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An Injury Prevention Formula for Adolescents
by Dev Mishra, May 31st, 2013 2:43AM



A new study suggests that adolescents who train more hours per week in a single sport than their age are at significant increased risk of serious overuse injury.

By Dev K. Mishra, M.D.

Results from a three-year prospective observational study on adolescent injuries suggests that there are significant increases in injury risk with certain training behaviors. The study was conducted by Dr. Neeru Jayanthi and colleagues at the Loyola University Chicago Stritch School of Medicine, and presented recently at the annual meeting of the American Medical Society for Sports Medicine. You can read a recap of the study HERE.

This is a very interesting study as the researchers followed a large group of adolescent athletes for three years and recorded a number of facts about the young athletes. Hours of sports participation, numbers of sports played, and types of injuries were some of the key facts obtained.

The study focused on adolescent athletes. There is no firm agreement about the definition of adolescence, but in general adolescence begins with the start of puberty (sometimes as early as age 11) and continues throughout the teenage years. We would broadly define “early adolescence” around age 11-14 and “late adolescence” around age 15-19.

A total of 1,206 athletes participated in the study, and over the course of the three years there were 859 total injuries, including 564 overuse injuries. The overuse injuries included 139 serious injuries such as stress fractures in the back, arms, or legs, elbow ligament injuries and cartilage/bone injuries. These serious injuries can often take months to recover from, and some will require surgery. Unfortunately some will be sport-ending injuries.

Not only does the study point out the statistics of adolescent sport injuries but also starts to get at the core of the reasons for the injuries. There are three topics to observe carefully: sport specialization, hours per week spent on training and games in a single sport, and the athlete’s age.

Single-sport specialization was a significant risk factor for serious overuse injury, regardless of the athlete’s age or the number of hours played.

The number of hours spent per week playing a single sport was an age-dependent risk factor. The researchers found that an athlete who played a single sport more hours per week than their age in years was at risk. For example, an 11-year-old who plays 12 or more hours per week in organized single sport activity is at risk. This is an easy concept to remember.

Risk from single sport specialization tended to decrease once the athlete reached late adolescence, roughly defined as older than 15 years.

In my opinion this study provides compelling evidence for the risks of single-sport specialization for the young adolescent athlete, something many sports medicine professionals have long believed. The researchers will be doing a follow up study to see if they can then reduce injury risk by modifying some of the risk factors.

This is a tough topic to deal with at the national sport level, as trends are moving strongly towards single-sport specialization even at the youngest levels. If you’re a parent of a single-sport athlete watch them carefully for signs of overuse.

Give them a day or more off each week, and if possible give them a month off somewhere during the year. Practice and play fewer hours per week than their age in years. Their bodies will be better for it, and their performance will likely benefit too.

(Dr. Dev K. Mishra is the creator of the injury management program for coaches. He is an orthopedic surgeon in private practice in Burlingame, Calif. He is a member of the team physician pool with the U.S. Soccer Federation and has served as team physician at the University of California, Berkeley. This article first appeared on

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