February 26, 2024 • 24 mins
Did you know almost 70% of kids drop out of sports by age 13? We talk with Dr. Joel Brenner, pediatric sports medicine physician and national expert in youth sports, about how to keep kids involved in sports. Dr. Brenner is the co-author of the American Academy of Pediatrics' recent Clinical Report on on overuse injuries over-training and burnout in young athletes. He shares practical strategies to reduce burnout and over use injuries in our young athletes. Most importantly, we're going to find out how early is too early for kids to specialize in one sport.
Our Guest: Dr. Brenner is a pediatric sports medicine physician and Director of the Sports medicine, Sports concussion, and Dance medicine programs at Children's Hospital of the King's daughters in Norfolk, Virginia.
Check out our website PsychEd4Peds.com for more resources.
Follow us on Instagram @psyched4peds
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr. Elise Fallucco (00:21):
Welcome back to PsychEd4Peds, the child
mental health podcast forpediatric clinicians and for all
of you who take care of kids.
We're helping you help kids.
Today we're very excited to haveDr.
Joel Brenner on the pod.
He is a national expert in youthsports.
Dr.
Brenner is a pediatric sportsmedicine physician and Director
(00:41):
of the sports medicine, sportsconcussion, and dance medicine
programs at children's hospitalof the King's daughters in
Norfolk, Virginia.
Dr.
Joel Brenner is the co-author ofthe recent report released by
the American academy of paeds onoveruse injuries over-training
and burnout in young athletes.
Today, we're going to talk toDr.
(01:02):
Brenner about how to help keepkids in sports.
And how we can reduce burnoutand over use injuries in our
young athletes.
Most importantly, we're going tofind out how early is too early
for kids to specialize in onesport.
So please join me in giving awarm welcome to Dr.
Joel Brenner.
Dr. Joel Brenner (01:20):
Thanks for having
Dr. Elise Fallucco (01:21):
me, Elise.
So excited to have you here.
So as a pediatric sportsmedicine doctor, what would you
say are the major benefits thatyou see in participating in
youth
Dr. Joel Brenner (01:31):
sports?
I think there's three differentcomponents.
There's a physical component, amental and a social component.
Youth sports is one way for kidsto meet the physical activity
guidelines that have been setout.
It also can help them sociallyjust to acquire a peer group and
learn how to manage interactionsand sometimes Conflict.
(01:54):
and then just mentally withphysical activity- it can help
with mood that help with stressreduction.
So just a variety of benefits.
Dr. Elise Fallucco (02:04):
Yeah.
And speaking from the mentalhealth benefit, I'm a huge fan
of sports and youth sports ingeneral, but we have really
great studies that have shownthat people who participate in
movement and sports activities,they are actually experience a
benefit in terms of milddepression and anxiety.
So it's can be very helpful foryour mood and for anxiety.
(02:25):
In addition for your physicalhealth and all the social
components.
So the sad news that I wasreally shocked to hear from the
clinical report is that 70percent of youth athletes drop
out of organized sports by age13.
Wow.
What do you think are some ofthe main causes or reasons for
(02:48):
this high dropout rate?
Dr. Joel Brenner (02:50):
So we highlighted that burnout and
injury are some of the causes,but actually most of the
attrition is not from burnout.
It's really from kids no longerhaving fun, not having time to
do other activities outside ofsports like, theater, like art,
like just going outside andhaving fun with their friends,
(03:12):
with their family.
Also just lack of skilldevelopment.
And just no longer enjoying it.
And those are really the majorreasons.
And so those are some of thethings that we need to change.
Dr. Elise Fallucco (03:25):
I love this idea that it's so important to
make sure that kids are havingfun and that they're enjoying
what they're doing and that wedon't start, pushing them or
that it doesn't become tooserious too early because then
you lose the potential benefitof participation in sports with
these kids.
Your clinical report, as youmentioned, focused on the role
(03:46):
of injury and burnout and howthat affects participation in
youth sports.
And I'm thinking about, when Ihear about injury and overuse
injuries, I think about thingslike little league shoulder or
in my sport of choice, which isswimming.
I think about swimmer'sshoulder.
Are there any things thatpediatric clinicians can do to
counsel parents and families totry to prevent or reduce the
(04:09):
risk of overuse injuries insports?
Dr. Joel Brenner (04:12):
Yes, I think there's a a variety of factors
that we can counsel on, andthat's also one of the reasons
why we recommend that sportsphysicals or the PPE be done in
the medical homes so that we canbe counseling both the athlete
and the family.
about preventing overuseinjuries, about preventing
burnout.
so when we're talking aboutoveruse injuries, it's all about
(04:35):
balancing volume and versus restand recovery.
And we want to make sure there'senough rest and recovery.
So we want to look at how muchsomebody is doing and how fast
they're doing it.
So making sure that if they'rejust starting out doing an
activity such as running, Maybeonly increasing the volume by 10
to 20 percent per week, but alsolooking at their weekly volumes.
(04:59):
So making sure they're having atleast one to two days off per
week from their particular sportand two to three months off
throughout the year from theirparticular sport.
And a lot of people don'tunderstand how they can do that,
but.
The key is that two to threemonths off, it can be broken up
a month here, a month there.
And during that time, we're nottelling kids to be a couch
(05:20):
potato.
We still want them to bephysical, physically active,
whether it's doing anothersport, cross training, just
getting outside, having fun.
So we can look at the volumethere.
We also want to look at theirtechnique to so especially, with
swimming with baseball withdance I take care of a lot of
(05:41):
dancers.
So if their technique is off,that's going to put them at risk
for overuse injuries.
Also, if they have a history ofa prior injury, we want to
really look at what caused thatinjury.
And if we don't really take careof the underlying, problem, the
causative factor, then they'regoing to be at risk for getting
injured.
Another injury.
(06:01):
Lastly, and just as importantly,two other things to always be
counseling on and to berecommending is sleep and
nutrition.
We know that kids and mostadults don't get enough sleep
and sleeps so important.
As it's so important for thebrain to clear out all the
debris that we've acquiredthrough today.
But by getting proper sleep, itactually helps us perform better
(06:25):
and it can help us decreaseinjuries to you.
Dr. Elise Fallucco (06:28):
The recommendations make a lot of
sense, obviously sleep andnutrition and gradually
increasing your training loadsby less than 10 to 20 percent
per week.
I imagine that potentially a bigsticking point would be the
issue of time off.
And I'm thinking there's such apush in youth sports now to be
playing year round sports and tobe traveling every weekend.
(06:51):
And so I think this clinicalreport comes at a good time
because it's really emphasizing,we need to think about the
balance between how much stresswe're putting on our body and
how much time we're giving ourbodies to recover and rest and
repair.
I liked your practical tip abouttaking time off that this idea
of taking two to three monthsoff per year from sports doesn't
(07:12):
have to be in one big block anddoesn't have to be mean taking
time off from all physicalmovement and activity.
It sounds like what you guys aresuggesting is more,
participating in an organizedsports league where there's
multiple practices per week or,regular weekend tournaments is
something that should not beyear round, but ideally, you
should have a one month break acouple of times of year from
(07:35):
that.
Is that right?
Dr. Joel Brenner (07:37):
Yeah.
Whether it's a one month or evenup to two months depends.
The other thing is that parentsreally want this information
because it's not just the kidswho are getting stressed out and
burned out.
The parents are too, becausethey're trying to juggle, the
whole family.
If they have multiple kids,they're driving in different
places.
They also have to juggle theirown career and everything else
(08:00):
that goes along with being aparent.
So the biggest problem and thatwhat we've been trying to do for
20 years is change youth sportsculture.
So working with nationalgoverning bodies, the NCA,
because all this stuff tricklesdown.
If we can change culture wherekids do not have to specialize
at nine years of age, kids donot have to play year round that
(08:22):
they can be multi sportathletes.
I think that can help a lot, butit's in since our first edition
back in 2007, we've made alittle progress, not as much as
we'd like.
So hopefully, we'll continue topush the envelope and continue
to educate and hopefully we'llmake some more improvements.
Dr. Elise Fallucco (08:41):
Yeah, and jumping off what you just said
about the potential risks ofearly specialization.
One of the things that I foundreally interested, interesting
that I don't think most parentsknow is that early
specialization is notnecessarily helping these kids
to be better athletes longterm,that in fact, playing multiple
sports throughout the yearcreates better athletes overall.
Dr. Joel Brenner (09:05):
Yeah, I think that's really key.
If we look at the statistics andin our AP paper on sports
specialization, we have a onepage infographic that I give out
to all my patients and it'sfreely downloadable and
pediatricians can give it out.
But if we look at statistics,only up to 10 percent of high
school athletes will play incollege.
(09:27):
Only 1 percent of high schoolathletes will get any college
scholarship.
That's not a full ride thatcould just be 1,000 dollars.
But less than 1 percent of highschool athletes will actually
play professionally.
We don't want to squash dreams,but we want to be realistic and
we want to look at ways topromote lifelong physical
(09:48):
activities at the same time.
Dr. Elise Fallucco (09:50):
I can think of some of my own peers and
some, people in my friend groupwho have kids even nine year
olds and 10 year olds who arebeing told Potentially by their
own coaches, like your daughterhas a lot of talent or your son
is really great.
And so we really just need toget in there and invest in them
and help them to be the bestthat they can be.
as a pediatrician, if you had aparent in your office, who's
(10:12):
saying, my child has talent andI want them to become the next
Michael Phelps or Olympicgymnast, what would you say to
keep them balanced?
Dr. Joel Brenner (10:21):
Yeah, I would say the most important things
are what we know from thecurrent research is that multi
sport athletes are moresuccessful for a variety of
reasons.
They're learning skills indifferent sports that transfer
over.
They're also mentally going tobe fresher by the time they get
to college.
And it's actually come up morecollege coaches are speaking out
(10:45):
that, by the time they'regetting their athletes in
college, most of them are nothungry anymore.
They're burned out.
They've been injured.
There's one college basketballteam this year who had a lot of
injuries and the coach said, bythe time they're getting to him,
they've already had catastrophicinjuries like ACL tears.
If you're you believe that yourchild is special then promoting
(11:09):
multi sports, but also alwayscommunicating with your child
and seeing what their goals are.
So it should be the intrinsicmotivation.
It's not the motivation of theparent or of the coach because,
this child might be good atbaseball.
But might have really no desireto play this in college or even
in high school, might want to dosomething else, might want to be
(11:29):
a dancer or anything.
So I think the more you canexpose a kid when they're
younger the better off they'regoing to be, not just in
college, but
Dr. Elise Fallucco (11:39):
beyond.
Yes, and exposing them tomultiple different disciplines
and having the long view of.
If let's say the child's goal isto keep playing this sport for
as long as they possibly can.
And the parent's goal is to helpthem excel.
Then really the recipe isn't thetraditional, let's practice four
(12:00):
hours a day of this sport, sixto seven days a week, starting
at age seven, but rather let'stry to keep, stay involved in
this sport and other sports.
And then, when you talk aboutspecialization, I like that you
guys gave a little bit of an.
Age cutoff saying, there's acertain age at which it doesn't
make sense to just play onesport.
(12:22):
When does that change?
Like, when do you think itbenefits the athletes to switch
over and just focus on onesport?
Dr. Joel Brenner (12:28):
So that is a key question that even within
the sports medicine world, wehave not been able to come to a
complete agreement with becauseof the research is lacking
there.
When we came up, I worked withthe NBA on some NBA guidelines
for youth basketball and workedwith American Medical Society of
Sports Medicine, the AP.
(12:49):
So what we've said just ingeneralities is, mid to late
adolescence.
But again, You don't have tospecialize, that might be an
okay time if you really want to,there's no other sports you want
to do.
But, if you look at so many ofthe NFL athletes, most of them
(13:09):
played Multiple sports intocollege to there's some sports
where there's more pressure andsometimes you need to specialize
earlier, such as gymnastics,especially in female gymnast,
because once you developphysically, then it's less
optimal but for the majority ofsports we would say at least
(13:32):
wait till mid to late
Dr. Elise Fallucco (13:34):
adolescence.
You should not specialize beforemid to late adolescence, unless
you're one of those, exclusionslike female gymnasts Going back
to what you talked about withburnout.
I've seen this in my friendsthat these incredible athletes
have been driving themselves orhave been externally motivated
by parents, coaches, et cetera.
And then they get to the pointwhere they're tired of it and
(13:56):
they know they're not interestedin seeing a swimming pool or
going out on the field anymore.
And it's interesting because alot of the symptoms of burnout
in sports seem to overlap withthose for depression.
And I'm thinking about fatigue,irritability, losing interest in
something that you formerlyloved, maybe sleep problems
(14:18):
maybe anxiety, and decreasedperformance.
I imagine you potentially see afair amount of burnout in your
clinics.
What advice would you givepediatric clinicians to help
them distinguish between burnoutand depression in an athlete?
Dr. Joel Brenner (14:33):
Well, I would say it is not clear cut and,
speaking with the experts ondepression, anxiety it's first
and foremost, we need to keep iton our radar we talk about,
physicians getting burned out,but if you're not thinking about
it, you're not going to see it.
You're not going to diagnose it.
And it's important to rememberthat you could be depressed but
(14:55):
still not burned out becauseyour depression is related to
other factors and your sportmight be the one thing that's
really keeping you going too.
So I think we need to keep it onthe radar.
We want to rule out any organiccauses such as thyroid problems,
anemia a variety of otherthings.
And then just really comes downto just having a conversation
(15:19):
with the child every childadolescent comes in, I always
ask them, are they stillenjoying their sport?
And what is their goals?
And I think those are twoimportant questions.
And I asked that right in frontof the parent.
And if they tell me they're notenjoying it but they're still
playing, I ask them why.
And sometimes they're thenlooking over at the parent there
and saying, that's why.
(15:41):
And so then we'll have adiscussion with the family,
myself and mom, dad and anathlete and talk about what the
goals are and how we can, helpfrom either prevent more burnout
or to just change the trajectorywith it, but it's not always
clear cut, but I think we justneed to think about it and have
(16:03):
a conversation.
Dr. Elise Fallucco (16:04):
Yeah I love these questions and I want to, I
think these are great clinicalpearls for our listeners.
So I'm going to highlight themagain.
But the two big questions to askyour athletes in the office are
one, are you still enjoying thesport?
And then the second question,what are your goals in the
sport?
And then a followup for, are youstill enjoying the sport?
If the answer is no.
(16:24):
In front of the parents or, thecaregivers asking why, what is
it about it that makes you notenjoy it?
Is this something as simple as,I'm practicing six days a week.
And so I can't spend time withmy friends and I'd like to cut
back to five days a week or fourdays a week, or is it just, I'm
done.
I've had my own child tell me, Iunderstand that you think that
I'm good at this sport and Idon't like it.
(16:46):
I just don't want to play it.
And.
It's funny because we push ourkids in other directions.
Mainly academically, I'mthinking Even if they don't feel
like doing their math homework,they have to do their math
homework.
But it's a different world whenit comes to the world of sports
and that child preference reallymatters.
We want them to find somethingthat they love, some form of
(17:08):
movement, some form of exercise,some activity so that they can
stick with it and continue toget the mental and physical
health benefits from exercise inthe longterm.
And I love this idea of justtrying to align your child's
interests and passions in adirection that, that's going to
stick.
Dr. Joel Brenner (17:28):
And I think just to go off of what you said
too, and we've said it a coupleof times, is movement and
physical activity is soimportant, and it's not just
Organize sports because in myfield in sports medicine, we
treat everyone as an athlete.
Some people think you have toplay a sport to be an athlete.
But in my mind, everyone's anathlete.
(17:49):
We want everyone to bephysically active.
So I think movement is reallythe key and getting it.
In some way that the childenjoys.
So I don't want to prescribe,okay, you've got to do it this
way.
I want them to come up with away they're going to do it so
they can continue to do it.
Dr. Elise Fallucco (18:07):
Do you have any special tricks?
Cause I've had some of theseconversations when we're trying
to motivate, to get outside, toexercise, to do something.
And sometimes I'll run into abrick wall and they're like, I
don't want to take a walk.
Do any programs or activitiesthat you think are sort of
outside of the box thatsometimes kids respond to?
Dr. Joel Brenner (18:25):
I think one is finding an exercise buddy.
So maybe their parent or theirsibling and getting out, I
always ask, is it safe wherethey are so that they can get
out or, the recreational centersaround here are fairly
inexpensive too.
I think an exercise buddy isgood for everybody because it
keeps us accountable.
(18:46):
And it helps get us out there.
And then I think just startingwith small quantities, even
getting out for 10 minutesthat's better than zero minutes.
So I think starting small andthen working
Dr. Elise Fallucco (18:58):
from there.
That reminds me of, I don't knowif you've read Atomic Habits by
James Clear, but he talks abouttrying to create a culture of
change and motivate somebodyinto movement and exercise.
And that the first step is asmall step, like you said, and
it's just going to the gym,being there for one minute, and
you can go home and that's it.
But the goal is just creating anew habit and a pattern.
(19:21):
And part of that also, isfacilitated when you have a
buddy, when you have some sortof friend or family member who
will motivate you on the dayswhen you're not feeling like it.
Exactly.
I also like rewards, And justthis idea of, okay, we went
outside and we did our movementfor the day.
And, give even a reward assimple as I'm so proud of you.
(19:43):
I'm like just the verbal praiseof that was excellent and this
is part of your goal and I'm abig fan of sticker charts.
Everyone makes fun of me andthis does not work for most
people, but sometimes a littlesticker can go a long way.
Dr. Joel Brenner (19:58):
Yeah.
So the other thing is, if we gonew age instead of stickers, we
can just be using technology.
Like the different, the fitnessapp on iPhones where you can see
how many days a week you'veexercised and how many miles or
how many steps.
So just seeing that visualrecognition for some people is
(20:19):
really exciting.
And then you can almost set upa, in-house competition.
Or maybe not a competition, butjust goals as a family of, okay,
we're gonna do this.
Five days a week, who's going toget the most steps, a friendly
competition.
Yes.
Dr. Elise Fallucco (20:33):
I love that.
Yeah.
Just like a family challenge.
We all have our goals for theweek and we're going to keep
track.
And I love the idea of justusing technology to provide
feedback.
And that, that helps motivatebehavior change.
So our goal ultimately is to tryto help these kids stay in
sports without injuries, withoutpain or with minimal pain and
(20:55):
without burning out.
And so keeping that in mind,what take home messages would
you like to share with ourpediatric clinicians to help
them promote healthy involvementin youth sports?
Dr. Joel Brenner (21:07):
So I think there's a few take home messages
here, and I'll try to keep itshort, but first and foremost,
the goals of sports should behaving fun and learning lifelong
physical activity skills.
So we need to promote that.
Remembering that.
If they're a football player,there's not many football
(21:27):
players at the age of 50 or 60.
But there's plenty of exfootball players who are
running, who are playing tennis,who are doing other things.
Also, just making sure we'realways asking what is the
intrinsic motivation.
What does the child andadolescent want to do?
Make sure we're not measuringsuccess by wins, but more by
(21:50):
effort and participation.
And then also trying to promotemore free play, just getting out
just being active going hiking,getting out with nature, which
can help so much from a physicaland mental standpoint, also As I
said before trying to promotegetting the PPE or sports
(22:10):
physical in the medical home,where we can be asking these
questions and we can becounseling.
And then lastly, we didn't talkabout it as much, but just
another avenue that can behelpful from a stress standpoint
is mindfulness.
There's a variety of apps outthere.
Some of the apps that I like,there's the 10 percent happier
(22:31):
app and there's the balance app.
Dr. Elise Fallucco (22:34):
The balance app and 10 percent happier app,
we'll go ahead and put those onour website.
And we're also going to put alink to the one page info
Graphic that you mentionedearlier that just helps people
understand realistic goals foryouth athletes.
Thank you so much, Dr Brennerfor taking your time and sharing
your expertise and for all thework that you're doing to try to
(22:56):
help support young athletes andmore importantly, to support
continued involvement inmovement and exercise and
fitness to promote physical andmental health.
Dr. Joel Brenner (23:07):
Thanks for having me, Elise.
Hopefully we can make adifference together.
Dr. Elise Fallucco (23:10):
Sounds good.
All right.
And as a brief recap of ourconversation, we talked about
different ways to promotehealthy involvement in youth
sports, by keeping things fun.
By balancing the volume oftraining with time for rest and
recovery, and specificallytaking one to two days off per
week and two to three months offper year of organized sports to
(23:32):
allow the body to recover.
Of course, we talked about theimportance of sleep and
nutrition.
And of making sure that the PPEor the sports physical takes
place in the medical home sothat we have the opportunity to
talk to athletes and familiesabout this.
We reviewed the importance ofintrinsic motivation in sports.
And Dr.
Brenner gave us two reallyhelpful questions to ask kids
(23:54):
one being, do you still enjoyplaying this sport?
And two, what are your goals inthis sport?
And finally Dr.
Brenner and the American academyof paeds advocated that we delay
sports specialization until atleast mid to late adolescents.
So, if you want copies of theone-page handout or information
about other resources, check outour websites, psyched the number
(24:16):
four paeds.com.
Please go ahead and share thispodcast with anyone you think
might be interested.
And please click follow orsubscribe in your podcast player
app, so that you'll make sure toget ongoing content relevant to
child mental health.
Thanks again for listening.
See you next time.
Welcome back to PsychEd4Peds, the child
mental health podcast forpediatric clinicians and for all
of you who take care of kids.
We're helping you help kids.
Today we're very excited to haveDr.
Joel Brenner on the pod.
He is a national expert in youthsports.
Dr.
Brenner is a pediatric sportsmedicine physician and Director
(00:41):
of the sports medicine, sportsconcussion, and dance medicine
programs at children's hospitalof the King's daughters in
Norfolk, Virginia.
Dr.
Joel Brenner is the co-author ofthe recent report released by
the American academy of paeds onoveruse injuries over-training
and burnout in young athletes.
Today, we're going to talk toDr.
(01:02):
Brenner about how to help keepkids in sports.
And how we can reduce burnoutand over use injuries in our
young athletes.
Most importantly, we're going tofind out how early is too early
for kids to specialize in onesport.
So please join me in giving awarm welcome to Dr.
Joel Brenner.
Dr. Joel Brenner (01:20):
Thanks for having
Dr. Elise Fallucco (01:21):
me, Elise.
So excited to have you here.
So as a pediatric sportsmedicine doctor, what would you
say are the major benefits thatyou see in participating in
youth
Dr. Joel Brenner (01:31):
sports?
I think there's three differentcomponents.
There's a physical component, amental and a social component.
Youth sports is one way for kidsto meet the physical activity
guidelines that have been setout.
It also can help them sociallyjust to acquire a peer group and
learn how to manage interactionsand sometimes Conflict.
(01:54):
and then just mentally withphysical activity- it can help
with mood that help with stressreduction.
So just a variety of benefits.
Dr. Elise Fallucco (02:04):
Yeah.
And speaking from the mentalhealth benefit, I'm a huge fan
of sports and youth sports ingeneral, but we have really
great studies that have shownthat people who participate in
movement and sports activities,they are actually experience a
benefit in terms of milddepression and anxiety.
So it's can be very helpful foryour mood and for anxiety.
(02:25):
In addition for your physicalhealth and all the social
components.
So the sad news that I wasreally shocked to hear from the
clinical report is that 70percent of youth athletes drop
out of organized sports by age13.
Wow.
What do you think are some ofthe main causes or reasons for
(02:48):
this high dropout rate?
Dr. Joel Brenner (02:50):
So we highlighted that burnout and
injury are some of the causes,but actually most of the
attrition is not from burnout.
It's really from kids no longerhaving fun, not having time to
do other activities outside ofsports like, theater, like art,
like just going outside andhaving fun with their friends,
(03:12):
with their family.
Also just lack of skilldevelopment.
And just no longer enjoying it.
And those are really the majorreasons.
And so those are some of thethings that we need to change.
Dr. Elise Fallucco (03:25):
I love this idea that it's so important to
make sure that kids are havingfun and that they're enjoying
what they're doing and that wedon't start, pushing them or
that it doesn't become tooserious too early because then
you lose the potential benefitof participation in sports with
these kids.
Your clinical report, as youmentioned, focused on the role
(03:46):
of injury and burnout and howthat affects participation in
youth sports.
And I'm thinking about, when Ihear about injury and overuse
injuries, I think about thingslike little league shoulder or
in my sport of choice, which isswimming.
I think about swimmer'sshoulder.
Are there any things thatpediatric clinicians can do to
counsel parents and families totry to prevent or reduce the
(04:09):
risk of overuse injuries insports?
Dr. Joel Brenner (04:12):
Yes, I think there's a a variety of factors
that we can counsel on, andthat's also one of the reasons
why we recommend that sportsphysicals or the PPE be done in
the medical homes so that we canbe counseling both the athlete
and the family.
about preventing overuseinjuries, about preventing
burnout.
so when we're talking aboutoveruse injuries, it's all about
(04:35):
balancing volume and versus restand recovery.
And we want to make sure there'senough rest and recovery.
So we want to look at how muchsomebody is doing and how fast
they're doing it.
So making sure that if they'rejust starting out doing an
activity such as running, Maybeonly increasing the volume by 10
to 20 percent per week, but alsolooking at their weekly volumes.
(04:59):
So making sure they're having atleast one to two days off per
week from their particular sportand two to three months off
throughout the year from theirparticular sport.
And a lot of people don'tunderstand how they can do that,
but.
The key is that two to threemonths off, it can be broken up
a month here, a month there.
And during that time, we're nottelling kids to be a couch
(05:20):
potato.
We still want them to bephysical, physically active,
whether it's doing anothersport, cross training, just
getting outside, having fun.
So we can look at the volumethere.
We also want to look at theirtechnique to so especially, with
swimming with baseball withdance I take care of a lot of
(05:41):
dancers.
So if their technique is off,that's going to put them at risk
for overuse injuries.
Also, if they have a history ofa prior injury, we want to
really look at what caused thatinjury.
And if we don't really take careof the underlying, problem, the
causative factor, then they'regoing to be at risk for getting
injured.
Another injury.
(06:01):
Lastly, and just as importantly,two other things to always be
counseling on and to berecommending is sleep and
nutrition.
We know that kids and mostadults don't get enough sleep
and sleeps so important.
As it's so important for thebrain to clear out all the
debris that we've acquiredthrough today.
But by getting proper sleep, itactually helps us perform better
(06:25):
and it can help us decreaseinjuries to you.
Dr. Elise Fallucco (06:28):
The recommendations make a lot of
sense, obviously sleep andnutrition and gradually
increasing your training loadsby less than 10 to 20 percent
per week.
I imagine that potentially a bigsticking point would be the
issue of time off.
And I'm thinking there's such apush in youth sports now to be
playing year round sports and tobe traveling every weekend.
(06:51):
And so I think this clinicalreport comes at a good time
because it's really emphasizing,we need to think about the
balance between how much stresswe're putting on our body and
how much time we're giving ourbodies to recover and rest and
repair.
I liked your practical tip abouttaking time off that this idea
of taking two to three monthsoff per year from sports doesn't
(07:12):
have to be in one big block anddoesn't have to be mean taking
time off from all physicalmovement and activity.
It sounds like what you guys aresuggesting is more,
participating in an organizedsports league where there's
multiple practices per week or,regular weekend tournaments is
something that should not beyear round, but ideally, you
should have a one month break acouple of times of year from
(07:35):
that.
Is that right?
Dr. Joel Brenner (07:37):
Yeah.
Whether it's a one month or evenup to two months depends.
The other thing is that parentsreally want this information
because it's not just the kidswho are getting stressed out and
burned out.
The parents are too, becausethey're trying to juggle, the
whole family.
If they have multiple kids,they're driving in different
places.
They also have to juggle theirown career and everything else
(08:00):
that goes along with being aparent.
So the biggest problem and thatwhat we've been trying to do for
20 years is change youth sportsculture.
So working with nationalgoverning bodies, the NCA,
because all this stuff tricklesdown.
If we can change culture wherekids do not have to specialize
at nine years of age, kids donot have to play year round that
(08:22):
they can be multi sportathletes.
I think that can help a lot, butit's in since our first edition
back in 2007, we've made alittle progress, not as much as
we'd like.
So hopefully, we'll continue topush the envelope and continue
to educate and hopefully we'llmake some more improvements.
Dr. Elise Fallucco (08:41):
Yeah, and jumping off what you just said
about the potential risks ofearly specialization.
One of the things that I foundreally interested, interesting
that I don't think most parentsknow is that early
specialization is notnecessarily helping these kids
to be better athletes longterm,that in fact, playing multiple
sports throughout the yearcreates better athletes overall.
Dr. Joel Brenner (09:05):
Yeah, I think that's really key.
If we look at the statistics andin our AP paper on sports
specialization, we have a onepage infographic that I give out
to all my patients and it'sfreely downloadable and
pediatricians can give it out.
But if we look at statistics,only up to 10 percent of high
school athletes will play incollege.
(09:27):
Only 1 percent of high schoolathletes will get any college
scholarship.
That's not a full ride thatcould just be 1,000 dollars.
But less than 1 percent of highschool athletes will actually
play professionally.
We don't want to squash dreams,but we want to be realistic and
we want to look at ways topromote lifelong physical
(09:48):
activities at the same time.
Dr. Elise Fallucco (09:50):
I can think of some of my own peers and
some, people in my friend groupwho have kids even nine year
olds and 10 year olds who arebeing told Potentially by their
own coaches, like your daughterhas a lot of talent or your son
is really great.
And so we really just need toget in there and invest in them
and help them to be the bestthat they can be.
as a pediatrician, if you had aparent in your office, who's
(10:12):
saying, my child has talent andI want them to become the next
Michael Phelps or Olympicgymnast, what would you say to
keep them balanced?
Dr. Joel Brenner (10:21):
Yeah, I would say the most important things
are what we know from thecurrent research is that multi
sport athletes are moresuccessful for a variety of
reasons.
They're learning skills indifferent sports that transfer
over.
They're also mentally going tobe fresher by the time they get
to college.
And it's actually come up morecollege coaches are speaking out
(10:45):
that, by the time they'regetting their athletes in
college, most of them are nothungry anymore.
They're burned out.
They've been injured.
There's one college basketballteam this year who had a lot of
injuries and the coach said, bythe time they're getting to him,
they've already had catastrophicinjuries like ACL tears.
If you're you believe that yourchild is special then promoting
(11:09):
multi sports, but also alwayscommunicating with your child
and seeing what their goals are.
So it should be the intrinsicmotivation.
It's not the motivation of theparent or of the coach because,
this child might be good atbaseball.
But might have really no desireto play this in college or even
in high school, might want to dosomething else, might want to be
(11:29):
a dancer or anything.
So I think the more you canexpose a kid when they're
younger the better off they'regoing to be, not just in
college, but
Dr. Elise Fallucco (11:39):
beyond.
Yes, and exposing them tomultiple different disciplines
and having the long view of.
If let's say the child's goal isto keep playing this sport for
as long as they possibly can.
And the parent's goal is to helpthem excel.
Then really the recipe isn't thetraditional, let's practice four
(12:00):
hours a day of this sport, sixto seven days a week, starting
at age seven, but rather let'stry to keep, stay involved in
this sport and other sports.
And then, when you talk aboutspecialization, I like that you
guys gave a little bit of an.
Age cutoff saying, there's acertain age at which it doesn't
make sense to just play onesport.
(12:22):
When does that change?
Like, when do you think itbenefits the athletes to switch
over and just focus on onesport?
Dr. Joel Brenner (12:28):
So that is a key question that even within
the sports medicine world, wehave not been able to come to a
complete agreement with becauseof the research is lacking
there.
When we came up, I worked withthe NBA on some NBA guidelines
for youth basketball and workedwith American Medical Society of
Sports Medicine, the AP.
(12:49):
So what we've said just ingeneralities is, mid to late
adolescence.
But again, You don't have tospecialize, that might be an
okay time if you really want to,there's no other sports you want
to do.
But, if you look at so many ofthe NFL athletes, most of them
(13:09):
played Multiple sports intocollege to there's some sports
where there's more pressure andsometimes you need to specialize
earlier, such as gymnastics,especially in female gymnast,
because once you developphysically, then it's less
optimal but for the majority ofsports we would say at least
(13:32):
wait till mid to late
Dr. Elise Fallucco (13:34):
adolescence.
You should not specialize beforemid to late adolescence, unless
you're one of those, exclusionslike female gymnasts Going back
to what you talked about withburnout.
I've seen this in my friendsthat these incredible athletes
have been driving themselves orhave been externally motivated
by parents, coaches, et cetera.
And then they get to the pointwhere they're tired of it and
(13:56):
they know they're not interestedin seeing a swimming pool or
going out on the field anymore.
And it's interesting because alot of the symptoms of burnout
in sports seem to overlap withthose for depression.
And I'm thinking about fatigue,irritability, losing interest in
something that you formerlyloved, maybe sleep problems
(14:18):
maybe anxiety, and decreasedperformance.
I imagine you potentially see afair amount of burnout in your
clinics.
What advice would you givepediatric clinicians to help
them distinguish between burnoutand depression in an athlete?
Dr. Joel Brenner (14:33):
Well, I would say it is not clear cut and,
speaking with the experts ondepression, anxiety it's first
and foremost, we need to keep iton our radar we talk about,
physicians getting burned out,but if you're not thinking about
it, you're not going to see it.
You're not going to diagnose it.
And it's important to rememberthat you could be depressed but
(14:55):
still not burned out becauseyour depression is related to
other factors and your sportmight be the one thing that's
really keeping you going too.
So I think we need to keep it onthe radar.
We want to rule out any organiccauses such as thyroid problems,
anemia a variety of otherthings.
And then just really comes downto just having a conversation
(15:19):
with the child every childadolescent comes in, I always
ask them, are they stillenjoying their sport?
And what is their goals?
And I think those are twoimportant questions.
And I asked that right in frontof the parent.
And if they tell me they're notenjoying it but they're still
playing, I ask them why.
And sometimes they're thenlooking over at the parent there
and saying, that's why.
(15:41):
And so then we'll have adiscussion with the family,
myself and mom, dad and anathlete and talk about what the
goals are and how we can, helpfrom either prevent more burnout
or to just change the trajectorywith it, but it's not always
clear cut, but I think we justneed to think about it and have
(16:03):
a conversation.
Dr. Elise Fallucco (16:04):
Yeah I love these questions and I want to, I
think these are great clinicalpearls for our listeners.
So I'm going to highlight themagain.
But the two big questions to askyour athletes in the office are
one, are you still enjoying thesport?
And then the second question,what are your goals in the
sport?
And then a followup for, are youstill enjoying the sport?
If the answer is no.
(16:24):
In front of the parents or, thecaregivers asking why, what is
it about it that makes you notenjoy it?
Is this something as simple as,I'm practicing six days a week.
And so I can't spend time withmy friends and I'd like to cut
back to five days a week or fourdays a week, or is it just, I'm
done.
I've had my own child tell me, Iunderstand that you think that
I'm good at this sport and Idon't like it.
(16:46):
I just don't want to play it.
And.
It's funny because we push ourkids in other directions.
Mainly academically, I'mthinking Even if they don't feel
like doing their math homework,they have to do their math
homework.
But it's a different world whenit comes to the world of sports
and that child preference reallymatters.
We want them to find somethingthat they love, some form of
(17:08):
movement, some form of exercise,some activity so that they can
stick with it and continue toget the mental and physical
health benefits from exercise inthe longterm.
And I love this idea of justtrying to align your child's
interests and passions in adirection that, that's going to
stick.
Dr. Joel Brenner (17:28):
And I think just to go off of what you said
too, and we've said it a coupleof times, is movement and
physical activity is soimportant, and it's not just
Organize sports because in myfield in sports medicine, we
treat everyone as an athlete.
Some people think you have toplay a sport to be an athlete.
But in my mind, everyone's anathlete.
(17:49):
We want everyone to bephysically active.
So I think movement is reallythe key and getting it.
In some way that the childenjoys.
So I don't want to prescribe,okay, you've got to do it this
way.
I want them to come up with away they're going to do it so
they can continue to do it.
Dr. Elise Fallucco (18:07):
Do you have any special tricks?
Cause I've had some of theseconversations when we're trying
to motivate, to get outside, toexercise, to do something.
And sometimes I'll run into abrick wall and they're like, I
don't want to take a walk.
Do any programs or activitiesthat you think are sort of
outside of the box thatsometimes kids respond to?
Dr. Joel Brenner (18:25):
I think one is finding an exercise buddy.
So maybe their parent or theirsibling and getting out, I
always ask, is it safe wherethey are so that they can get
out or, the recreational centersaround here are fairly
inexpensive too.
I think an exercise buddy isgood for everybody because it
keeps us accountable.
(18:46):
And it helps get us out there.
And then I think just startingwith small quantities, even
getting out for 10 minutesthat's better than zero minutes.
So I think starting small andthen working
Dr. Elise Fallucco (18:58):
from there.
That reminds me of, I don't knowif you've read Atomic Habits by
James Clear, but he talks abouttrying to create a culture of
change and motivate somebodyinto movement and exercise.
And that the first step is asmall step, like you said, and
it's just going to the gym,being there for one minute, and
you can go home and that's it.
But the goal is just creating anew habit and a pattern.
(19:21):
And part of that also, isfacilitated when you have a
buddy, when you have some sortof friend or family member who
will motivate you on the dayswhen you're not feeling like it.
Exactly.
I also like rewards, And justthis idea of, okay, we went
outside and we did our movementfor the day.
And, give even a reward assimple as I'm so proud of you.
(19:43):
I'm like just the verbal praiseof that was excellent and this
is part of your goal and I'm abig fan of sticker charts.
Everyone makes fun of me andthis does not work for most
people, but sometimes a littlesticker can go a long way.
Dr. Joel Brenner (19:58):
Yeah.
So the other thing is, if we gonew age instead of stickers, we
can just be using technology.
Like the different, the fitnessapp on iPhones where you can see
how many days a week you'veexercised and how many miles or
how many steps.
So just seeing that visualrecognition for some people is
(20:19):
really exciting.
And then you can almost set upa, in-house competition.
Or maybe not a competition, butjust goals as a family of, okay,
we're gonna do this.
Five days a week, who's going toget the most steps, a friendly
competition.
Yes.
Dr. Elise Fallucco (20:33):
I love that.
Yeah.
Just like a family challenge.
We all have our goals for theweek and we're going to keep
track.
And I love the idea of justusing technology to provide
feedback.
And that, that helps motivatebehavior change.
So our goal ultimately is to tryto help these kids stay in
sports without injuries, withoutpain or with minimal pain and
(20:55):
without burning out.
And so keeping that in mind,what take home messages would
you like to share with ourpediatric clinicians to help
them promote healthy involvementin youth sports?
Dr. Joel Brenner (21:07):
So I think there's a few take home messages
here, and I'll try to keep itshort, but first and foremost,
the goals of sports should behaving fun and learning lifelong
physical activity skills.
So we need to promote that.
Remembering that.
If they're a football player,there's not many football
(21:27):
players at the age of 50 or 60.
But there's plenty of exfootball players who are
running, who are playing tennis,who are doing other things.
Also, just making sure we'realways asking what is the
intrinsic motivation.
What does the child andadolescent want to do?
Make sure we're not measuringsuccess by wins, but more by
(21:50):
effort and participation.
And then also trying to promotemore free play, just getting out
just being active going hiking,getting out with nature, which
can help so much from a physicaland mental standpoint, also As I
said before trying to promotegetting the PPE or sports
(22:10):
physical in the medical home,where we can be asking these
questions and we can becounseling.
And then lastly, we didn't talkabout it as much, but just
another avenue that can behelpful from a stress standpoint
is mindfulness.
There's a variety of apps outthere.
Some of the apps that I like,there's the 10 percent happier
(22:31):
app and there's the balance app.
Dr. Elise Fallucco (22:34):
The balance app and 10 percent happier app,
we'll go ahead and put those onour website.
And we're also going to put alink to the one page info
Graphic that you mentionedearlier that just helps people
understand realistic goals foryouth athletes.
Thank you so much, Dr Brennerfor taking your time and sharing
your expertise and for all thework that you're doing to try to
(22:56):
help support young athletes andmore importantly, to support
continued involvement inmovement and exercise and
fitness to promote physical andmental health.
Dr. Joel Brenner (23:07):
Thanks for having me, Elise.
Hopefully we can make adifference together.
Dr. Elise Fallucco (23:10):
Sounds good.
All right.
And as a brief recap of ourconversation, we talked about
different ways to promotehealthy involvement in youth
sports, by keeping things fun.
By balancing the volume oftraining with time for rest and
recovery, and specificallytaking one to two days off per
week and two to three months offper year of organized sports to
(23:32):
allow the body to recover.
Of course, we talked about theimportance of sleep and
nutrition.
And of making sure that the PPEor the sports physical takes
place in the medical home sothat we have the opportunity to
talk to athletes and familiesabout this.
We reviewed the importance ofintrinsic motivation in sports.
And Dr.
Brenner gave us two reallyhelpful questions to ask kids
(23:54):
one being, do you still enjoyplaying this sport?
And two, what are your goals inthis sport?
And finally Dr.
Brenner and the American academyof paeds advocated that we delay
sports specialization until atleast mid to late adolescents.
So, if you want copies of theone-page handout or information
about other resources, check outour websites, psyched the number
(24:16):
four paeds.com.
Please go ahead and share thispodcast with anyone you think
might be interested.
And please click follow orsubscribe in your podcast player
app, so that you'll make sure toget ongoing content relevant to
child mental health.
Thanks again for listening.
See you next time.
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