Early Sport Specialization and Long-Term Athletic Success

Sport specialization is defined as year-round (≥8 months per year) intensive training in a single sport at the exclusion of other sports.   Early sport specialization refers to those who focus on a single sport before entering high school.  Advocates for early specialization propose that athletic performance in that sport will be better than the performance of those who play multiple sports.  These beliefs became popularized after several recently published best-selling books proposed a “10,000 hour rule” of practice for developing expertise in any given skill or sport.

The effectiveness of increasing the amount of early exposure to a single sport on athletic performance is questionable.  In fact recent research suggests those youth athletes who participate in multiple sports and delay specialization are at an advantage over those who specialize.  The long-term athletic development (LTAD) model provides a structured framework where youth athletes participate in multiple sports in order to maximize their full athletic potential over the lifespan.  Emerging research supports multiple sports participation and the LTAD model as methods to reduce injury risk and maximize athletic potential through high school, college, and beyond.

Early Sport Specialization & High School Athletics

Present day athletes are specializing in a single sport earlier than previous generations.  One recent study showed current high school athletes specialize at an average age of 13 years old.  Current collegiate athletes specialized at an average age of 15 years old.  High school athletes who specialize in one sport for more than 8 months of the year are 2 to 3 times more likely to suffer a lower body overuse injury.  Athletes who engage in baseball for more than 8 months per year are more likely to develop overuse arm injuries.  The repetitive nature of engaging in a single sport predisposes youth athletes to chronic injuries which will likely impact their career beyond high school.  Also, there is currently no evidence which suggests athletes who specialize in a single high school sport are more successful performers than multisport athletes.

Early Sport Specialization & Collegiate Athletics

A survey of Division I college athletes showed 16% specialized in 9th grade and 41% specialized in 12th grade.  This suggests the majority of NCAA Division I athletes were late to specialize in their chosen sport.  Therefore, early specialization does not appear to be necessary in order to succeed at the collegiate level.   Other research found college basketball players who specialized late in their playing career developed their skills and performance to a greater level than those who specialized early.    Several Division I college coaches have gone on record to state their preference for recruiting multisport college athletes.  Athletes who participate in multiple sports possess superior fundamental movement skills and are generally more “coachable” than single sport athletes.

Early Sport Specialization & Professional Sports

Professional athletes are now advocating for multiple sport participation in today’s youth.  Sixty-three percent of surveyed professional baseball players believe early sport specialization is not required to play professionally.  Only twenty-two percent of professional athletes from multiple sports would want their own child to specialize in 1 sport during childhood

NBA players who played multiple sports in high school participate in more professional basketball games throughout their career compared to those who specialized early.  These same NBA players who played in more games were less likely to suffer an injury compared to those who specialized early.  Also, those NBA players who specialize late demonstrate greater longevity in the league.

Approximately half of present day MLB players specialized prior to high school.  Those who specialized early sustain more serious injuries during their professional career compared to those who specialize late.   Youth baseball players should be encouraged not to participate in a single sport given the increased incidence of serious injuries later in their careers. To date no research suggests that early specialization is needed to reach the professional level of any team sport.

Closing Thoughts

Parents and coaches should encourage youth athletes to delay sport specialization as late as possible.  Athletes who specialize late are at least as likely to compete at high levels (college and professionally) as those who specialize early.  Also, those  who delay specialization are less likely to sustain injuries and more likely to achieve long-term success at the professional level.   Most importantly, encouraging multiple sports participation promotes long-term enjoyment of sport which will build health and fitness habits for a lifetime.

References

  1. Bell DR, Post EG, Trigsted SM, Hetzel S, Mcguine TA, Brooks MA. Prevalence of sport specialization in high school athletics: A 1-year observational study. Am J Sports Med. 2016;44(6):1469-1474. doi:10.1177/0363546516629943.
  2. Buckley PS, Bishop M, Kane P, et al. Early single-sport specialization and professional athletes. Orthop J Sport Med. 2017;5(7):1-7. doi:10.1177/2325967117703944.
  3. Post EG, Thein-Nissenbaum JM, Stiffler MR, Brooks MA, Bell DR. High school sport specialization patterns of current division I athletes. Sport Heal A Multidiscip Approach. 2016;XX(x):1-6. doi:10.1177/1941738116675455.
  4. Santos S, Mateus N, Sampaio J, et al. Do previous sports experiences influence the effect of an enrichment programme in basketball skills? J Sports Sci. 2017;35(17):1759-1767. doi:10.1080/02640414.2016.1236206.
  5. Wilhelm A, Choi C, Deitch J. Early sport specialization effectiveness and risk of injury in professional baseball players. Orthop J Sport Med. 2017;9:1-5. doi:10.1177/2325967117728922.

 

Little League Elbow: 5 Things Parents and Coaches Should Know

Little League elbow is an overuse injury affecting the inside part of the overhead athlete’s elbow.  The injury occurs in youth athletes 8 to 13 years old with open growth plates.  In these youth baseball players, the growth plate is much weaker than the ligaments and muscles surrounding it.  Once the growth plates fuse, athletes are more likely to injure soft tissues such as the ulnar collateral ligament (UCL).  Little League elbow is most common in baseball pitchers but can also occur in any position player, softball players, or tennis players.

During the late cocking and acceleration phases of throwing, the shoulder and elbow are subjected to very high forces.  The repetitive stress of throwing can lead to pain, swelling, and tenderness in this area.  The youth baseball player may also show signs of decreased throwing velocity and accuracy.   If untreated, there is a small chance for early growth plate closure or fracture, which could require surgery.  Little League elbow will often heal completely with 2 to 4 months of rest and an individualized physical therapy program.  Below are 5 things parents and coaches should know to prevent Little League elbow in youth baseball players.

#1: Elbow injuries are more common in those who play year-round

 The repetitive stress of throwing a baseball subjects the growing elbow to excessive forces.  The growing bones of youth athletes need time away from throwing.  Youth baseball players should take 3 to 4 months off from throwing each year.  This period should be devoted to playing other sports in order to develop overall athleticism.  This is also the ideal time to perform resistance exercise to build strength in the lower body, core, and arm.  Players who throw year-round or in multiple leagues are often plagued by arm fatigue.  Throwing with fatigue is the number one risk factor for shoulder and elbow injury in youth baseball players.

 #2: Little League elbow is common in both pitchers and catchers

 A 2004 study in the American Journal of Bone and Joint Surgery found 70% of youth catchers demonstrate signs of Little League elbow on x-rays.  In comparison, 63% of pitchers demonstrated these findings. Approximately half of these pitchers and catchers complained of elbow pain.  The other half were not experiencing pain.  However, catchers complained of elbow soreness more often than pitchers. During a game, catchers and pitchers may perform an almost equal number of throws.  Also, catchers often throw from a squat or semi-squat position.  Without the ability to generate force from the lower body, this position may place additional stress on the catchers elbow.  It may be advantageous for catchers to throw from a standing position whenever possible.  In any case, parents and coaches should closely monitor catchers and pitchers during the course of a season.  Any signs of altered throwing or complaints of pain by the athlete should prompt a medical evaluation.

#3: Taller players are more likely to develop Little League elbow

Overall height and a recent increase in growth have been shown to be risk factors for developing Little League elbow.  During the growth spurt it is believed that the rate of bone length growth exceeds the rate of bone strength development.  Therefore, the growing bone and growth plate may be more susceptible to those who are experiencing rapid changes in height.   Taller players are also more likely to throw at greater velocities which subject the elbow to greater stress.  Therefore, the stress associated with these developmental factors, along with throwing excessively at increased velocities, may predispose the taller baseball player to elbow injury.  Parents and coaches should keep a close eye on these taller players and be on the lookout for any early warning signs of arm pain or fatigue.

#4:  Little League elbow is more common in players working with private coaches

A recent study investigating Little League players in the United States found two factors associated with positive elbow MRI findings.  These two factors were year-round play and working with a private coach.   Additionally, a history of arm pain was also associated with year-round play and working with a private coach.  This is not to say that youth baseball players should not work with private coaches.  Private coaches can be instrumental in improving throwing mechanics thus potentially improving performance and reducing injury risk.  However, working with pitching coaches can contribute to throwing excessively or even year-round.   Baseball players should be encouraged to work with coaches to improve their skills and love for the game.  However, it is extremely important that these players get ample rest from throwing so they do not jeopardize their long-term playing career.

#5: Strengthening and stretching exercise can reduce the risk for developing elbow injuries

Muscle imbalances and poor movement patterns during and following growth spurts predispose youth athletes to overuse injuries such as Little League elbow. Modifiable risk factors for injury relate to improving shoulder flexibility and total arm strength.  A recent study in the American Journal of Sports Medicine showed youth baseball players can significantly reduce their risk for elbow injury by engaging in a regular stretching and strengthening program.  These exercises should target the trunk and arm musculature to address factors shown to be associated with injury risk.  Strengthening the shoulder blade and rotator cuff muscles us often emphasized in overhead athletes.  Athletes should be instructed in individualized programs based on their own unique needs.  There is no one size fits all program for baseball players.   Below are a few exercises which are useful for some overhead athletes.

Closing Thoughts

Little League elbow is becoming increasingly more common as youth baseball players are throwing more often and at greater velocities.  It is more important than ever for parents and coaches to closely monitor all youth baseball players for excessive amounts of throwing and the early signs of arm fatigue.  Also, pitchers, catchers, taller players, and those with private coaches may be at an increased risk for injury thus requiring close observation.  Youth baseball players who adhere to regular stretching and strengthening exercise can reduce their risk for injury.  Therefore, preventing Little League elbow requires a team approach involving the player, parents, coaches, trainers, and the medical staff.

 References

  1. Hang DW, Chao CM, Hang Y. A clinical and roentgenographic study of Little League elbow. Am J Sports Med. 2004;32(1):79-84. doi:10.1177/0095399703258674.
  2. doi:10.1177/2325967114566788.
  3. Pennock AT, Pytiak A, Stearns P, et al. Preseason assessment of radiographic abnormalities in elbows of Little League baseball players. J Bone Jt Surg. 2016;98:761-767.
  4. Sakata J, Nakamura E, Suzuki T, et al. Efficacy of a prevention program for medial elbow injuries in youth baseball players. Am J Sports Med. 2017; Published:1-10. doi:10.1177/0363546517738003.
  5. Yukutake T, Kuwata M, Yamada M. A preseason checklist for predicting elbow injury in Little League baseball players. Orthop J Sports Med. 2015;3(1):1-7.

Serratus Anterior: 3 Exercises to Improve Overhead Mobility

The serratus anterior is a key muscle involved with the performance of many overhead movements such as throwing a baseball, serving in tennis, and pressing a barbell overhead.   The serratus anterior muscle spans from the upper 8 ribs along the side of the trunk up to the inner border of the shoulder blade.  This muscle assists with rotating the shoulder blade (scapula) upwards and tilting it backward in order to position the shoulder and arm for optimal overhead function.  Along with thoracic spine extension mobility, these scapular movements are often ignored as important components of overhead function.  The serratus anterior is also the primary muscle which protracts the scapula during upper extremity function.  This involves the scapula moving forward along the rib cage such as when punching in boxing.

The Serratus Anterior and Overhead Function in Athletes

Individuals with shoulder problems demonstrate decreased upward rotation of the scapula, decreased posterior tilt of the scapula, and increased activity of the upper trapezius muscle.  In particular, swimmers and baseball pitchers commonly present with a pattern of decreased serratus anterior activation and increased activation of the upper trapezius.  This alteration in muscle patterns leads to compensatory movements, decreased overhead range of motion, and increased stress to other structures such as the rotator cuff and elbow joint.

The serratus anterior functions to upwardly rotate and posteriorly tilt the scapula
Assessing strength of the serratus anterior

Exercises which combine scapular upward rotation, posterior tilt and protraction are ideal to activate the serratus anterior.  It is also advantageous to include closed chain exercises where the hand is fixed to a surface or weight bearing through the floor or a wall.  Finally, exercises performed with the arm elevated above the shoulder or eye level elicit greater activation of the serratus compared to exercises performed at or below shoulder level.  Wall slide and bear crawl variations fulfill these criteria which are optimal to train the serratus anterior in overhead function.

 Wall Slide with Foam Roll

Begin with your forearms resting on a foam roller against the wall placed just below shoulder height.  Protract the shoulder blades by pushing the upper back away from the wall to activate the serratus anterior.  Next, “roll” the forearms up the wall in a controlled manner to approximately eye level or slightly higher, making sure you don’t lose protraction.  Return back to the starting point in a controlled manner and repeat for the desired number of repetitions.

Serratus Anterior Wall Walks with Band

Begin by wrapping a resistance band around your wrists and pulling your wrists apart. Your forearms should remain parallel and take the form of the number “11” throughout the exercise.  Protract the shoulder blades by pushing the upper back away from the wall to activate the serratus anterior. Then, “walk” the forearms up the wall in a controlled manner to approximately eye level or slightly higher, making sure you don’t lose protraction.  Return back to starting point in a controlled manner and repeat for the desired number of repetitions.

Bear Crawl

Assume an all-4’s position with the hands in front, shoulder-width apart, feet behind the hips and up in the air.  The knees should remain elevated from the floor so you are stabilized by 4 points of contact.  Begin by pushing the back up towards the sky to protract the scapula and activate the serratus anterior.  Crawl forward starting with your right hand and your left foot following with the left hand and the right foot.  After each step, pause briefly to exhale. Take four steps or more depending on space, then turn around and bear crawl back.

Closing Thoughts

Building a foundation of strength targeting the scapular muscles is crucial for overhead athletes.  This foundation should include movements which facilitate activation of the serratus anterior through scapular upward rotation, posterior tilt, and protraction.  These exercises can be included as part of a strength training session warm-up or part of a regular arm care program.   Overhead athletes, such as baseball players and swimmers, should particularly include exercises targeting the serratus anterior as part of their year-round strength and conditioning program.

 

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5 Thoracic Mobilization Drills to Improve Overhead Mobility

The position and mobility of the thoracic spine directly affects the amount of overhead shoulder movement available.   A more erect and mobile thoracic spine and rib cage will result in greater overhead range of motion.  A slouched posture or stiffness in the thoracic spine and rib cage will result in a loss of range of motion reaching overhead.   Excessive thoracic kyphosis, or a slouched posture, may alter the position of the shoulder blade and impair muscle activation patterns both of which contribute to limited overhead function and shoulder pain.

Approximately 15 degrees of thoracic spine extension mobility is required for full overhead motion when lifting both arms such as when performing a barbell overhead press. Full 1-arm elevation requires approximately 9 degrees of thoracic extension.  Thoracic spine rotation is also crucial for rotational sports such as baseball where a large amount of power is transferred through the trunk.   A baseball pitcher who lacks thoracic spine rotation will compensate by increasing movement and stress through the shoulder and elbow joints.

Strength is foundational for optimal shoulder health but thoracic spine mobility is often a neglected area when athletes attempt to maximize their overhead shoulder function.  Therefore, exercises targeting thoracic spine extension and rotation mobility should be included in any rehabilitation or performance enhancement program seeking to optimize shoulder function.  Instead of jumping to restore shoulder mobility with bands and balls, try these thoracic spine mobility exercises first.

Bench T-Spine Mobilization

This is my favorite exercise for restoring thoracic spine extension.  It also provides a nice stretch to the lattisimus dorsi muscle which can also limit overhead mobility. The exercise begins by assuming a kneeling position facing a bench.  Place your elbows on the bench in front of you holding a PVC pipe or dowel with the palms facing up.  Sit back, pushing your buttocks towards your heels, keeping your spine relaxed, until you feel a stretch in your upper back.  For an added stretch you can bend your elbows further past your head.  Hold this position, and exhale fully.  Reverse the motion to return to the start and repeat the desired number of repetitions.

Thoracic Extension + Rotation (Reach Backs)

Begin this exercise by sitting back on your heels, face down, with one hand behind your head and the opposite forearm resting on the ground in front of you.  This position minimizes available movement in the low back and maximizes movement to the upper back.   From this position rotate your elbow up to the sky while exhaling.   The opposite forearm remains in contact with the ground.  Return to the starting position and repeat for the desired number of repetitions before switching to the opposite side.

Foam Roll Thoracic Extension Mobilization

This exercise can be a challenge to perform correctly.  Most end up extending through the lumbar spine and not the thoracic spine.  Begin in a lying position over a foam roll.  Place the hands behind the neck supporting, but not pulling on, the neck.  Raise the buttocks off the ground and roll the upper back up and down the foam roll.  Identify a sensitive, stiff, or tender area and then drop the buttocks down to the ground.  From this position perform small extension movements by lifting the elbows up towards the ceiling.  Be careful not to overextend at the lower back.

Thoracic Spine Windmill

This is my “go to” exercise to restore thoracic spine rotation.  Begin on your side with both arms outstretched in front of you.  Place a foam roll under your top leg with the knee and hip bent to 90 degrees.  The bottom knee and hip remain extended throughout the exercise.   Reach forward with your top hand and then complete a large circular windmill motion as you rotate your entire upper body.  Keep reaching as if you were attempting to lengthen your entire arm.  Follow your hand with your eyes to ensure proper thoracic spine and rib cage movement.  The top knee and leg should remain in contact with the foam roll throughout the exercise.  Perform the desired number of repetitions and then repeat on the opposite side.

Standing Thoracic Rotation Mobilization

The standing rotation exercise is ideal to incorporate into a pre-workout dynamic warm-up.  From a standing semi-squat position place one arm between your thighs just above the knees.  This position will block unwanted hip and pelvic movement.  Next, rotate the body upwards towards the sky by following your open hand with your eyes.  At the top of the movement, exhale before returning to the starting position.  Perform the desired number of reps and then repeat on the opposite side.

Closing Thoughts

After performing these mobility drills it is important to work on strength and endurance of the thoracic muscles.  Also, manual therapy to the thoracic spine and rib cage has been shown to accelerate recovery and reduce shoulder pain immediately and for up to 1 year.  Maintaining or improving thoracic spine mobility is imperative for any active individual who regularly functions overhead.  Manual therapy, mobility drills, and strength/endurance exercise targeting the thoracic spine can lead to significant gains in overhead function for athletes and the general population.  These 5 mobility drills can be easily integrated into any pre-workout warm-up routine or as part of a home exercise program.

Improving Running Mechanics

Spring is finally here and the nicer weather is nearly upon us. With longer and warmer days we are starting to see more and more folks outdoors exercising. Runners in particular tend to ramp up their training during this time in preparation for the spring and summer running season. One event we are looking forward to is the annual Get LBI Running 5k which is slated for Saturday May 16th.  It is important to properly prepare now in order to avoid some common running injuries.

In a given 12-month period 50% to 75% of runners sustain an injury. Due to the repetitive loading involved with running, even mild abnormal movement patterns can accumulate over time and result in overuse injuries. Some of the more common overuse injuries that runners sustain include patellofemoral pain, IT band syndrome, stress fractures, plantar fasciitis, compartment syndrome, and medial tibial stress syndrome (commonly called “shin splints”). Running mechanics play a significant role in running related injuries. Physical therapists are experts in examining and correcting abnormal movement patterns and this inlcudes running mechanics.

Research shows that training by qualified experts can improve running mechanics and potentially decrease the risk of injury. For example, runners undergoing cadence retraining showed improved running mechanics after 6 weeks of training. One case study, showed that step rate retraining combined with hip strengthening exercise resulted in improved running mechanics and reduced pain for a runner with iliotibial band syndrome. In controlled laboratory settings, computer and video analysis can show which features of running should be corrected. This could include excessive vertical oscillation, over-striding, excessive trunk lean, and excessive arm rotation. In clinical settings, real time feedback using a treadmill, mirror, and verbal cues by a physical therapist have been shown to improve running mechanics. One study showed that this type of running retraining also carried over to improved movement patterns with squatting and stair descent even though no additional movement-specific training was undertaken.

Runners with a history of overuse injuries and those currently experiencing pain may benefit from a running analysis by a physical therapist. Retraining running patterns does not require high tech equipment or multiple sessions with a physical therapist. Research shows that running mechanics can be improved with a treadmill, mirror, verbal cues from a physical therapist, and quite a bit of deliberate practice on the part of the runner.

Cheers!

Ernie