Should My Child Play Just One Sport?

Let's start the year with a controversial topic shall we?! There is an on going out cry among many in the sports medicine community to stop young athletes from specializing in just one sport.  We are a country of bigger is better--when it comes to a Samsung TV I can't really argue. When it comes to training for Little League there is some room for debate.

Figure #1

Using baseball for example, we are seeing some disturbing trends over the last decade.   More Ulnar Collateral Ligament tears (Tommy John) are occurring in youth throwers. Figure #1 shows the percentage growth of UCL tears in youth and high school throwers according to the American Sports Medicine Institute.  Not only are there more tears we are seeing these in younger and younger players.  So why the trend?

Intuitively, one would think that we are seeing more injuries because children are spending more hours playing a sport.  A very interesting paper was just released in The American Journal of Sports Medicine in 2015 stating that the specialization of sport may in itself be harmful.  The title Sports-Specialized Intensive Training and the Risk of Injury in Young Athletes by Jaynathi, et al. was a case controlled study using youths age 7-18. 1

The children filled out surveys and were placed into groups depending on their level of specialization.  Low, moderate, and high specialization were determined by answering 3 questions:  "Can you pick a main sport?" "Did you quit other sports to focus on a main sport?" "Do you train > than 8 months a year?"  The athletes medical records were than analyzed for minor and major injuries, including overuse verses acute injuries. 1

Results showed as we would somewhat expect that injured athletes were older and spent more time in organized sports.  However, they also had higher specialization scores.  Also, youths with the serious overuse injuries were almost 2 times (1.90) more likely to be highly specialized compared with non-serious overuse injuries.  An interesting point from the study was that specialized athletes were not at more risk of getting acute injuries like ACL tears.  These are the accidents that just happen to our kids, the slips and falls.  However, the specialized kids are much more likely to experience the chronic severe stress fractures, spine injuries, and yes the UCL tear.

Me, my senior year of college. After having surgery on my own chronic shoulder injury.

One final thought on overuse in the specialized athlete comes from the authors Jayanthi and his counterparts at Loyola. "There is an increased risk of serious overuse injury for athletes who spend numerically more hours per week participating in sports versus their age in years."1   

Great resources exist for how to limit the impact of intensive sport on young athletes.

Multisport

• Stop sport injuries

Softball

• Coach Safely

Soccer

• Momsteam

Baseball

• Pitchsmart from MLB 
• ASMI 

Sources:
1. Jayanthi N, LaBella C, Fischer D, Pasulka J, Dugas L. Sports-Specialized Intensive Training and the Risk of Injury in Young Athletes: A Clinical Case-Control Study. The American Journal of Sports Medicine. 2015;43(4):794-801. doi:10.1177/0363546514567298.

2. http://www.asmi.org/research.php?page=research&section=UCL

What is the Labrum Anyway?

Many of our patients have heard the story of my college softball career.  I am not here to go into details about it, but I do like for patients to know that I have also had shoulder surgery.  A labral repair to be exact--and during my junior year of college softball no less.

Of all the structures in the shoulder, I think the labrum is most difficult to visualize.  We refer to the shoulder as a "ball and socket" joint.  Describing the humerus (upper arm bone) as the ball, and the glenoid of the scapula (shoulder blade) as the socket.  (Figure #1)  If one thinks about the ball of the humerus sitting like a golf ball on a tee, the labrum would be a ring around the tee to deepen it keeping the ball more stable.  If this system worked 100% of the time we would all be very happy and I would be out of a job.  Unfortunately injuries happen and force that humerus off the glenoid either partially or completely.

Injuries can include falls, pulling, pushing, repetitive injuries like throwing, impact directly to the shoulder, and motor vehicle accidents.  Events like falls may cause the shoulder to fully dislocate in that case there is often injury to the labrum.  Repetitive overhead throwing can pull on the top (superior) labrum where the biceps attaches.

Figure #1

The labrum is surgically described like the face of a clock with 12, 3, 6, and 9 o'clock positions.  Look at Figure #2.  The center picture shows the labrum looking straight on, at the 12 o'clock position you see a tendon attaching.  This is the biceps tendon and is an important      landmark for labral tears.  Labral tears involving the superior portion of the labrum and or the biceps are called SLAP tears.  There is an entire classification system for them, if you would like to see if check here.

Tears of the labrum do not heal. However, small tears may not feel as symptomatic and can stay stable for a period of time.  Larger tears should be repaired to prevent instability, pain and degeneration of the shoulder.  Surgery is an outpatient scope procedure that involves placing sutures through the torn labrum.  These sutures are then anchored to the bone.  Depending on your level of activity most people return to recreational activities around 4 months post operative and competitive sports closer to 6 months.

Figure #2

Speaking from experience, shoulder surgeries are not fun! But with diligent physical therapy and rehabilitation labral repair surgery can be a success.