Why Early Sport Specialization Ends in Career-Ending Injury for Most Kids

High school baseball pitcher
Nagel Photography / Shutterstock

Last year, 15-year-old Danny Glimco was tossing a baseball with a friend when he felt an intense tingling in his fingers. The young lefty pitcher from Western Springs, Illinois, was a rising star preparing to show off his stuff for college scouts, and the last thing he needed was an injury. Playing in two leagues, plus summer ball, meant he was suiting up for as many as 60 games a year, throwing thousands of pitches. On doctor’s orders, he rested for six weeks, but the tingling returned. An MRI revealed Glimco had torn the ulnar collateral ligament in his elbow—a classic pitcher’s injury. The fix is Tommy John surgery, named for the pitcher who, in 1974, was the first to undergo it. Glimco sat out his all-important junior year. “I was devastated,” he says. “Tears were shed.”

What has experts worried is that the number of high-school-age pitchers having the procedure is rising—it could be as much as sixfold since the 1990s. Pitching every spring isn’t enough to cause such an injury. But with year-round leagues, baseball camps, and private coaching, kids are playing—and throwing—more than ever. And it’s not just a baseball problem, says chiropractor and sports and wellness trainer Tommy John, the son of the namesake pitcher and a former pro ballplayer himself. “It’s soccer, football, tennis, gymnastics,” John says. “I’m treating 11-year-olds for things I used to treat only 40-year-olds. It’s the worst I’ve seen over 20 years.”

Early sport specialization—exclusively playing one sport starting at a young age—brings with it a higher risk of injury and developmental problems. What’s worse is it can rob kids of the very thing they’re striving for—the chance to become an elite player. Tennis great Roger Federer has blasted early sport specialization and credits his longevity to his varied interests growing up.

The science is with Federer. “Diversifying athletic activities in childhood likely leads to better long-term performance in team sports,” says Charles A. Popkin, M.D., a pediatric orthopedic surgeon at Columbia University Medical Center. Popkin’s research found that current Division I college athletes typically didn’t settle on a sport until their sophomore year of high school. Yet the trend among today’s preteens is to focus earlier than that. A study at Thomas Jefferson University in Philadelphia found that high school athletes today started specializing in a single sport an average of two years earlier than current college athletes and pros.

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Early specialization may not turn kids into elite athletes, but it does produce injuries: torn ACLs (common in soccer, especially among girls); Osgood-Schlatter disease, a painful inflammation of the tendons just below the knee (basketball); hip deformities (hockey, especially goalies); and shoulder tears of various types (baseball, tennis, volleyball).

Injury potential remains high even after athletes quit playing. A 2019 study from the National Athletic Trainer’s Association found that out of 892 West Point cadets, those who had specialized early in a sport had a 50 percent higher risk of lower-body injury in the first year at the academy compared with less-specialized classmates. It may be due to a lack of physical literacy, meaning they don’t possess the varied movement skills or physical fitness that come from exposure to different activities, says study author Kenneth Cameron, M.D., director of orthopedic and sports medicine research at Keller Army Hospital at West Point. “You’re preparing your child to be a one-trick pony,” Cameron says. “The reality is, most of these kids do not go on to play at the next level.”

The risk also comes in the sheer repetition of certain movements. Young players’ bodies are still developing, and repeated motions specific to a sport can create issues. For example, “Little League shoulder” is an overuse injury seen in kids under age 16. It’s when a growth plate in their arm that hasn’t fused becomes swollen from all the overhand throws, and it’s as concerning as the kind of ligament tear that leads to Tommy John surgery.

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Depressing as this sounds, there are kids who go on to be great athletes. The Williams sisters are the Federer counterpoint. “There is a small subset of kids for whom specialization is great,” says Jordan Metzl, M.D., a sports physician focusing on young athletes at Hospital for Special Surgery in New York City. “They want to be elite, have the mental and physical characteristics for it, and are in supportive environments.” For performance vocations like ballet, gymnastics, and figure skating, not specializing is a competitive disadvantage. “The key is honestly determining whether your kid is really good or truly exceptional,” he says.

Pitch more than 100 games a year and risk of serious injury is 3.5 times greater, research in the American Journal of Sports Medicine suggests.
Pitch more than 100 games a year and risk of serious injury is 3.5 times greater, research in the American Journal of Sports Medicine suggests. Men's Journal

Whether young athletes are good or exceptional, parents have to be cognizant of the psychological impact of specializing, particularly if an injury occurs. “They’re children, and they may not be equipped to cope with the stress and trauma,” says Dan Jensen, a sports physical therapist and expert in early specialization at Black Hills State University in Spearfish, South Dakota. Kids who specialize often build their social lives around their teams, and an injury—or not making the cut for a roster—can mean suddenly losing crucial social connections, leading to a sense of isolation and even depression.

Who’s to blame? It can be an overzealous coach. Often it’s the parents. Some of that push owes itself to Malcolm Gladwell’s book Outliers, which floats the idea that 10,000 hours of focused effort is what it takes to get extremely good at an endeavor.

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It can also be a financial decision. Parents can be enticed by the prospect of a child landing an athletic scholarship. Plus the cost of play—pricey equipment, league fees—can be so high that funding multiple sports seems out of reach. It’s something that Dean Smith, operations director for the youth soccer program Heart of the City, outside Chicago, runs into. “Soccer is expensive, so parents tell their kids, ‘If you want to play, you better commit and be good at it,’ ” he says. A former pro soccer player himself, Smith sees some young athletes training for hours each night, maintaining a competition schedule that’s more intense than English Premier League players, who get two months off a year. And research from the University of Wisconsin revealed that highly specialized soccer players were five times likelier to suffer an overuse knee injury than those who play multiple sports.

When a kid does get injured, parents tend to view it as a freak accident. “They don’t correlate it at all with the fact that their child has played for three months solid, 2.5 hours every night,” Smith says.

But it’s not always fair to point the finger at coaches and parents, says Carles Bush-Joseph, M.D., Glimco’s physician and one of the country’s top Tommy John surgeons. “There’s more awareness than ever,” he says. “Often the kids want to specialize after realizing they have a knack for a sport and get praise from coaches and peers.”

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Ultimately, parents and coaches need to be more sensitive to kids’ motivations. Popkin sometimes asks parents to leave the exam room, at which point young injured athletes may confess that they don’t want to play as much as they do. “They see their shoulder pain as their way out,” Popkin says.

The true culprit may be the changing structure of sport. The youth pitching guidelines set by Major League Baseball and USA Baseball, the national governing authority for amateur ball, allow for upwards of 50 games a year. Soccer, hockey, and basketball leagues and tournaments run year-round and may call on a team to play as many as seven games in a weekend.

How much is too much? A rough guideline is to limit the weekly hours of playing and training to a kid’s age. So a 10-year-old should limit play and training in one sport to 10 hours a week. “The most important thing is to expose kids to multiple sports, and let them pick one when they’re high school sophomores if they want,” Popkin says. “They should never be pushed. They should do it because they love it.”

Glimco just entered his senior year, and he’s determined to do rehab right and avoid being part of the 26 percent of high-school Tommy John recipients who don’t return to pre-injury skill. “I’m really careful now, even when I’m just hanging out with friends,” he says. “I want to be ready to play in the spring, and I want to play in college.” Glimco insists he’s gotten the message: To play more in the long run, he needs to play less now.

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