Overuse Injuries and Burnout in Youth Sports: A Position Statement

Overuse injuries and burnout in sports is not catastrophic in the same way as SCA, neck injuries and EHS have the potential to be, but these are two “hot topic” concepts are making their way through the news these days.  These concepts have become a popular topic of conversation as youth sports continues to be a major focus here in the US.  Overuse injuries may be the physical consequence of the changing youth sports participation (or should I say competition) environment, while burnout is the mental consequence.  The AMSSM position statement does a great job of introducing you to the concepts of overuse injuries and burnout and can provide you key information in a variety of areas, including risk factors, sport specialization and prevention.

OVERUSE INJURIES

According to the position statement from the American Medical Society for Sports Medicine (AMSSM) an estimated 27 million children between ages 6 – 18 participate in team sports, while 60 million children participate in some form of organized athletics (44 million in more than one sport).  Overuse injuries are estimated at approximately 46% across all sports, with lower incidence in sports such as skiing (37%) and higher incidence in sports such as running (68%).  These numbers are attention getters, but even more important to note is that many experts believe these injuries are underestimated in the literature based on how “injury” is defined.

When focusing on overuse injuries, prevention is the best medicine, but also understanding which athletes may be at risk (so you can modify their activity as needed) may be helpful.  The position statement clearly delineates several key factors to help you identify whether your athlete(s) may be at risk.  Parents should be familiar with these factors in an effort to safely navigate the youth sport experience.  Sometimes, more isn’t always better.  Especially in the case of injuries described as “high-risk”.  These are the injuries that can result in a lot of time loss from sport and may even endanger future sports participation.  Do you know what these “high-risk” injuries are?  If not, refer to the position statement.

BURNOUT

“Burnout”, as a psychological term was coined in the 1970s by Herbert Freudenberger as a way to describe the consequences of severe stress and high ideals.  He originally coined this term when looking those in the helping professions who because exhausted and listless, often quitting their jobs because they struggled to balance caring for their patients and themselves, often putting their patients first.

Today burnout is used frequently to describe anyone who is experience emotional exhaustion, alienation and reduced performance (most often relative to a job or work), but a clear definition still alludes the experts.  This idea of emotional exhaustion, alienation from activities and reduced performance has made it into the sports landscape and is a common area of investigation.  Burnout in sports is similar to burnout at work and at its worst often leads to young athletes dropping out of their (once favorite) sport.  As with overuse injuries understanding important risk factors and key signals can help any parent decrease the likelihood of burnout in their young athlete(s).  The position statement lists some key facts to understand about burnout,

In the end overuse injuries and burnout in youth athletes seem to be connected in some ways,  similar risk factors ranging from possible early sports specialization, over training and high performance expectations.  It is important to recognize these potential risk factors and make decisions on behalf of your young athletes to help preserve their health, both physically and mentally.

 

Heather L. Clemons, MS, MBA, ATC

 

 

 

YOUTH SPORTS SAFETY: LOOKING BEYOND OUR BORDERS

It seems each week as I discuss different youth sport topics I am constantly directing you to information made available by a wide range of professional organizations, institutes and associations that most often originate here in the United States.  As I continue to push what I can learn and convey I’ve started to find useful information made available by other countries and international organizations.  The concussion statement out of the 4^th International Congress on Concussion in Sport (Zurich, 2012) is probably the most familiar example of the growing international effort and cooperation on improving youth sport safety.  Keeping this in mind I wanted to introduce you to a few organizations that you may not be familiar with since they are not US-based.  Many of these organizations provide statements that support much of what we know here in the US, but other statements may actually provide new information on a familiar topic or address and sport or activity that isn’t addressed directly in the US.

CANADIAN ACADEMY OF SPORT AND EXERCISE MEDICINE (CASEM)

This group is akin to the American Academy of Sports Medicine (ACSM) and provides direction in a variety of sports and topics.  I bring this group to your attention for two reasons:  1) It provides information on topics (ex. snowboarding) that is harder to come by here in the US and 2) Athletic Trainer is a profession in Canada (it’s referred to as Athletic Therapist) and it is possible to practice as an AT in Canada and vice versa assuming you meet certain guidelines.

Here are some statements published by CASEM that I thought you might find interesting:

Bicycle Helmets (2013)

Abuse, Harassment and Bullying in Sport

In-line Skating (2012)

Head Injuries and Concussions in Soccer (2010)

Snowboarding Injuries (2006)

Violence in Hockey (2007)

Physical Activity Recommendations for Children with Specific Chronic Health Conditions (2010)

The site also provides additional links where you can find more information about other sports medicine organizations around the globe.  One particular link I found interesting was the Sport Concussion Library.

SPORTS MEDICINE AUSTRALIA (SMA)

A comprehensive sports medicine website providing information for providers, parents and athletes alike.  While it appears that there are not direct links to position statements as we understand them here there is a resources and advice section that includes tons of useful information.  This information is divided into fact sheets (injury and sport) and policies and guidelines.  The fact sheets cover common injuries and sport-specific information.  The policies and guidelines are divided to special populations including active children, weather conditions, and health conditions and screening among others.

INTERNATIONAL FEDERATION OF SPORTS MEDICINE (FIMS)

This group is an overarching organization that could encompass all national sports medicine organizations worldwide.  This is a member-based group that functions in a similar capacity as national organization providing educational opportunities for sports medicine providers around the world.  Similar to the ACSM and CASEM, FIMS has provide a series of position statements on a wide range of sports medicine topics.  Some of the statements I thought you might be interested in include:

 

Fluids in Sports (2012)

Female Athlete Triad (2011)

Exercise Induced Asthma (2011)

Vegetarian Diet and Athletes (2009)

Scoliosis and Sports Participation (2008)

Diabetes Mellitus and Exercise

Excessive Physical Training in Children and Adolescents

Eye Injuries and Eye Protection in Sports

Athletes with a Family History of Sudden Cardiac Death

BRITISH ASSOCIATION OF SPORT AND EXERCISE MEDICINE (BASEM)

I put this link in here so that you’re aware of this organization.  The educational tab on the association website focuses primarily on continuing education for its members and doesn’t appear to have on outward, public focus, but the British Journal of Sports Medicine (BJSM) is published by BASEM.  BJSM is a commonly cited journal when addressing current topics in sports medicine.

 

Submitted by Heather L. Clemons, MS, MBA, ATC

Concussion Recognition and Management: Where Are We Now?

Concussions are such a prevalent sport safety topic in the news that I must admit I have days where I don't want to read another article or news story on the topic.  I'm just hoping the day you decide to click on this blog entry you're in the mood to read one more commentary on the topic.  While concussions are not the only injury that can potentially be suffered by our child-athletes, it's the one that has the most legs in the media these days.  This means there is lots of information to sift through when educating yourself. 

I was recently teaching concussion evaluation to a group of students and was looking through the current position statements to see what I wanted to convey to them.  I realized that I had a longer view on the topic given my years in the profession of athletic training and I wondered how I could demonstrate how far we've come in the recognition and management of these injuries despite continued challenges.  The result was an assignment that asked students to compare four different concussion statements by various organizations.  The four statements were:

• National Athletic Trainers' Position Statement:  Management of Sports Related Concussion (2004)
• Consensus Statement on Concussion in Sport (Zurich, 2012)
• American Medical Society for Sports Medicine Position Statement:  Concussion in Sport (2013)
• American Academy of Neurology:  Position Statement:  Sports Concussions (2013)

If completed as directed the assignment would be a table that allowed comparison between statements on a variety of topics ranging from concussion definition, evaluation guidelines, assessment tools discussed, management recommendations, and recommendations specific to youth and adolescent athletes among others.  After completing my answer key for the assignment I began to notice how much we've pushed ahead in just the last 10 years.

Using the NATA (2004) position statement as a starting point and a basis for comparison when reviewing the more recent statements the evidence of changes in practice becomes easier to see.  Many of the things on this list are now more standardized or the supported standard of practice as compared to the guidelines presented in 2004.  Here are some of the highlights I noticed:

• The definition of concussion has been expanded to include descriptions of various injury mechanisms and the pathophysiological response of the brain
• Treating concussions has become an ever expanding team effort
• Grading scales are no longer used to classify concussions in the acute stage
• Same day return to play is not recommended, especially with adolescents and youth
• Various concussion assessments are consistently recommended as a key component of every sideline evaluation and follow up as appropriate, assessments have been clarified and developed to focus on those areas research shows are most impacted by concussion injuries
• Neuropsychological testing continues to be one tool used in the assessment of concussions; but broad stroke baseline testing is not always recommended; it's effectiveness may be better served when using it with specific groups of athletes/patients
• Legislation has been passed in all 50 states that requires concussion education and evaluation guidelines 
• Clear graded return to play protocols are the standard as part of an athlete's return to sports
• Following a concussion athletes must be cleared by a trained medical professional (physician) before returning to play
• Cognitive rest and gradual return to academics has become just as important as physical rest and gradual return to play (although clear guidelines for academic return have yet to be developed, basic recommendations have been provided by the American Academy of Pediatrics)
• We have confirmed via research that teens typically take longer to recover from concussions and it a symptom free return to sport is critical in preventing the possibility of second impact syndrome
• Prevention has focused on education efforts along with legislating key safety steps; despite continued advancement in protective equipment effective prevention starts with limiting the number of head contacts through practice guidelines, game rules and proper techniques

Sometimes it can be hard to sift through all the information out there. but as you see here if we can organize it in a way that allows for easy comparison we can learn a lot about the standard of care and the progress we've made.

Heather L. Clemons, MS, MBA, ATC