Early Specialisation and Injuries in Children's Sport

Many of the Australian sporting agencies have long promoted that early specialisation in sport seems to correlate with children experiencing more significant injuries early in life. Theoretically children have not organised all of their personal movement patterns by an early age.  In effect they are still learning how to use their bodies.  It is no surprise when you hear of the premier league footballer who had a background in ballet.  Of course ballet may not be for everyone but learning the agility, body balance and control will always transfer into the child’s other endeavours. Broadly early specialisation can be defined by training more than three times a week and not participating in other activities before the age of 14.

Recently the SBS TV program “Insight” aired an excellent broad panel discussion (Kids sports injuries - 5th March 2019) to consider the issues around the increase in children suffering significant injuries earlier in their sporting lives. Notably children aged 11-16 are most likely to be hospitalised for a sporting injury. The experts on the panel included Professor Gary Browne from Westmead Children’s Hospital, Dr Chris Vertullo who is a Brisbane based Orthopaedic Surgeon and Alanna Antcliff who is the current Australian netball physiotherapist.  Here are some of the issues that were discussed in reference to Australian statistics and in discussion with the experts :

Overtraining injuries/Early Specialisation

• Children may not have adequate healing time when combined with high levels of repetitive movements, especially during growth spurts when the body needs to rest.
• Overtraining can lead to a higher degree of injuries which are more commonly associated with adults. An example being 9 and 10 year olds suffering from ACL ruptures.

Changing Recreation Activities

• Children become less agile as they spend more time on screens and less time outside running jumping and playing. This leads to less expert movement patterns and a higher propensity to injury.

ACL Prevention Programs

• There has been a 74% increase in ACL reconstructions in Australia in the last 10 years in patients under 25 years of age. The greatest growth has been seen seen in the 5-14 year age group showing the largest increase of 7% each year. Women are 2- 5 times more likely to suffer an ACL injury with AFL and Netball being two of the more higher risk sports.
• FIFA 11 Plus and Netball Australia Knee programs are evidencing up to 50% less ACL injuries. These are freely available programs but have not been embraced by the community sports associations. They require three efforts per week with a mixture of agility and neuromuscular control training. Some components of these programs have also evidenced decreased rates in injuries such as hamstring strains (Nordic hamstring protocol) and I am sure in the future that other injuries such as ankle sprains may decrease with the use of these programs.

Concussion

• The SMA (Sports Medicine Australia) has some clear and well developed protocols when considering concussion in sport. The player must stop playing that game and requires rest prior to returning to full activity. This might normally be about 10-14 days but can be much longer particularly in adolescents and children. So this decision is best made in consultation with a medical practitioner.
• Females have a higher rate of concussion, a contributing factor may be because girls have 50 percent less neck strength. A strengthening neck program may help avoid these concussions.  Younger children with a relatively large skull size are also more at risk.

Overall, injury prevention here is the key. The trainer/parent who is aware that over-training may be occurring needs to adapt the child program accordingly. Injury during growth spurts do occur and this might especially be a time to review a child’s activities. Try to diversify a child’s activities and consider the programs such as the Fifa and Netball Australia programs for injury prevention. The child and adolescent continue to develop emotionally and physically and these can both be influenced positively by their continued participation in sport. Should you feel out of depth when considering these issues or your child seems to be getting injured a lot it may be time to talk to a physiotherapist or other qualified health professional.

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