Specialization...Is it the problem we think it is?

Early specialization in sport, it is becoming more of a hot topic than ever. A growing number of coaches are recruiting multi-sport athletes rather than specialized athletes. Let me present some research statistics about early specialization paraphrased from (http://changingthegameproject.com/is-it-wise-to-specialize/)

  1. Specialization leads to:
    1. 50% of overuse injuries in young athletes
    2. Higher rates of adult physical inactivity. 
    3. In a study of 1200 youth athletes, Dr Neeru Jayanthi of Loyola University found that early specialization in a single sport is one of the strongest predictors of injury. Athletes in the study who specialized were 70% to 93% more likely to be injured than children who played multiple sports!
  2. Far greater risk for burnout due to stress, decreased motivation and lack of enjoyment
  3. Female adolescents is associated with increased risk of anterior knee pain disorders including PFP, Osgood Schlatter and Sinding Larsen-Johansson compared to multi-sport athletes, and may lead to higher rates of future ACL tears (added May 2014)
  4. Better Overall Skills and Ability
  5. Smarter, More Creative Players

Ok, we get it specialization is important. But what are we really trying to change here, injuries, enjoyment, or advancing the sport? Let’s talk about injuries as it is the biggest common denominator. If you’re hurt you cannot play and you definitely aren’t happy about it. 

Can anyone tell me exactly why specialization creates injuries? Is it just a ticking time bomb and the only recipe is to give the exact appropriate amount of pitches per days of rest? There are countless studies and articles like this 

A 2006 study in the American Journal of Sports Medicine said youth pitchers who threw more than eight months per year were more likely to have shoulder or elbow surgery. And pitchers between the ages of 9 and 14 who pitched more than 100 innings per year were 3.5 times more likely to suffer an injury resulting in being sidelined, according to a 10-year prospective study of 481 youth baseball pitchers co-authored by famed orthopedic surgeon James R. Andrews” (https://www.youthletic.com/articles/early-specialization-can-lead-to-overuse-injuries-in-youth-sports/

Yet this does not tell me WHY these injuries occur. It is just saying when I have a shiny new car, if I drive it 10,000 miles in a year it is 3.5 times more likely to break down… But why? The only reason my car would breakdown is if I was driving it incorrectly or something mechanical happened…right? Andrews says on his website “The most obvious treatment for overuse is rest, especially from the activity that created the injury.” Ok so I have my car that has magically started to break down at 10,000 miles this year. Let me just put it in the garage for a few weeks, that will magically fix the problem, right? Magic created the problem so lets use magic to fix the problem. 

Alright, now lets do some more digging to see if we can find what the famed Dr. James Andrews speculates the causes are:

What are some common causes of elbow pain?

Playing tennis and golf are common causes of elbow pain. However, many other activities can create inflammation and pain in the tendons of the elbow. These include using a screwdriver, grasping, hammering, throwing, raking, and painting, among others.

So if I love to play tennis and golf, I should just stop? Further into his website he states that repetitive stress, and overuse of my forearm muscles causes my hypothetical tendonitis, again putting a magic number to how many miles I’m allowed to drive my car. I’m still not convinced this is the cause. But why am I overusing my forearm muscles? If I have them, why can I not use them?

Why am I being so difficult and stubborn with this dilemma? Well reader, I’m glad you asked. I have had the opportunity to do quite a bit of traveling, especially to Asia. While backpacking through Thailand, Laos, and Cambodia I made some pretty unique observations. Then on my next trip was to lecture to the Chinese Olympic Committee and work with several of their Olympic Athletes. Those of you who do not know about the Chinese Olympic development program, a quick summary is: around the ages of 7-10 specific children are selected as future hopeful athletes. They stop going to school entirely and train year round. 

Now everybody gasp in the horror of early specialization. “They obviously will not last in this system,” said no one in China for the last several generations.  

What did my esteemed colleague Jeff Moreno and I see with the athletes from the epitome-of-early-specialization-Chinese-Olympic-development-program? Well I’ll tell you what we did not see. We did NOT see the same movement signatures of the early specialized athletes we see in America. We did NOT see the same physical illiteracy running rampant through America. We did NOT see worse overall skills and abilities. We did NOT see a poorer knowledge of the sport.

Fifth Place at 2015 World Championships

Furthermore, during my time in Southeast Asia, I saw people working tirelessly at their meaningful jobs all day long for most of their lives. I trekked out to a village that was very far removed from the busy city of Chaing Mai. I watched these three (picture below) execute the same pattern over and over again.

Surely a nightmare in Dr. Andrews eyes. Later that day I watched them walk back into the village to join us for dinner. They were not limping, they did not have braces wrapped around their joints and had a smile on their face. They came home, squatted NOT into a chair (like picture of women below) but the floor and drank rice whiskey with us. 

So two very different examples proving the research isn't exactly hitting the nail on the head. I believe that the research is taking too much of a reductionist approach. That if A exists than B is at the other end of the magical yellow brick road.

Look at this image as it describes research and complex biological systems. In the top image it states, “The underlying paradigm in reductionist research: major parameters (a, b and c) had a major impact, and minor parameters (d) have a minor impact.” The bottom caption reads, “The underlying paradigm in complex biological systems: under some circumstances both major and minor parameters (a, b, c and d) may have a major impact, but in other circumstances little or no impact, on what happens in the system.”

 Image from “Strength Training and Coordination: An Integrative Approach” By - Frans Bosch

This is a lot of the reason why America has these issues. We love simple answers, quick fixes, and “if this than that” solutions. Just look at the diet industry, no one actually wants to change their lifestyle (the greek root of diet actually means lifestyle), they want a 24 day juice cleanse, or a pill to take every day. When the best answer is, put down the vat of Ben & Jerry’s, eat something heathy and get your ass off the couch! 

This next story is what really hit home for me and Jeff. All the Olympians we saw were above the age of 19. We saw two 15 year old soccer players that were in the development system, they did not resemble the older athletes we saw. They looked like the physically illiterate kids Jeff & I see daily in America. Not only did they have no idea how to move their bodies, their lifestyle resembled that of most Americans. After our 2 hours of working with them, they returned to their normal activities, slouching in a chair on their cell phones.  We asked them what they do at home, and they play video games when they are not on their phones. Here’s an image I snapped that is representative of the youth in China, whom are catching up to our already failing American Youth. 

The problem isn’t specialization as most understand it! Specialization is the equivalent of a running shoe in a runner’s life. If the runner has bad mechanics, it doesn’t matter what shoe they wear, they are going to be inefficient and have pain. The shoe is part of the equation to optimize performance and lifestyle, but not the answer. The same thing is true for specialization. 

Here’s another story I recently experienced at a volleyball camp in Virginia. I saw one girl who was one of the best movers I have ever seen play the sport (my background is volleyball btw). I went up to her and got to know her better as she was a major outlier in the group of 60 high school aged kids. She is 14 and has specialized in volleyball since she was 11. Yet she did not display ANY characteristics of the aforementioned specialization risks. She LOVED the sport, she took ownership and was intrinsically motivated enough to ask how she can get better and optimize her life outside of her sport to be better within it (this is extremely rare with most American athletes). She has never had a non-contact or overuse injury, she was creative with her playing strategy and had lots of confidence. What factors in her life created such good characteristics? An active, outdoors lifestyle. She never spent much time inside, physically labored on a ranch taking care of her horses and has experienced lots of different living environments from moving from Hawaii, to Texas, to Virginia. Her development outside of the sport seeped into how well she is able to play today, and probably 15 years from now too. 

Now for the other outlier within this camp. There was a 15 year old boy, who played nervously, moved with poor motor patterns, and had knee pain. I of course got to know him better. Surprisingly, he has played lots of different organized sports…So clearly avoiding specialization has not worked out for him. Why do I think he moved this way? Because of how much sedentary time he clocks in at school and at home. That the two hours of structured practice a few times a week is not enough to tip the scales in his favor. 

Let’s see some more facts, here is a list of high school multi-sport athletes that got drafted into the some professional sport.

  1. Robert Griffin III – Quarterback for Baylor & Washington Redskins and was a record-setting college hurdler, also played basketball
    1. One of the most notably hurt professional football players in history that played 3 very different sports!
      1. Right ACL tear (2009), Right LCL sprain (contact injury 2012), Right LCL, ACL, meniscus (non-contact 2013), Left ankle dislocation (2014
  2. Derrick Rose - Point Guard for the Chicago Bulls, youngest ever MVP: played baseball in high school.
    1. Sprained big toe & groin injury (2011), Left ACL (non-contact) takes one of the longest recovery times ever (2011-2012), Right meniscus (non-contact 2013), Both ankles sprained, strained left hamstring, sore left knee, torn right meniscus (2014). 
  3. Kevin Love - Forward for Cleveland Cavaliers: Played football in high school.
    1. Hand, left groin, hand, back spasms, back injury, back spasms, stiff neck, dislocated shoulder. 

There are many many more of these stories of non-specialized athletes suffering many injuries. The problem is not early specialization, and it is not that simple either. The problem is the lifestyle that creates bad movement patterns. Ultimately it is the bad movement patterns that creates injuries. Understanding what factors lead to decreased efficiency of movement patterns is what is the answer. For now, my recipe would be an active, adversity rich environment, and diversity of movement throughout all ages of life, especially children. If you want your kid to not get hurt, here’s my recipe: let them fail, let them experience adversity, take their damn phone away from them, kick them out the front door and say don’t come home until sunset or you have scraped your knees. Or even better, put your work emails aside and go play with them! 


Austin Einhorn, CSCS, DNSET
Apiros Performance