When sports medicine physician Rebecca L. Carl, M.D., M.S., FAAP, advises families that their young athlete needs to take time off from a sport due to an injury, overtraining or burnout, she often hears a common complaint.
“But you don’t understand!” they tell her.
“And I always laugh because I’ve been doing this for a while, and I think I have a pretty good understanding of it. But I do understand … when you love something and you’re really committed to it, it’s really hard to take a break,” said Dr. Carl, chair of the AAP Council on Sports Medicine and Fitness.
An updated AAP clinical report says pediatricians should encourage athletes to take at least one to two days off a week from competition and sport-specific training, as well as two to three months a year away from a specific sport, to help them recover physically and psychologically.
“It’s tough because kids are really committed to their sports and they love doing it,” said Dr. Carl. “And there’s often a big social piece — their friends are on the team.”
But kids also need time for homework, family responsibilities, free play and downtime, she added.
The report Overuse Injuries, Overtraining and Burnout in Young Athletes, from the Council on Sports Medicine and Fitness, is available at https://doi.org/10.1542/peds.2023-065129 and will be published in the February issue of Pediatrics.
It covers risk factors, diagnosis, management and prevention of overuse injuries, overtraining and burnout.
Defining the terms
Overuse injuries can result from repetitive stress without sufficient recovery that leads to accumulated musculoskeletal damage. Extended periods of increased training loads that exceed the intervening recovery can result in overtraining syndrome, leading to decreased performance, increased injury and illness risk, and derangement of endocrine, neurological, cardiovascular and psychological symptoms.
Overtraining is the physical component, and burnout is more of the psychosocial component, Dr. Carl said.
Injuries generally fall into two groups: acute injuries and overuse injuries. An acute injury can occur when an athlete falls or gets tackled. When injuries arise out of the blue, they can be called overuse injuries.
“Overuse makes it sound like you overdid it … and that’s not necessarily the case,” said Dr. Carl, who practices at Ann and Robert H. Lurie Children’s Hospital of Chicago. “You could have 10 athletes doing the exact same routine, and only one of them gets injured. Maybe it was just where they were with growth or something about the mechanics. … So we’ve got to figure out a better pattern that keeps them in sports, not having injuries, not having pain.”
Various factors, including fitness level and sport environment, can influence how training load combined with rest promote adaptation without increasing injury risk.
Attrition, professionalization in sports
Injury and burnout are among the top reasons for attrition in youth sports, according to the clinical report. While more than 60 million children and adolescents participate in organized sports, 70% of youth athletes drop out of these sports by age 13. That plays a role in the 75% or more of U.S. teens who don’t meet physical activity recommendations.
In addition, high-pressure youth sports environments can lead to a loss of enjoyment and burnout. Professionalization of youth sports “is widely considered responsible for the high volumes of training and the pressure to specialize in a single sport that may lead to overuse injury, overtraining, and burnout in young athletes,” the clinical report states.
The report also faults the perception that overtraining is the most efficacious route to future athletic success.
“We see a lot of pressure for kids to commit early to a sport and play that sport year round,” Dr. Carl said.
Stress that leads to overtraining can come from multiple sources, like training load, sleep impairments, environmental stress, academic difficulties, social problems and family dynamics.
“The good news about kids is that most of the injuries we see aren’t really serious,” said Dr. Carl, “and we can find ways to modify their activity. So generally we don’t have to hold them out of activity completely, at least not for long periods.”
She believes in encouraging kids to be active in sports because there are so many benefits.
“I love to see kids passionate about their sport. I love to see parents supporting them in their passion. Usually those go together, which is good.”
Dr. Carl takes the long view when dealing with sports injuries, telling the patient: “‘My goal is for you, if you love baseball, to have a really long baseball career.’ And I’m thinking, ‘What can I do to keep you in baseball in the long term, over many years and lots of different seasons — not just in the next four weeks?’
“We know that both the body and mind need a rest from whatever activity it is,” Dr. Carl said, “no matter how much you love it.”
Following are among the clinical report’s recommendations:
- Discuss risks of overuse injuries, overtraining and burnout during preparticipation exams and well visits. Promote exams within the medical home.
- Encourage intrinsic motivation.
- Promote proper nutrition and sleep to optimize recovery.
- Measure success on well-rounded participation and effort, and foster positive experiences with others. Focus on fun, skill acquisition, safety and sportsmanship.
- Ensure gradual increases in weekly training time, number of repetitions or total distance.
- If an athlete complains of nonspecific muscle or joint problems, fatigue, mood changes or poor academic performance, be alert for the possibility of overtraining or burnout.