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Sports Specialization: Yea or Nay?

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Sports specialization: Yea or nea? I am a parent and coach of my two kids but I also have the perspective as doctor who treats a lot of children with sport injuries so this is a great question.

The short answer is no. We’ll go into why this is my answer.

Only 2% of high school athletes go on to play at the top level of college sports, the NCAA Division1. Only 1% of them play sports professionally.

Well-intentioned parents encourage children to pick up a sport or two to develop personal character: to learn the value of teamwork and collaboration, to develop grit and perseverance, engage and embody good sportsmanship, build self-esteem, and more. Sports activities not only provide children and students with a healthy activity to engage in for personal development but also creates an opportunity for fitness and energy. Adolescents who participate in sports activities may find them enjoyable as a healthy outlet for play.

Engaging in healthy physical exercise, such as organized sports, becomes an even more important endeavor from a health perspective. With the rise of obesity and lack of physical activity in school-aged students, particularly American high school students1, encouraging the youth to engage in at least one sport has become both underutilized and imperative.

The last decade has witnessed a steady decline in youth sport participation.1 With the increasing rarity of young persons actively engaging in athletic leadership, it is no wonder then that parents, coaches, and others tend to be encouraging when a young athlete shows talent and dedication in a particular sport.2

Sports specialization in youth is defined as engaging in a single sport for at least three seasons a year at the exclusion of other sports.2,3 Early sports specialization occurs in children under the age of 12.

Athletic specialization is inherently not a bad thing. Encouraging a student’s deep commitment to a sport can lead to several notable benefits such as recognition of college and professional coaches, the chance to attend prominent training academies, personal development of perseverance and time management, and an improvement in athletic skills and performance within a chosen sport.3

However, can there be too much sport for the individual? While it is important to foster a youth’s promising talent and dedication, doing so to an extreme can have detrimental effects on the long game. Intense focus on a single sport, largely driven by parents and coaches, can lead to a young athlete developing both injury and burnout. Almost 55% of parents encourage their children to specialize in a single sport.2

And if that wasn’t difficult enough, the number of hours of vigorous, repetitive, athletic activity are just as large a risk factor for injury as sport specialization, if not greater. This is especially true for female athletes who are more physically impacted by long repetitive hours devoted to sport than male athletes.2

That’s not accounting for additional factors that can contribute to overuse injuries. These include poor technique, inappropriate equipment, improper training methods, poor conditioning, prior injury, and more.

It is true that any sports activity invites a chance of injury. However, the potential for injury increases as the intensity level and training volume increases.5  A series of studies in the Journal of Athletic Training were performed to evaluate the effects of being a specialized athlete at a young age.4 The results? Focusing on one sport increases the risk of major, career-threatening injury later in life.

And predictably, the type of injury accumulated from long periods of sustained, repetitive wear-and-tear on the body correlated with the sport. For example, in girl’s basketball, soccer, and volleyball, specialization increased the risk of knee joint and hip injuries.5 In baseball, especially Little League, pitchers who specialized had a higher risk of elbow and shoulder injuries.5,6,8

The strongest argument against sports specialization is the idea of building overall athleticism before honing laser-sharp athletic focus; in essence, encouraging young athletes to foundationally move well before they move more and at higher intensities.4 The focus is to encourage overall movement until the young athlete is developmentally ready to learn sport-specific skills, and physical maturation will grant the required strength and speed to succeed at a specific sport.

Early sports specialization also creates a lack of cross-trained foundation, inhibiting the body’s natural capacity for adaptation and leaving young aspiring athletes more prone to injury. Multiple sports builds fundamental motor skill development, which should be trained to achieve success in sports activities such as running, jumping, kicking, and throwing.5 Cross training builds better brains. In turn the brain will be able to control the body more effectively.

Repetition is an important part of athleticism, and one key factor that separates young athletes from mature athletes is that young athletes undergo numerous changes in a relatively small timeframe due to puberty and adolescence. Repetitive movements found in sport specialization can create microtrauma in areas that are still growing. Changes in body weight, height, and muscle mass provide additional stress to joints and connective tissue, and as young athletes grow, growth cartilage is vulnerable to the stress of repeated microtraumas. As muscle develops from repetition faster than bone, areas of musculotendinous attachment can be more susceptible to pathological injury. Such examples include Sever’s disease and Osgood-Schlatter disease, which are rarely found in adults.

Two-time NBA MVP Stephen Curry spoke on the topic of playing multiple sports at a sports panel with the junior NBA and the Positive Coaching Alliance. Curry advocates that children and adolescents should not specialize in a single sport too soon. “Because […] you might be better (than your peers) at any certain sport, you might feel comfortable in that space, and that zone. But you don’t really get to push yourself, you don’t really get to test yourself and how you deal with failure and success,” Curry said.8

It is important to vary training and avoid repetitive activities that place physical stress on an athlete’s body. Many options exist while resting from a specific sport; one such example is replacing overtraining with strength and conditioning. Not only can this enhance overall health, but also provide an opportunity for injury prevention and rehabilitation, improve body composition, and increase bone health. This can also lead to better outcomes with regards to athletic performance as it avoids staleness or unexpected long-term decreases in performance without evidence of injury.5

Sport diversification also enhances the mental health of a young athlete. Early specialization of one sport can lead to burnout6, which is defined as physical and emotional exhaustion from the athletic demands of a singular sport. With a decrease in performance from overtraining and the increase in the likelihood of being injured, burnout can ultimately lead to a promising athlete withdrawing or dropping out entirely.

Ultimately, sport diversification is what’s necessary to help prevent youth injuries. Playing as many sports as possible, as often as possible, creates an environment that is both physically and emotionally nurturing and productive. Sports specialization may be better utilized with structured practice once the foundations of proper movement have been placed in the aspiring young athlete.

Early involvement in sports should be encouraged. The development of gross motor skills is enhanced alongside the personal development that takes place with engaging in sports. A crossover between sports creates a positive physical, social, and mental experience that will springboard the young athlete into becoming a well-rounded elite — if he or she chooses.

References

1. Hainline, B. (2019) Early Sport Specialization: Shifting Societal Norms. Journal of Athletic Training: October, Vol. 54, No. 10, pp. 1011-1012.

2. “The growing trend of youth sports specialization.” Posted Mar 6, 2018. PR Newswire for the American Academy of Orthopedic Surgeons. Retrieved Feb 2020 from: https://www.prnewswire.com/news-releases/the-growing-trend-of-youth-sports-specialization-300608434.html

3. “The dangers of youth sport specialization and the benefits of diversification.” Posted May 20, 2019. Global Sports Development. Retrieved February 2020 from: http://globalsportsdevelopment.org/2019/05/20/specialization-vs-diversification

4. Newman, L. “Studies: Sports specialization at young age increases risk of career-threatening injury.” Posted Oct 22, 2019. USA Today High School Sports. Retrieved February 2020 from: https://usatodayhss.com/2019/jat-nata-sports-specialization-young-age-can-be-harmful

5. Caruso, T.H. (2013) Early sport specialization versus diversification in youth athletes. National Strength and Conditioning Association. December, Vol. 2, Issue 4. n.p.

6. Kutz, M, and Secrest, M. Contributing factors to overtraining in the adolescent multi-season/sport athlete. Strength and Conditioning Journal 31(3): 37-42, 2009.

7. Holt, J.B., et al. (2020) Progressive elbow magnetic resonance imaging abnormalities in Little League players are common: a 3-year longitudinal study. Am J Sports Med. 2020 Feb;48(2):466-472.

8. Interview with Stephen Curry with Stack. “Steph Curry says playing multiple sports gave him confidence to be an MVP.” Posted Feb 15, 2018. Retrieved Feb 2020 from: stack.com/a/steph-curry-says-playing-multiple-sports-gave-him-confidence-to-be-an-mvp

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Can Stronger Hips Help Knee Arthritis?

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Knee Osteoarthritis

Does adding hip exercises to quadriceps exercises result in superior outcomes in pain, function and quality of life for people with knee osteoarthritis? The short answer is YES.

Anyone with Osteoarthritis in their knees knows how it can limit their life. For one example walking could become difficult and painful.

A study from the British journal of sports medicine has found strengthening the hips muscle can help with knee osteoarthritis.

Walking improved after the addition of hip strengthening to quadriceps strengthening in people with knee Osteoarthritis. The addition of resistance hip exercises to quadriceps resulted in greater improvements in patient-reported pain and function

simple but effective hip exercise

Key points

  • Land-based exercise reduces pain and improves function in people with knee osteoarthritis (KOA) over the short to medium term.
  • People with KOA have weakness in hip abduction is (7%–24% weaker than control patients).
  • Hip abduction strength is positively related to function in people with KOA.
  • Hip strengthening is beneficial compared with non-exercise interventions in people with KOA.

Hislop AC, Collins NJ, Tucker K, Deasy M, Semciw AI. Does adding hip exercises to quadriceps exercises result in superior outcomes in pain, function and quality of life for people with knee osteoarthritis? A systematic review and meta-analysis. British Journal of Sports Medicine. 2020 Mar 1;54(5):263-71. Link

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Should Pain be Expected when Expecting?

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Pregnancy is a span of time in which a woman’s body undergoes many changes, some changes being more comfortable than others.

Although we often picture pregnancy as a wonderful expectation in the growth of new life, the physical changes a woman’s body goes through can feel anything but miraculous. Over 50% of pregnant women report their biggest complaint during pregnancy is low back pain, sometimes lasting over 3 months!  Additionally, up to three-fourths of women will experience low back pain at some point during their pregnancy.1,2

Add to this pelvic girdle pain, which is experienced by up to 20% of women at some point during pregnancy,3, and it’s no wonder that pregnancy can be physically exhausting!

Although pain is usually experienced sometime between the fifth and seventh month of being pregnant, it can begin as soon as eight to twelve weeks after becoming pregnant.2

And as the fetus grows, a woman’s center of gravity changes to accommodate, shifting forward to accommodate for the growth of the baby.  The abdomen stretches, and the woman’s belly moves forward and out accordingly to increase in the baby’s weight and development; so, too, does the shift in gravity of a woman’s weight3 on her low back, pelvis, knees, ankles, and feet.

In fact, the thoracic (mid-back) and lumbar (low back) spine curvature can change during pregnancy, causing an increase in pain in the low back and pelvic regions.  This can also cause alterations to balance and gait patterns.3  Think of the pregnant “waddle” that some women do while walking, and you have an idea as to the changes that take place in the abdomen, low back, pelvis, and sacrum!

This can, and often does, place additional stress and strain on the joints in the low back and posterior pelvis, known as the lumbar and sacroiliac areas.  These postural changes lead to increased pain, muscle tightness, tenderness, and discomfort.2  Pregnancy can even lead to changes in the curvature of the woman’s spine.

Low back and pelvic pain can also be major deterrents in a woman who could, and would, be otherwise motivated to continue working and taking care of both herself and her home.  Pain has shown to influence pregnant women’s daily lives in the challenges they encounter concerning their physiological, psychological, occupational, and social functions.4

And it doesn’t always stop there.  Sometimes women can experience low back and pelvic region pain the year after birth, and even up to three years after labor and delivery.1,5  Pregnancy-related low back and pelvic pain, as well as post-partum mechanical spinal disorders, are not only common, but they can impede recovery, nursing, and caregiving – three very important components in taking care of the newborn after labor and delivery.5

How will a pregnant woman know if her pain is being caused by her pregnancy?  What is pregnancy pain like?  Some women describe it as a deep discomfort.   Others describe it as stabbing, continuous, recurrent, and intense.6  The discomfort can also vary in intensity; some days can be more difficult than others, and there may be times when the pregnant woman feels like even basic tasks are difficult to do.

Where might pregnancy-related pain be felt on the body?  For some, the pain occurs anteriorly, or in the front, by the pubic bone.  Others may feel discomfort directly at the low back above the gluteal area – sort of around the beltline.  And for others still, the pain also occurs between the hip bones and the gluteal fold. 

Sometimes this discomfort even travels down the back of the thigh to the knee and the calf6, or even down to their feet.2,7   Most women say that their pelvic and low back pain is more intense during pregnancy than after labor and delivery, and it is still physically limiting as it may cause a pregnant woman to withdraw from activities that she would normally gravitate toward, such as social interactions or work.6

Since pregnancy can drastically change a woman’s body in such a relatively small period of time with lasting effects, how can chiropractic care help with physical changes encountered during pregnancy, especially ones that contribute to pain?

While a chiropractor cannot help with changes in hormones that naturally occur with fetal growth, the resulting biomechanical changes that occur in a woman’s body during pregnancy can be lessened or alleviated by the help of a knowledgeable chiropractor.

A chiropractor who is well-versed in addressing pregnancy-related issues will be able to accurately assess, diagnose, and treat low back pain and pelvic girdle pain.

Some options for treatment include chiropractic spinal manipulation, soft tissue therapy, exercises, and ergonomic advice, as well as encouraging regular visits to her obstetrician.  Treatment could improve functional activities such as sitting, traveling comfortably in a car, walking, and more.3  And, addressing this discomfort sooner rather than later is preferred, especially if employment or maternity leave is a concern.  Low back pain is the most common cause of sick leave after delivery!7

Maintaining optimal function and reducing pain levels to more manageable levels are goals that should be discussed with a doctor of chiropractic as well as an OBGYN when it comes to pregnancy-related pain.2  A detailed history and clinical examination are essential for determining what biomechanical source is causing a pregnant woman’s low back or pelvic pain.6 

A knowledgeable chiropractor will be able to accurately assess changes in pelvic positioning, curvature changes in the upper and lower back, stress on the lower back including muscle tension and tightness in the lumbosacral area, and any radiating (shooting) pain that can travel from the low back into the legs or lower extremities.

A chiropractor can also help identify any areas of stiffness7 that may accumulate in weak areas of the body8, contributing to an increase in back pain during pregnancy.  This may be the case if poor posture, excessive standing, and bending over trigger or escalate any back and pelvic pain.

Low back pain and pelvic pain do not have to be an inevitable part of pregnancy.  If you are one of the 50%+ of pregnant women experiencing pain during your pregnancy, there are options for treatment available to help make your pregnancy more comfortable and productive!

Even as your body changes, a well-trained chiropractor will be able to give you conservative management options for your low back and pelvic pain.  Your doctor will work with your OB/GYN to make sure that your options for treatment are safe and effective.

References

  1. Yoo, H., Shin, D., and Song, M. (2015). Changes in the spinal curvature, degree of pain, balance ability, and gait ability according to pregnancy period in pregnant and nonpregnant women. J Phys Ther Sci. 2015 Jan; 27(1): 279–284.
  2. Montgomery, S.P. “Management of back pain during pregnancy.” (2009). Retrieved March 2020 from: https://www.spine-health.com/conditions/pregnancy-and-back-pain/management-back-pain-pregnancy
  3. Verstraete, V.H., Vanderstraeten, G., and Parewijck, W. (2013). Pelvic Girdle Pain during or after pregnancy: a review of recent evidence and a clinical care path proposal. Facts Views Vis Obgyn. 2013; 5(1): 33–43.
  4. Bernard, M., and Tuchin, P. (2016). Chiropractic management of pregnancy-related lumbopelvic pain: a case study. J Chiropr Med. 2016 Jun; 15(2): 129–133.
  5. Maiers, M., et al. (2018). Chiropractic in Global Health and wellbeing: a white paper describing the public health agenda of the World Federation of Chiropractic. Chiropr Man Therap. 2018; 26: 26.
  6. Katonis, P., et al. (2011). Pregnancy-related low back pain. Hippokratia. Jul-Sep; 15(3): 205–210.
  7. Sabino, J., and Grauer, J.N. (2008). Pregnancy and low back pain. Curr Rev Musculoskelet Med. 2008 Jun; 1(2): 137–141.
  8. “Back pain during pregnancy: causes, treatment and prevention.” American Pregnancy Association. Retrieved March 2020 from: https://americanpregnancy.org/pregnancy-health/back-pain-during-pregnancy
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What Pillow should I get?

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Are you Sleeping on the Right Pillow?

Determining the right pillow is a personal choice that a person will make every so often. When it comes to thinking about sleep equipment, most people solely focus on the mattress. The mattress is one of the most important sleep equipment you will buy, but when it comes to sleep quality pillows are just as important. How you lay your head when sleeping plays a huge role in determining the type of support you need. Pillows not only impact the quality of sleep but can prevent any neck discomfort.

Why Does Your Pillow Matter?

A proper pillow will facilitate a good night’s sleep without you waking up at night or waking up with pain or a stiff neck. Having the wrong pillow over time can exacerbate unnecessary neck pain. There are a few factors that go into making a guide for yourself to determine the proper pillow for you.

Back Sleeper:

Sleeping on your back might appear to be comfy, but will highlight the underlying issue of snoring if you have a pillow that allows your head to sink. As you lay your head back, gravity will push the tongue back and block your throat. A better alternative will be a pillow that offers height, neck support and keeps the throat at a comfortable level.

Side Sleeper:

One of the most common positions to sleep in is on the side. You will need more support to keep the neck at a neutral angle.

Stomach Sleeper:

Sleeping on your stomach might be comfortable for a few nights, but after a while can become taxing on your back and neck. However, having the right pillow can negate some of these issues. A firm/plump pillow will force your neck into an odd angle that might lead to some discomfort. A better alternative would be a softer option.

When Is It Time To Replace Your Pillow?

On average, a pillow should be replaced every 18 months. The old age rule “ you pay for what you get” applies to this transaction. A higher quality pillow will last longer than an inexpensive option. Something you can do to your pillow to see if you need a new one is, take it out of the pillowcase to see if there are any stains or fold it in half and see if the pillow stays folded. If either of these are a yes then it is time to replace your pillow.

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Maintain a healthy brain: How to protect the body’s control center

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Healthy brain function is essential for optimal wellness, but conditions such as Alzheimer’s disease and concussions are emerging as critical concerns for our health care system. as conventional medicine searches for solutions, cutting-edge research is starting to show that nutrients and herbal extracts may have beneficial effects on memory and brain function.

Top Supplements to Boost Brain Function:

  • Fish oils high in DHA
  • Turmeric (bioavailable forms)
  • Magnesium
  • Vitamins D and E
  • B vitamins (especially B12)
  • Bilberry (anthocyanins)

Did You Know?

  • Most concussions do not involve a loss of consciousness.
  • Sports-related concussions do not show evidence of damage on MRI or CT scans.
  • Across the same sports, girls have higher rates of concussions.

Hrkal, Paul ND (2019) Maintain a Healthy Brain Sage: A Healthy Living Magazine

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What happens you get adjusted?

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Chiropractic adjustments help restore proper mechanics to the spine or the joint being adjusted.

A Spine Journal study was “the first to measure facet gapping during cervical manipulation on live humans”.

A patient being adjusted by Dr. Sikorsky

The results demonstrate that:

  • Target and adjacent motion segments undergo facet joint gapping (0.9 mm ± 0.4mm) during manipulation.
  • Intervertebral range of motion is increased (8-13 degrees) in all three planes of motion after manipulation.
  • Pain score improved from 3.7±1.2 before manipulation to 2.0±1.4 after manipulation.

Anderst WJ et al. Intervertebral Kinematics of the Cervical Spine Before, During and After High Velocity Low Amplitude Manipulation. The Spine Journal Volume 18, Issue 12, December 2018, Pages 2333-2342

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More research showing chiropractic is safe

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A systematic review of 47 randomized trials found that cervical manipulation is safe and effective:

  • An effect in favor of thrust manipulation plus exercise compared to an exercise regimen alone for a reduction in pain and disability.
  • Of the 25 studies (that evaluated adverse events), either no or minor events occurred.
  • According to the published trials reviewed, manipulation and mobilization appear safe.  

Coulter ID et al. Manipulation and Mobilization for Treating Chronic Nonspecific Neck Pain: A Systematic Review and Meta-Analysis for an Appropriateness Panel. Pain Physician. 2019 Mar;22(2):E55-E70.

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Why does my back hurt in the morning?

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People that come into our chiropractic clinic for treatment after lumbar disc herniation or disc bulging frequently have a history of pain which is worse in the morning and then improves after they’ve been up moving around for a bit.

Often they have some questions about what exercises and stretches they can do in the morning to make them feel better. We learned more about morning back pain in a disc – injured patient after the research of Michael Adams in the 1980s.(1,2) Adams referred to the “diurnal behavior of the disc” which mostly refers to the tendency for the discs to absorb moisture from the tissues around them overnight.

The discs soak up the fluids from the tissues around them while a person is recumbent in bed overnight. So in the morning when they wake up the outer layers of the disc are under a bit more tension, which we refer to as hydrostatic pressure.

In turn, the disc becomes a bit more plump, adding pressure to nerves and surrounding structors.

So what should you do? Once you get out of bed you should not bend over right away. Try to keep your back straight or try stretching backward .

Next, use your hips to bend over the sink to brush your teeth.

A straight back using my hips to bend over.
Bending at the lumbar spine causing lots of pressure on the lumbar discs

The above picture is a great way to cause sharp shooting pain in the morning.

Try to sit up straight or use a back support in the small of your back like in the picture above.

Sitting with a more normal curve in the lumbar spine helps take the pressure off of the lumbar discs and helps decrease pain.

A wrong way to sit

Sitting like this cause more disc pressure causing disc irritation. It can cause the disc to bulge more.

Discs are fatter in the morning because the absorb fluid overnight. So think of a jelly doughnut if the doughnut has more jelly its more likely to shoot out if you put pressure on it.

So remember back straight, stomach tight will help prevent lower back pain and help you heal if you have pain.

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Impaired Core Stability as a Risk Factor for the Development of Lower Extremity Overuse Injuries: A Prospective Cohort Study

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A weak core can increase your chances for lower extremity injury during exercise!

The core is important for your lower back and neck health for sure. It’s also very important for extremity health. If you have been dealing with an arm or leg injury (extremity) that has not been getting better with treatment, it might be good to add in some core exercise to improve outcomes.

Take Home Message from the study: A college freshman with dynamic postural control limb imbalances, decreased hip extension strength, or decreased core muscle endurance during bridging exercises is more likely to develop a lower extremity overuse injury.

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Muscle as viewed through an electron microscope!

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This is a pretty cool picture. Can you believe the detail? The red in the picture is the muscle and the white stuff is the connective tissue is called fascia. A painful area in a muscle can be caused by damage to one or both of theses structures!