Pediatric Sports Medicine


As the fall approaches there likely will be an increase in sport and activity related injuries. This article hopes to introduce the topics of early sport specialization, rules of thumb for musculoskeletal injuries, and general return to play guidance.

Early Sport Specialization

Early sport specialization (ESS) is defined as participation in intensive training and/or competition in organized sports greater than 8 months per year (year round), participation in 1 sport to the exclusion of participation in other sports, and the involvement of prepubertal children (7th grade or below 12 years old)1. It’s estimated that 10-30% of youth athletes specialize in a single sport by age 142. The American Medical Society for Sports Medicine (AMSSM) consensus statement indicates early sport specialization can lead to overuse injuries and burnout in youth sports3. Often the rationale for ESS is the hope that it will lead to elite performance. With the exception of a limited number of sports (figure skating, diving, and gymnastics) there is limited data to support this thought process. The American College of Sports Medicine, American Orthopedic Society of Sports Medicine, and the AMSSM do not believe there is evidence to encourage early sport specialization. There are potential harms of ESS including burnout and overuse injury. Currently all professional societies recommend against ESS to promote lifelong enjoyment of physical activity and exercise.

Rules of Thumb for Musculoskeletal Care

The presence of growth plates (apophysis) changes the probability that certain musculoskeletal injuries are present. It is much more common that there will be an injury to the growth plate compared to ligaments and tendons. This means it is less common that children sustain sprains and strains. The presence of the growth plate allows for unique injuries such as incomplete fractures and Salter Harris fractures. High risk injuries/pain include wrist pain, hip pain with a limp, and significant knee swelling. Urgent referral for specialist evaluation is warranted if these conditions are present. An XR can greatly aid in establishing a diagnosis for many musculoskeletal conditions. Utilizing crutches is a reasonable first step until a diagnosis is confirmed, if you’re concerned about a thigh or leg injury. 

Return to Play Guidelines

For concussion management the CDC has website for parents and physicians4. The majority of concussions resolve within 2 weeks. Return to play is in a step wise progression that is based on the patient’s symptoms. After 48 hours there is limited evidence to support complete rest. Light aerobic activity (walking) for 20-30 minutes a day may improve recovery time.

Early range of motion and weight bearing can speed recovery times for leg, foot and ankle injuries if there is no broken bone. Rule of thumb for return to play includes even strength compared to the uninjured extremity and no pain. The ability to do a single leg hop and single leg balance without pain are great tests for return to play. While it can be challenging to withhold athletes from sport, ensuring the athletes are pain free and strong with functional testing is the safest strategy before returning the athlete to sport.


COPC Sports, Spine and Joint does see pediatric patients aged 13 and up. Our office is located in Westerville. Click here to learn more about our office.

[1] LaPrade RF, Agel J, Baker J, Brenner JS, Cordasco FA, Côté J, Engebretsen L, Feeley BT, Gould D, Hainline B, Hewett T, Jayanthi N, Kocher MS, Myer GD, Nissen CW, Philippon MJ, Provencher MT. AOSSM Early Sport Specialization Consensus Statement. Orthop J Sports Med. 2016 Apr 28;4(4):2325967116644241. doi: 10.1177/2325967116644241. PMID: 27169132; PMCID: PMC4853833.

[2] Kliethermes SA, Marshall SW, LaBella CR, Watson AM, Brenner JS, Nagle KB, Jayanthi N, Brooks MA, Tenforde AS, Herman DC, DiFiori JP, Beutler AI. Defining a research agenda for youth sport specialisation in the USA: the AMSSM Youth Early Sport Specialization Summit. Br J Sports Med. 2021 Feb;55(3):135-143. doi: 10.1136/bjsports-2020-102699. PMID: 33462103.

[3] DiFiori JP, Benjamin HJ, Brenner JS, et al

Overuse injuries and burnout in youth sports: a position statement from the American Medical Society for Sports Medicine

British Journal of Sports Medicine 2014;48:287-288.

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