The Hidden Risks of Early Sports Specialization: A Podiatric Perspective on Injury Prevention

Q: From a podiatric perspective, what is early sports specialization, and what primary issues surround that trend?

A: I think it’s important to mention, before we define early sports specialization, that youth sports are very positive. They can be a very important component of growing up, teaching children good values, relationships, healthy habits, good discipline, stress reduction, and leadership skills. The problem is, there can be too much of a good thing. Overparticipation in sports can lead to negative consequences. With increasing demand, kids can start losing the benefits. They can experience burnout. They can lack motivation to keep going or can see an increase in injury risk. But looking at the whole child, we want to make sure they have a chance to be kids. 

The American Orthopedic Society of Sports Medicine defines early sports specialization as participation in intensive training and/or competition in an organized sport greater than 8 months per year.^1-3 Essentially, they’re doing that single sport year-round. The second criteria is participation in that single sport to the exclusion of participation in other sports, activities, or just to the exclusion of free play. The third criteria is the focus on kids roughly 12 years or younger. We still have concerns with specialization in adolescents, but the definition specifies ages 12 and under or seventh grade and younger.^1-3 From a podiatric standpoint, we’re really attuned to the effects that this could have on the foot and ankle. 

Q: Can you share some of the biomechanical patterns one might see in these young athletes? 

A: About half of youth sports injuries are overuse injuries.⁴ And 2 of the biggest risk factors for these in kids are overtraining/early sports specialization and biomechanical abnormalities. So, biomechanics plays a big role. As far as podiatric pathology, one of the most common things I see in kids is Severs disease, or calcaneal apophysitis. What we see there biomechanically is often pes planus and tight calf muscles. 

Looking at the kinetic chain, it might not be a structural abnormality, often we can see poor flexibility, weakness, poor muscle control, and decreased core stability. This is something that is often highlighted in throwing sports, specifically baseball pitchers. For pitchers, It is very easy to think about a strong core and shoulders because if they don’t have good muscle control, they can’t properly decelerate in throwing mechanics and they put undue stress on the shoulder and elbow leading to injury. The same principle should be considered with lower extremity. You need good core stability and muscle control for proper lower extremity mechanics. For example, looking a kicking sports, like soccer. You need good, stable control along your kinetic chain. So, if they don’t have good muscle control and stability, they’re going to significantly increase the risk of lower extremity injury as well. Sometimes prevention is the best treatment with generalized strength, flexibility, and mobility.  

Q: What do you think clinicians should look for in examinations of these young athletes that may tip them off before injuries happen?  

A: I think a big part of this is taking a good history, talking to not just the kids, but also to the parents. What sports are you (the child) playing? How many months are you playing that sport? How often are you practicing? Another big question I’ll ask is, how often are you warming up or stretching before and after your sport? What other conditioning are you doing? What kind of shoes are you wearing? How often are you wearing your cleats? And then, looking for biomechanical features through a good standing and walking biomechanical exam is important, Pes planus, pes cavus, leg length discrepancy, etc. But a big part of it, I think, is asking the right history questions.  

Q: When these athletes walk into the clinic, what kind of approaches have worked for you in balancing recovery from that injury with their eagerness to get back into play? 

A: That gets back to the conversations with the kids and the parents. Oftentimes, going back to the calcaneal apophysitis example, we have to balance the ideas of rest versus active rest vs report back to sport. Most kids with Severs aren’t going to need complete rest, they are not going to need to stop playing all sports. In most cases they need activity modification and “active rest.” Rest from some things, but not all things. Maybe tournaments and games 6-7 days a week is too much, and instead temporarily they’ll only play 2-3 days a week to reduce the load. Or, reduce the amount of time in cleats, save cleats for technical drills, scrimmages and games, and then wear running shoes for jogging and conditioning. Listen to their symptoms, modify their training, and determine complete vs active rest based on severity.  

It’s not just focusing on what they can’t do, but also focusing on what they can. With most injuries, they don’t have to stop everything! Can they still do some lifting, bike, or do some drills safely? Usually there’s still a little bit of something they can do. If you can at least get them to the sideline, somehow participating with their team, with their friends, even if it’s only a very small thing, at least they’re doing something. It’s so important to keep them engaged – there is a mental health component of making it through an injury. 

Q: How do you see podiatric physicians fitting into the greater care team for these athletes? 

A: Especially when you’re talking to the older kids, including the parents, or when you have the opportunity to talk with the coaches, going through some important statistics can be helpful. Some studies cite anywhere between 17-41% of youth athletes as specializing in one sport,⁴ which is not a good statistic, because we know that they are a significantly increased risk of injury compared to those who sample multiple sports. 

Many parents want their child to be an elite athlete and play in college. Some kids just have those elite dreams. Its important for the parent to know that early sports specialization isn’t required to be elite athletes. Actually, most elite athletes don’t specialize in one sport as a kid. They did a poll of professional athletes in the US and they found that 97% of professional athletes believe that being a multisport athlete as a kid was beneficial to their success.³ 

If anybody listens to the New Heights podcast, which is the Kelce brothers, Jason and Travis Kelce, these are NFL players who were or are at the top of the game. They talk about being multisport athletes at kids all the time. They played ice hockey. They played basketball, as well as football. Jason Kelce was in the band. He played the saxophone. So, they did other things. And they always talk about how beneficial it was for them to do the other sports. Plus, if you’re playing other sports, you’re diversifying what muscles you’re using in certain ways. So, you actually get better muscle development and neuromuscular control if you’re doing other things, especially at a young age. Playing multiple sports can actually make you a better athlete!  

There was also a study that looked at German Olympians. They asked all the people on the German Olympic team if they played more than one sport as a child. Here, 88 percent of the Olympians reported participating in more than one sport as a child.⁵ The outliers of that were the sports where you compete at much younger ages, such as gymnasts, some of the divers, and the figure skaters. They were the exceptions because they compete at a higher level at a younger age. 

As I said, diversification in sports can lead to better health later. Also, if you look at kids who play multiple versus one sport and their later athletic endeavors as an adult, you see that with diversification a child, they’re more likely to be a long-term sports participator.

An hour of unstructured activity a day is vital for these children. If you’re only ever doing one sport, the easy example is baseball pitching, you’re doing the same motion over and over with the shoulders. Whereas, if you’re playing tag, you’re cutting, changing directions, reaching out, back-pedaling. So, playing these unstructured games help develop better patterns and coordination anyway; all in all, it’s making you a better athlete.

Q: What else do you think podiatrists should know?  

A: I think one more important thing to share are the American Academy of Pediatrics and the National Athletic Trainers Association recommendations for youth sports specialization.^1-6 First, kids and adolescents should delay specializing in a single sport for as long as possible. Youth athletes should only participate in one organized sport per season. Too often we have kids with injuries that play on 2-3 sports teams at the same time!

Next is less than 8 months per year in a single sport. This is a big one, especially in our area, with youth soccer. Kids are encouraged to play on multiple teams by for profit youth sports organizations. They get stuck in a pyramid scheme-type trap of, “they can’t get good playing time unless they also play on this team, and they can’t get to the elite team unless they first play on this travel team, If they don’t play on this travel team, they can’t get playing time on the original team.” So, then they are essentially playing year-round on multiple teams, way more than recommended maximum of 8 months per year in a single sport. 

Kids should have at least 2-3 months off from ALL organized sports each year. And with adolescent and younger athletes, they need to spend time away from organized sport activity at the end of the competitive season (~1 month). You need to have a little bit of time in between to rest and recover. Now, that’s not sitting doing nothing. You can still do unstructured play, just don’t jump right into the next organized sports.

Another addresses weekly training time. The repetitions, total distance running, or intensity shouldn’t increase by more than 10% each week. Too often you have these kids that basically do nothing and then transition directly into sports. They’ve got to ease into it. 

The next one, which can be a little vague depending on the kid and sport, recommends no more hours per week than age in years. So, if the child is 5, they shouldn’t do more than 5 hours per week on a baseball team. They’ve got to diversify and do other things. Although there is a little leeway, that’s the general rule. 

Last but not least is free play! is encouraging those periods of fun structured play we previously mentioned. Let those kids be kids. The American Academy of Pediatrics recommends that children spend at least one hour a day engaged in free unstructured play.²  

Published in partnership with the American Podiatric Medical Association.

Dr. Canzanese is a Fellow and past President of the American Academy of Podiatric Sports Medicine, board certified by the American Board of Podiatric Medicine, and holds a certificate of added qualification in sports medicine. In addition to her practice, she’s an attending with the Chestnut Hill Residency program in the Philadelphia region and an adjunct faculty member at Temple University School of Podiatric Medicine where she teaches the podiatric sports medicine course. She also lectures at multiple podiatry conferences around the country and is a certified athletic trainer. Recently, she was installed as the President of the Pennsylvania Podiatric Medical Association. 

References
1.    Sports Medicine Update. The Fallacy of Falling Behind: The Realities of Early Sports Specialization. Sports Medicine Update. https://www.sportsmed.org/membership/sports-medicine-update/fall-2024/the-fallacy-of-falling-behind-the-realities-of-early-sports-specialization. Accessed February 2025.
2.    AAP releases recommendations on overuse injuries and overtraining in child athletes. Am Fam Physician. 2007;76(11):1725.
3.    LaPrade RF, Agel J, Baker J, et al. AOSSM early sport specialization consensus statement. Orthop J Sports Med. 2016;4(4):2325967116644241. doi:10.1177/2325967116644241
4.    Jayanthi NA, Post EG, Laury TC, Fabricant PD. Health consequences of youth sport specialization. J Athl Train. 2019;54(10):1040-1049. doi:10.4085/1062-6050-380-18
5.    Myer GD, Jayanthi N, DiFiori JP, et al. Sports specialization, part II: alternative solutions to early sport specialization in youth athletes. Sports Health. 2016;8(1):65-73. doi:10.1177/1941738115614811
6.    National Athletic Trainers’ Association. Youth Sports Specialization Recommendations. https://www.nata.org/sites/default/files/2025-08/youth_sports_specialization_recommendations.pdf. Accessed February 2025.