Training the specialised youth athlete: a supportive classification model to keep them playing

S.P.O.R.R.T.-A Comprehensive Approach to the Assessment and Non-Operative Management of Overuse Knee Conditions in Youth Athletes

PURPOSE OF REVIEW

The evaluation of a young athlete with an overuse injury to the knee involves a comprehensive approach. There are a number of elements to consider including assessments of skeletal maturity (biologic maturation), workload (training load + competition load), sport specialization status, and biomechanics. The type of injury and treatment, as well as future prognosis, may be influenced by these and other factors.

RECENT FINDINGS

Calculating the percentage of predicted adult height (PPAH) is a valuable tool in assessing overuse injury patterns and diagnoses in youth athletes. Modifiable and non-modifiable overuse injury risk factors require monitoring from clinicians as young athletes mature and develop over time. Training and rehabilitation programs should be adapted to account for these. In this manuscript, we seek to introduce a novel, comprehensive approach: S.P.O.R.R.T. (Skeletal Maturity, Prior Injury Risk, One Sport Specialization, Rehabilitation, Return to Play, Training Recommendations) (Fig. 1). Overuse, non-traumatic injuries to the knee in youth athletes will be presented in a case-based and evidence-based model to provide a framework for a comprehensive approach to the assessment and treatment of youth athletes with overuse injuries.

Early Sport Specialization in College Athletes and the Impact on Health-Related Quality of Life: A Critically Appraised Topic

Clinical Scenario: Youth athletes may specialize in a sport of their choosing, or based on external pressures, to pursue elite status in that sport. Current evidence shows an association between highly specialized athletes and an increase in injuries as well as a connection between injury and lower health-related quality of life (HRQOL). Clinical Question: In college athletes, do early sport specialization characteristics (ie, age at specialization and degree of specialization) impact current HRQOL? Summary of Key Findings: The literature was searched for studies that investigated the age of specialization (early vs late) or degree of specialization (high, moderate, and low) and the impact on HRQOL. (1) The search returned 6 possible studies related to the clinical question. Three of the studies met the inclusion criteria and were used for this appraisal. (2) Two of the 3 included studies reported that highly specialized athletes noted lower HRQOL. (3) One study found there to be no significant difference in HRQOL between athletes who specialized early versus late but did find those who specialized early to have a greater incidence of injuries that required surgery. Clinical Bottom Line: There is moderate evidence that early sport specialization is associated with lower HRQOL compared with late sport specialization. It is important to educate athletes, parents, and coaches on the potential detriments that are associated with early sport specialization to allow stakeholders to make informed decisions regarding participation. Strength of Recommendation: Grade B evidence exists to support the idea that early, intensive sport specialization may be associated with decreased HRQOL in current college athletes.

Developmental Training Model for the Sport Specialized Youth Athlete: A Dynamic Strategy for Individualizing Load-Response During Maturation

CONTEXT

Most available data on athletic development training models focus on adult or professional athletes, where increasing workload capacity and performance is a primary goal. Development pathways in youth athletes generally emphasize multisport participation rather than sport specialization to optimize motor skill acquisition and to minimize injury risk. Other models emphasize the need for accumulation of sport- and skill-specific hours to develop elite-level status. Despite recommendations against sport specialization, many youth athletes still specialize and need guidance on training and competition. Medical and sport professionals also recommend progressive, gradual increases in workloads to enhance resilience to the demands of high-level competition. There is no accepted model of risk stratification and return to play for training a specialized youth athlete through periods of injury and maturation. In this review, we present individualized training models for specialized youth athletes that (1) prioritize performance for healthy, resilient youth athletes and (2) are adaptable through vulnerable maturational periods and injury.

EVIDENCE ACQUISITION

Nonsystematic review with critical appraisal of existing literature.

STUDY DESIGN

Clinical review.

LEVEL OF EVIDENCE

Level 4.

RESULTS

A number of factors must be considered when developing training programs for young athletes: (1) the effect of sport specialization on athlete development and injury, (2) biological maturation, (3) motor and coordination deficits in specialized youth athletes, and (4) workload progressions and response to load.

CONCLUSION

Load-sensitive athletes with multiple risk factors may need medical evaluation, frequent monitoring, and a program designed to restore local tissue and sport-specific capacity. Load-naive athletes, who are often skeletally immature, will likely benefit from serial monitoring and should train and compete with caution, while load-tolerant athletes may only need occasional monitoring and progress to optimum loads.

STRENGTH OF RECOMMENDATION TAXONOMY (SORT)

B.