start him young no pain no gain
practice makes perfect these are the
mottos and myths of Youth Sports today
there are so many amazing benefits and
life lessons in sport but our current
youth sports culture is putting the
emotional and physical health of our
children in danger we have all seen and
heard about the stories and consequences
of this win at all costs mentality
overzealous parents coaching from the
sidelines year round play early sports
specialization the epidemic of overuse
injuries and burnout I’m navigating you
sports as a mom a pediatrician and a
sports medicine physician I do see the
amazing benefits there are in sport but
more often I see the physical and
psychological toll that it is taking on
our children and the financial toll that
it takes on as parents but as a
disclaimer I don’t always get it right I
started my kids young they both played
year-round we even have a hockey room in
our basement equipped with synthetic ice
but I have learned a lot along the way
so I’m going to share with you today
some of those stories of patients I see
in my clinic each day but to protect the
privacy of these annual athletes I’ve
changed a lot of details so growing
bones are different because they have
growth plates which are the areas on the
bone where the body lays down new bone
to grow that bone longer so this is an
x-ray of a wrist you can see the radius
and the ulna and those dark lines across
the edge of those bones are the growth
plates or the faces because it’s an open
area it’s a weak link
and prone to injury like in this gymnast
who had been complaining of left wrist
pain we’re not meant to walk on our
hands and she’s stressed this growth
plate here and then it appears widened
on the x-ray and that can cause
long-term growth issues here they also
have these areas called Apophis YZ which
are also open areas on the bone like you
can see in this x-ray of the foot but
they’re not for growing the bone longer
they’re just where tendons attach but as
their long bones are growing longer
those muscles and tendons take a little
bit extra time to stretch out and catch
up and so they’re tugging on that
offices there and with all the running
and jumping and overuse it can cause
injury to this like in this dancer who
had been complaining of left post your
hip pain for a while and she went to
just do a simple leap and felt a painful
pop over the back side of her hip and
she sustained an avulsion fracture of
the apophysis there where that hamstring
tendon attaches to the sit bone and this
is Joe he is a 12 year old competitive
hockey and soccer player plays both
sports year round he’d been complaining
of low back pain for nine months his
coach said you’re fine suck it up we
need you out there
and finally mom noticed that he was
limping on the field one day and she
thought I better bring him in his exam
was concerning for a fracture a stress
fracture in the lumbar spine and one of
the bones called the vertebra and an
x-ray confirmed that here’s a side view
or a lateral view of that lumbar spine
and that dark line across the bone there
is the fracture an MRI confirmed that he
had bilateral chronic appearing
vertebral stress fractures but he also
had bilateral sacral stress fractures
the sacrum is that bone just right above
the tailbone and this in this MRI you
can see all that white is the swelling
in the bone and then those dark lines in
the midst of that swelling are the
fractures this child was only 12 years
old and it took him three months to heal
this was will competitive baseball
pitcher plays year-round had been
complaining of medial elbow pain for a
while and in the second ending of a game
went to throw a pitch felt a painful pop
over the inside of his elbow and had
more swelling and he fractured off of
that apophysis his parents said he’s the
best pitcher in the state he’s worth
hundreds of thousands of dollars in
scholarship money he needs to be able to
play in the tournament this weekend
instead he was having a surgery to fix
this and this is Anna she’s an 11 year
old it plays hockey soccer and lacrosse
all at the same time and while I think
it’s imperative for kids to play
multiple sports when you’re playing them
all at the same time and going from
sport to sport is when I see even more
overuse injuries so she’s been diagnosed
with something called osgood-schlatters
disease which is really common a lot of
you probably pad it yourselves or your
kids have it now and it’s an overuse
injury where that that kneecap is the
patella turns into the patellar tendon
and attaches onto the shin bone there
and there’s no patha –ss so a weak link
involve
running and jumping you can get painful
and swollen there so she had had this
diagnosis but she continued to play
through the pain and one day just went
to kick a soccer ball and felt a pop and
had more swelling there and she
fractured through and needed a surgery
to fix it all of these injuries were
preventable 50% of all sports injuries
are due to overuse which means half of
all of these injuries are preventable
preventable injuries preventable
surgeries so I’ve been asking myself
these three questions first how did we
get here second why does the culture
persist and third what can we do to
transform youth sports into the positive
inspiring character building legacy that
it should be so first the roots of
sports specialization are so interesting
and can be traced back to ancient Roman
and Greek times and the Olympics where
the motto is stronger faster higher fast
forward to the 1800s and you start to
have more organized societies like YMCA
and then in the 1920s and 30s be a Pop
Warner Little League USA hockey soccer
associations and then Nadia Comaneci hit
the scene with her perfect ten
in the 1976 Olympics and we all wondered
how did the Eastern Europeans become so
successful it was start young train hard
so we started to do that and then we
started to look at some other
disciplines like musicians and chess
masters and we wondered how did they get
so good at what they’re doing and it
turns out it’s about the quantity and
quality of practice in 1985 psychologist
Benjamin bloom described his theory of
deliberate practice where there are
three stages to mastering a skill first
is the romance phase where the kids are
young and they’re just playing and
having fun and exploring and they’re
learning to love the game and then the
precision stage where they’re a little
older and now they can develop the more
technical skills in a systematic way and
then the integration phase where they’re
old enough now and can put everything
together and really master that skill or
sport but this is a long-term process
and it takes deliberate practice in 1991
Anders Ericsson came out with his 10
year rule which was made more famous by
Malcolm Gladwell in his book the
outliers in the 10,000 hours it takes to
master something but that was
oversimplified in the public media
because there’s more to mastery than
just practice inherent talent luck
wealth and if you skip that critical
romance phase how will you have the
motivation to sustain a deliberate
practice so it’s this theory of
deliberate practice then that fueled
early sports specialization and then we
start to look to the professional
athletes and we start training these
kids like little professionals we even
put them on the cover of Sports
Illustrated now this was just a cute
tournament Dory tag but still we have
professionalized youth sports children’s
bodies are not meant to withstand this
kind of stress and now we see the
consequences of year-round play and
early sports specialization overuse
injuries burnout compromise growth so
this exhaustion and physical burnout
that these kids are going through 70% of
kids will quit sports by the time
they’re 13 now that’s multifactorial in
ideology but a lot of it is due to
burnout from a developmental anatomical
perspective kids are not ready to
specialize until they’re age 13 or 14
most kids don’t even understand the
concept of a team sport until they’re
eight and by then many are already
specialized in on traveling teams I do
think it’s important for kids to play
recreationally younger but just don’t
expect them to spread out on the field
right so so why does this culture
persist them we all sit at our kids
games and commiserate about the politics
and intensity of youth sports we all
know that it’s become an unhealthy
environment and yet we allow it to
persist it is the most fascinating
social phenomenon it’s parent to parent
peer pressure at its finest we all drank
the kool-aid and jumped off the cliff
Youth Sports has become a 15 billion
dollar industry that’s more than the NFL
professor and journalist mark Hyman who
wrote the book the most expensive game
in town wrote our children our customers
not athletes it is all about the money
we received this flyer in the mail from
a local hockey organization that we’re
promoting their hockey clinics from the
might level kids and my levels are kids
eight and under and it says remember
when you are not practicing somewhere
someone is and when you meet him he will
win these kids are eight years old but
it’s their parents who are buying into
it and yet when you see your child have
a moment like this you want to do
everything you can to support their
success what I love about this picture
as my son had just centered a pass to
this kid in front of the net who was a
three-sport athlete plays the sport of
the season exceptional baseball player
and he literally batted the puck into
the net you can see the ref signal the
goal the boys look at each other and
celebrate it’s moments like these that
you want for your kids you also want
them to experience loss and struggle so
we are doing the best we can to advocate
for our children but we are so misguided
so what can we do to change you sports
culture if peer pressure can work in one
way they can certainly work on the
opposite we are the silent majority and
we are nearing a tipping point of
collective exhaustion and outrage where
we can create a cultural mind shift if
we do it together as a team my goal is
to keep these kids in the game as long
as we can so here’s what we can do we
must dispel the myths of stardom young
practice makes perfect no pain no gain
avoid early sports specialization
playing multiple sports throughout the
year and playing the sport of the season
has been shown to reduce injury and keep
kids playing longer allow appropriate
periods of rest so that growing bodies
and bones can recover the rule of thumb
is that a child should be playing no
more hours per week than they are years
old so an 8 year old should not be
playing more than 8 hours a week now
some of you might be calculating right
now ok my kid plays way more hours than
that or you might say but they’re so
intrinsically motivated I’m not pushing
them and that might be true but kids are
also intrinsically motivated to play
Fortnight all day
and that’s not necessarily a good thing
either right so this is just a guideline
you know your child best but in my
experience and studies show it works so
the next thing is to understand the
concept the theory of developmental
readiness so you can’t expect a
seven-year-old to understand how to do a
pick-and-roll right so all coaches
should receive training in positive
developmentally appropriate coaching I
support the positive coaching Alliance
whose mission it is to create better
athletes better people by hosting
workshops for coaches athletes parents
and leadership and demonstrating ways to
honor the game as an executive board
member the positive coaching Alliance
Minnesota chapter we teach concept like
concepts like routes where we respect
the rules
opponents officials teammates and self
another concept is the elm tree of
mastery effort learning mistakes it’s
about the effort you put in the learning
of new skills and that mistakes are
essential to master your sport and
improve positive coaching Alliance is
not an organization that promotes
trophies for all I think this is all in
the same season by the way which is
hysterical but they do promote three
different roles the first is for the
athlete the triple impact competitor
whose job it is to elevate themselves
their teammates and the game and then
the double goal coach whose first job is
to strive to win but second is to teach
those life lessons through sport and
third is the single goal parent whose
only job it is to support your child let
the coaches and athletes worry about the
X’s and O’s and the scoreboard
ultimately this is all about filling the
emotional tanks of our children with
continuous positive feedback a child
with a full tank will be more likely to
take on adversity and challenge have
more fun and be willing to continue to
play despite loss or injury how do you
know if your kid has burned out or
running on empty sometimes it’s obvious
but more often it’s subtle they may lack
ambition and enthusiasm to attend prac
and games you might see their sports
performance even their school
performance start to decline
they might complain of of joint pain and
chronic muscle pain be fatigued and
easily irritable or you might just have
yourself a teenager it’s hard to tell
sometimes but again you know your child
the best do everything you can to keep
their emotional tanks full so here’s my
prescription for youth sports as parents
we must back off and let our children
choose their own path unstructured play
allow them to innovate it improvise on
their own we can shift the momentum our
children can be independent well-rounded
and self-motivated if we take ourselves
out of the equation sometimes and allow
them to focus on the three FS fun
fitness and friends let kids be kids honor the game thank you
practice makes perfect these are the
mottos and myths of Youth Sports today
there are so many amazing benefits and
life lessons in sport but our current
youth sports culture is putting the
emotional and physical health of our
children in danger we have all seen and
heard about the stories and consequences
of this win at all costs mentality
overzealous parents coaching from the
sidelines year round play early sports
specialization the epidemic of overuse
injuries and burnout I’m navigating you
sports as a mom a pediatrician and a
sports medicine physician I do see the
amazing benefits there are in sport but
more often I see the physical and
psychological toll that it is taking on
our children and the financial toll that
it takes on as parents but as a
disclaimer I don’t always get it right I
started my kids young they both played
year-round we even have a hockey room in
our basement equipped with synthetic ice
but I have learned a lot along the way
so I’m going to share with you today
some of those stories of patients I see
in my clinic each day but to protect the
privacy of these annual athletes I’ve
changed a lot of details so growing
bones are different because they have
growth plates which are the areas on the
bone where the body lays down new bone
to grow that bone longer so this is an
x-ray of a wrist you can see the radius
and the ulna and those dark lines across
the edge of those bones are the growth
plates or the faces because it’s an open
area it’s a weak link
and prone to injury like in this gymnast
who had been complaining of left wrist
pain we’re not meant to walk on our
hands and she’s stressed this growth
plate here and then it appears widened
on the x-ray and that can cause
long-term growth issues here they also
have these areas called Apophis YZ which
are also open areas on the bone like you
can see in this x-ray of the foot but
they’re not for growing the bone longer
they’re just where tendons attach but as
their long bones are growing longer
those muscles and tendons take a little
bit extra time to stretch out and catch
up and so they’re tugging on that
offices there and with all the running
and jumping and overuse it can cause
injury to this like in this dancer who
had been complaining of left post your
hip pain for a while and she went to
just do a simple leap and felt a painful
pop over the back side of her hip and
she sustained an avulsion fracture of
the apophysis there where that hamstring
tendon attaches to the sit bone and this
is Joe he is a 12 year old competitive
hockey and soccer player plays both
sports year round he’d been complaining
of low back pain for nine months his
coach said you’re fine suck it up we
need you out there
and finally mom noticed that he was
limping on the field one day and she
thought I better bring him in his exam
was concerning for a fracture a stress
fracture in the lumbar spine and one of
the bones called the vertebra and an
x-ray confirmed that here’s a side view
or a lateral view of that lumbar spine
and that dark line across the bone there
is the fracture an MRI confirmed that he
had bilateral chronic appearing
vertebral stress fractures but he also
had bilateral sacral stress fractures
the sacrum is that bone just right above
the tailbone and this in this MRI you
can see all that white is the swelling
in the bone and then those dark lines in
the midst of that swelling are the
fractures this child was only 12 years
old and it took him three months to heal
this was will competitive baseball
pitcher plays year-round had been
complaining of medial elbow pain for a
while and in the second ending of a game
went to throw a pitch felt a painful pop
over the inside of his elbow and had
more swelling and he fractured off of
that apophysis his parents said he’s the
best pitcher in the state he’s worth
hundreds of thousands of dollars in
scholarship money he needs to be able to
play in the tournament this weekend
instead he was having a surgery to fix
this and this is Anna she’s an 11 year
old it plays hockey soccer and lacrosse
all at the same time and while I think
it’s imperative for kids to play
multiple sports when you’re playing them
all at the same time and going from
sport to sport is when I see even more
overuse injuries so she’s been diagnosed
with something called osgood-schlatters
disease which is really common a lot of
you probably pad it yourselves or your
kids have it now and it’s an overuse
injury where that that kneecap is the
patella turns into the patellar tendon
and attaches onto the shin bone there
and there’s no patha –ss so a weak link
involve
running and jumping you can get painful
and swollen there so she had had this
diagnosis but she continued to play
through the pain and one day just went
to kick a soccer ball and felt a pop and
had more swelling there and she
fractured through and needed a surgery
to fix it all of these injuries were
preventable 50% of all sports injuries
are due to overuse which means half of
all of these injuries are preventable
preventable injuries preventable
surgeries so I’ve been asking myself
these three questions first how did we
get here second why does the culture
persist and third what can we do to
transform youth sports into the positive
inspiring character building legacy that
it should be so first the roots of
sports specialization are so interesting
and can be traced back to ancient Roman
and Greek times and the Olympics where
the motto is stronger faster higher fast
forward to the 1800s and you start to
have more organized societies like YMCA
and then in the 1920s and 30s be a Pop
Warner Little League USA hockey soccer
associations and then Nadia Comaneci hit
the scene with her perfect ten
in the 1976 Olympics and we all wondered
how did the Eastern Europeans become so
successful it was start young train hard
so we started to do that and then we
started to look at some other
disciplines like musicians and chess
masters and we wondered how did they get
so good at what they’re doing and it
turns out it’s about the quantity and
quality of practice in 1985 psychologist
Benjamin bloom described his theory of
deliberate practice where there are
three stages to mastering a skill first
is the romance phase where the kids are
young and they’re just playing and
having fun and exploring and they’re
learning to love the game and then the
precision stage where they’re a little
older and now they can develop the more
technical skills in a systematic way and
then the integration phase where they’re
old enough now and can put everything
together and really master that skill or
sport but this is a long-term process
and it takes deliberate practice in 1991
Anders Ericsson came out with his 10
year rule which was made more famous by
Malcolm Gladwell in his book the
outliers in the 10,000 hours it takes to
master something but that was
oversimplified in the public media
because there’s more to mastery than
just practice inherent talent luck
wealth and if you skip that critical
romance phase how will you have the
motivation to sustain a deliberate
practice so it’s this theory of
deliberate practice then that fueled
early sports specialization and then we
start to look to the professional
athletes and we start training these
kids like little professionals we even
put them on the cover of Sports
Illustrated now this was just a cute
tournament Dory tag but still we have
professionalized youth sports children’s
bodies are not meant to withstand this
kind of stress and now we see the
consequences of year-round play and
early sports specialization overuse
injuries burnout compromise growth so
this exhaustion and physical burnout
that these kids are going through 70% of
kids will quit sports by the time
they’re 13 now that’s multifactorial in
ideology but a lot of it is due to
burnout from a developmental anatomical
perspective kids are not ready to
specialize until they’re age 13 or 14
most kids don’t even understand the
concept of a team sport until they’re
eight and by then many are already
specialized in on traveling teams I do
think it’s important for kids to play
recreationally younger but just don’t
expect them to spread out on the field
right so so why does this culture
persist them we all sit at our kids
games and commiserate about the politics
and intensity of youth sports we all
know that it’s become an unhealthy
environment and yet we allow it to
persist it is the most fascinating
social phenomenon it’s parent to parent
peer pressure at its finest we all drank
the kool-aid and jumped off the cliff
Youth Sports has become a 15 billion
dollar industry that’s more than the NFL
professor and journalist mark Hyman who
wrote the book the most expensive game
in town wrote our children our customers
not athletes it is all about the money
we received this flyer in the mail from
a local hockey organization that we’re
promoting their hockey clinics from the
might level kids and my levels are kids
eight and under and it says remember
when you are not practicing somewhere
someone is and when you meet him he will
win these kids are eight years old but
it’s their parents who are buying into
it and yet when you see your child have
a moment like this you want to do
everything you can to support their
success what I love about this picture
as my son had just centered a pass to
this kid in front of the net who was a
three-sport athlete plays the sport of
the season exceptional baseball player
and he literally batted the puck into
the net you can see the ref signal the
goal the boys look at each other and
celebrate it’s moments like these that
you want for your kids you also want
them to experience loss and struggle so
we are doing the best we can to advocate
for our children but we are so misguided
so what can we do to change you sports
culture if peer pressure can work in one
way they can certainly work on the
opposite we are the silent majority and
we are nearing a tipping point of
collective exhaustion and outrage where
we can create a cultural mind shift if
we do it together as a team my goal is
to keep these kids in the game as long
as we can so here’s what we can do we
must dispel the myths of stardom young
practice makes perfect no pain no gain
avoid early sports specialization
playing multiple sports throughout the
year and playing the sport of the season
has been shown to reduce injury and keep
kids playing longer allow appropriate
periods of rest so that growing bodies
and bones can recover the rule of thumb
is that a child should be playing no
more hours per week than they are years
old so an 8 year old should not be
playing more than 8 hours a week now
some of you might be calculating right
now ok my kid plays way more hours than
that or you might say but they’re so
intrinsically motivated I’m not pushing
them and that might be true but kids are
also intrinsically motivated to play
Fortnight all day
and that’s not necessarily a good thing
either right so this is just a guideline
you know your child best but in my
experience and studies show it works so
the next thing is to understand the
concept the theory of developmental
readiness so you can’t expect a
seven-year-old to understand how to do a
pick-and-roll right so all coaches
should receive training in positive
developmentally appropriate coaching I
support the positive coaching Alliance
whose mission it is to create better
athletes better people by hosting
workshops for coaches athletes parents
and leadership and demonstrating ways to
honor the game as an executive board
member the positive coaching Alliance
Minnesota chapter we teach concept like
concepts like routes where we respect
the rules
opponents officials teammates and self
another concept is the elm tree of
mastery effort learning mistakes it’s
about the effort you put in the learning
of new skills and that mistakes are
essential to master your sport and
improve positive coaching Alliance is
not an organization that promotes
trophies for all I think this is all in
the same season by the way which is
hysterical but they do promote three
different roles the first is for the
athlete the triple impact competitor
whose job it is to elevate themselves
their teammates and the game and then
the double goal coach whose first job is
to strive to win but second is to teach
those life lessons through sport and
third is the single goal parent whose
only job it is to support your child let
the coaches and athletes worry about the
X’s and O’s and the scoreboard
ultimately this is all about filling the
emotional tanks of our children with
continuous positive feedback a child
with a full tank will be more likely to
take on adversity and challenge have
more fun and be willing to continue to
play despite loss or injury how do you
know if your kid has burned out or
running on empty sometimes it’s obvious
but more often it’s subtle they may lack
ambition and enthusiasm to attend prac
and games you might see their sports
performance even their school
performance start to decline
they might complain of of joint pain and
chronic muscle pain be fatigued and
easily irritable or you might just have
yourself a teenager it’s hard to tell
sometimes but again you know your child
the best do everything you can to keep
their emotional tanks full so here’s my
prescription for youth sports as parents
we must back off and let our children
choose their own path unstructured play
allow them to innovate it improvise on
their own we can shift the momentum our
children can be independent well-rounded
and self-motivated if we take ourselves
out of the equation sometimes and allow
them to focus on the three FS fun
fitness and friends let kids be kids honor the game thank you
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