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Link Between Early Specialization And ACL Injury Increase: No Surprise to Me

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Today's annual meeting of the American Academy of Orthopaedic Surgeons brought some news sports parents need to hear.

The shoe doesn't fit

The first bit of disturbing news came from Swiss researchers. Think your child is wearing the right size shoes when playing sports? Think again. A study by researchers in Switzerland found that a surprising majority of kids ages 5 to 10 are wearing shoes that are too small for their feet, putting them at risk of developing serious foot deformities including bunions. No wonder the shoes were too small considering the study's finding that nine of ten of the shoes kids wear for outdoor activities were smaller than the size marked on the box!

The three lessons parents should take from the study: (1) Measure your children's feet every time you buy them new shoes using a special measuring device to ensure that the length of the shoe exceeds the length of the child's foot by at least 10 millimeters; (2) Consider the actual size of the shoe rather than just the number marked on the inside of the shoe or the box; and (3) Check every month or so to see if a child's shoes still fit, especially when the child is in a growth spurt. (Remember: many children will often outgrow their shoes well before the shoes are worn out).

Link between ACL injury epidemic and early specialization

The second was a presentation by Darren L. Johnson, M.D., orthopaedic surgeon and director of sports medicine at the University of School of Medicine. Dr. Johnson suggested that the alarming increase in the number of younger children and adolescents suffering ACL (anterior cruciate ligament) injuries playing sports, particularly among girls, may be the result of the trend towards early specialization and year-round play in a single sport.

"Not long ago our youth participated in multiple sports, which effectively allowed an athlete to cross train and use multiple muscle groups differently and develop their potential," Dr. Johnson said. "But nowadays kids are picking one sport by the time they are 13 and playing year round on multiple teams, home and travel, which only allows development of the specific muscle group that applies to that specific sport. To play multiple sports is, in the best sense, childlike and fun," says Dr. Johnson. "Specialization at an early age conveys a seriousness of purpose that can lead to burnout, injury or both, which is common in high school athletes."

Dr. Johnson said that while all the effects of the extra wear and tear on a 13-year-old's growing body from playing so many games (often more than college athletes play) aren't yet known, what is known is that "participating without taking time off, playing on multiple teams at one time and at higher competition levels, makes young athletes susceptible to ACL tears at a younger age."

Doomed to pain-filled future?

To add injury to injury, pressure from parents and coaches or placed by the athletes on themselves is leading too many young athletes to come back from an ACL injury - which usually requires surgery and as much as a year of intensive rehabilitation - far too soon.  Returning too soon puts the athlete at a higher risk for another ACL injury.  Between 30 and 40 percent of athletes suffering a single ACL tear never return to their previous level of performance and are at increased risk of long-term degenerative changes in the knee such as arthritis.  The chances of coming back from two ACL injuries are even less.

Indeed, Dr. Johnson, notes, it is not uncommon these days for young athletes to have had two ACLs replaced by the time they enter high school. "Once that happens," Dr. Johnson warns, "it is very unlikely their knees will ever be normal."

The suspected link between an increase in ACL injuries in 12- and 13-year old children and early specialization and year-round play doesn't surprise me. I have been warning parents for years, both on this site and in my book, Home Team Advantage, about the many reasons early specialization is a bad idea for their kids, and that the trend is supported by myths, not facts. It is a trend we must reverse. If we don't, more and more kids will be doomed to a life of chronic knee, elbow or ankle pain. Is that what we want for our kids? I don't think so.