Parents vs. Science in Youth Sports. Who Wins?

What parents and their youth athletes consider sport specialization and what science defines it as is starkly different according to a new study, “Sport Specialization and Increased Injury Frequency in Youth Baseball Players: A Prospective Study,” published in a special thematic issue on sport specialization in The Journal of Athletic Training, the scientific publication of the National Athletic Trainers’ Association.

This study included 159 asymptomatic, competitive male baseball players, ages 9 to 12 years. Each player had their baseline flexibility and strength assessed and then they were prospectively followed for 6 months.

Of the 159 players, only 31% of them self-classified as specialized; however, when the researchers used scientific standards to reclassify, 83% were actually considered to be specialized.

According to the data collected there was an arm-injury incidence rate of 2.22 per 1,000 athlete-exposures among the players. In addition, the frequency of arm injuries was higher in specialized players than in nonspecialized players (100% vs. 80%; p = .03), but did not differ between pitchers and position players (13.2% of each; p = 1.00). The researchers called for larger studies with longer follow-ups.

“We found it alarming that most athletes misclassified themselves as not specializing in sport when scientifically, they fell into the specialization category. This suggests not only a huge disconnect between community perception and scientific understanding of youth sport specialization, but the potential risks associated with specializing too soon,” the lead author Amanda J. Arnold, Ph.D., DPT, OCS, CSCS.

She added, “Parents should speak with a medical professional such as an athletic trainer to ensure their youth athlete is not putting their health at risk.”

OTW asked Stephen Fealy, M.D., a sports medicine surgeon at Hospital for Special Surgery, who was not involved in the study, for a physician’s take on the findings and this is what he had to say:

OTW: How might these findings affect physicians treating these types of patients?

Dr. Fealy: “This is a good study, but we do need to take into consideration the cohort of patients that were used. Nine to 13 year old athletes are considered a young group of players so this study is an early look at a potentially prone group of athletes. The main takeaway for me is the parents.”

“There can often be a large disconnect between reality and what parents think their children ‘will be.’ While orthopedic surgeons are not counselors, it is important to have pattern recognition. Players often come in with throwing coaches or strength coaches, and the data and performance of the athlete does not correlate with expectations.”

“In my opinion, this is equally as important as the diagnosis. The good news is that athletes at this age can easily remedy their often soft tissue ailments with proper rehabilitation.”

OTW: If a baseball player is specializing in baseball but tells his doctor that he is not, could that affect any treatment or recovery from injury?

Dr. Fealy: Absolutely. It’s so important to make sure that there is continuity of care. Now with email and social media, patients often do not prioritize a follow-up appointment. Non-surgical cases may not always be on our radar to make sure patients commit to a 6-week follow up appointment. These players will frequently follow up closer to 9-12 months with tightness and soreness from overuse injuries.”

“This cohort of athletes are young and likely doing a lot of other things so their daily schedule is not as well-documented as higher level athletes’ may be. Therefore, it is possible that physicians may miss the subtle signs of overuse and early extra or sub specialization if there’s no regular check-in.”