a may be a ∘ that athletes early training from sport either due to injury or bu