The Breaking Point: How Year-Round Specialization of Youth Sports Is Landing Children on The Operating Table

Dr. Karim Meijer had only a few minutes to speak to a reporter while awaiting X-ray results for a 14-year-old volleyball player with a shoulder problem. For the last seven years, Dr. Meijer has served as a team physician for the Denver Broncos of the National Football League. In that role, he manages the physical preservation of multi-million dollar athletes. Yet, a massive portion of his private orthopedic practice is treating a disturbing rise in sports injuries to pre-teens and teenagers.Across the United States, children are landing on operating tables with injuries such as ligament tears, tendon ruptures and severe cartilage degradation that require major reconstructive surgery.“This is the story of my clinic,” Dr. Meijer tells The New York Sun. “But this doesn’t surprise me.”Dr. Karim Meijer says he is seeing a disturbing rise in sports injuries to pre-teens and teenagers. OrthoColorado Hospital via InstagramThe culprit, according to Dr. Meijer, is a cultural and commercial shift toward single-sport specialization and grueling, year-round competition fueled by business enterprises.“Nobody cares about a kid’s safety if you’re playing year-round sports,” he said. “Let’s just start right there. There’s nothing safe and reasonable about that.”The Death of An Off SeasonIn previous generations, youth sports had a natural calendar that encouraged kids to play multiple sports. Football was played in backyards during football season, basketball courts at local parks were crowded during basketball season, and dirt lots became makeshift baseball fields during baseball season.Today, the dreams of earning a college scholarship and chasing a professional career has created a multi-billion dollar youth sports industry. Parents and their youngsters are encouraged to specialize in one sport, locking them into an endless cycle of year-round league play, regional team travel, and competitive weekend tournaments.According to data in a report from the Sports and Fitness Industry Association, the average number of sports children ages 6-17 regularly played in 2023 was 1.63 down 13 percent since 2019.The average has been declining over the last decade amid the increased commercialization of youth sports and the pressure on families to pick one sport at younger ages, which many youth leaders oppose.“We’ve got to get off this play more, pay more and the focus on every little element of development,” Tom Cove, the former president of SFIA, said in the report. “The purpose of youth sports is not to create the next Tiger Woods. It should be to provide a quality experience to the vast number of kids so they enjoy it.”Between league competition, travel teams and tournaments, youth sports has become a business as much as an opportunity, which is not necessarily a good thing.“Everybody basically has the ability to go play 24-7, 365 days a year,” Dr. Meijer said. “The opportunities for these kids to play is constant. That also creates more opportunities for injuries.”The Structural Toll of OveruseAccidental injuries are an inherent risk of any physical activity. But the numbers are alarming. According to figures reported by the web portal AOL, about 3 million kids go to the emergency room each year for sports related injuries, and another 5 million visit their primary care physician or a sports medicine clinic. Another 1 in 10 children will miss time in their sport because of an injury.Dr. Meijer suggests that an overwhelming percentage of young patients are suffering preventable overuse syndromes.He recently treated a 14-year-old who literally ripped the growth plate away from the inside of his elbow while making a hard throw from third base to first. “He heard a pop in his elbow and was done,” Dr. Meijer said.His surgical log includes another 14-year-old soccer player, who needed complete ACL reconstruction, and a 12-year-old slated for surgery to repair cartilage damage in his knee. The clinic sees a constant influx of teenage volleyball and basketball players who suffer from “Jumper’s Knee” or patellar tendonitis.The increased opportunities for women to compete in sports has resulted in a rise in complex ligament and tendon ailments among women.“The farmers got it right when they rotated crops,” Dr. Meijer said. “They never just put crops on the same field year round. They would rotate the crops and let the nutrients build back up and let the soil regenerate and maybe next season go back to the same field.”He said the same concept should apply to youth sports. “You can’t stay in the same field year end and year out and not let that body regenerate.”The Scale of the Youth Injury CrisisDr. Meijer finds himself treating athletes ranging from youth leagues to the professional ranks after discovering medicine while playing football at the University of Texas. A member of the Longhorns 2005 national championship squad under coach Mack Brown, Dr. Meijer thought he was headed to a coaching career before pursuing a different interest.“I played football and kept getting hurt,” he said. “I’d talk a lot with the team doctors and finally Mack Brown said that I should go to medical school. Now I’ve taken care of athletes for the past 20 years.”When comparing the scientific maintenance of professional athletes to the unmonitored grind of youth sports, Dr. Meijer points out a bizarre paradox: pros get significantly more rest than children. “The NFL regular season isn’t 40 weeks a year,” he said. “But you have kids in travel ball playing five games a weekend. Major League Baseball players don’t do that. They take time off to recover, or they develop other skills or work on their core without picking up or having to throw a ball.”Long-Term Bills Comes DueBeyond treating younger athletes with more serious injuries, Dr. Meijer links extensive participation in youth sports to a spike in injuries suffered by young professional athletes. A rash of Achilles and ligament injuries has been attributed to everything from playing turf to sneakers, but Dr. Meijer suggests some injuries can be the culmination of minor injuries suffered while competing in youth sports. “People ask why is there a rise in Achilles ruptures in the NBA?” Dr. Meijer said. “Remember players in the NBA now are kids who started in AAU circuits 10 to 15 years earlier. They grew up playing basketball year round. They have put mileage on their Achilles tendon and likely developed micro tears. When you get micro tears or tendonitis that becomes abnormal and as the years go on, by the time they get to the NBA, the same maneuver they’ve done as a kid causes a rupture.”A Prescription for PreventionDr. Meijer offers the following rules of management for parents to help protect young athletes from overuse:Don’t play the same sport year round. “Play football, play basketball, go swimming, go cycling, go do different things,” he said. “Rotate sports as much as possible.”Take breaks. “If the kid is a one-sport athlete, don’t play year round,” he said. “Take a few months off. If you pitch one season, don’t pitch the next season. Play first base.”Diversify training habits. “Baseball players don’t just play baseball all year,” he said. “They spend time focusing on their core or their legs or arms without having to throw a ball.Pay attention. “If parents notice something is not right, their child is not walking the same or running the same, then seek care. Those can be initial indicators that there’s a problem.”In professional leagues, load management has become part of everyday language. Players are intentionally held out of practices and games, pitch counts are strictly monitored in baseball, contact practices are limited and two-a-days are a thing of the past. Yet, developing teenagers are routinely expected to push their skeletal structures to the absolute limit without any regulatory protection.Don’t expect them to tell you when they’re hurting.“Kids are like chameleons,” Dr. Meijer said. “You cut their tail off and they grow one back. They learn to adapt and conform. But if you get a ligament, tendon or cartilage injury the body will never forget that and those accumulation of injuries can start at a young age, especially when you increase the opportunities to get these injuries.”

The Breaking Point: How Year-Round Specialization of Youth Sports Is Landing Children on The Operating Table

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