Dr Feldman's Super Bowl weekend 100 miler
“I’m a runner.”
Sports and activities we love become something we identify our personalities and lives around. I frequently have patients come into my office who describe themselves in this manner. “I’m a dancer”, “I’m a jiu-jitsu martial artist”, “I’m a baseball player”. Before you finish reading this paragraph, know that I love when my patients are active people. I’m not advocating for inactivity. However, I get concerned when people say things like this and don’t mention any other form of activity or training, particularly my runners.
I think that there are two problems with this single sport specialization. The first problem is that, because many sports require and train repetitive movement patterns, overuse injuries can develop. The second problem is, should an injury occur, the patient now has to deal with both the physical pain, but also an emotional pain from loss of routine and their self-identity. This leads to a complex psycho-physical feedback that is very toxic and leads to bad decision making. This is something that I have lived personally through my own running at Providence College, UMass-Lowell and post-collegiately.
Dr Saviet in his prime of bad decision making
My first problem with single sport specialization is frequently discussed and is now being borne out in the medical literature. The sooner you focus on one sport, the more likely you are to get injured. Studies involving professional baseball players (1) and NBA players (2) both indicate lower rates of serious injury in players that specialized later or were “multi-sport athletes” in high school, respectively. Additionally, both studies showed longer professional careers from the late specialization groups. And if you’re thinking that those guys are pros so that doesn’t apply to you, think again. A study from October 2017 in the American Journal of Sports medicine (3) showed that high school athletes that were classified as highly specialized had almost twice the lower extremity injury likelihood as their low specialization peers. Physiologically, this makes perfect sense. To over-simplify, our bodies are bunch of connected parts (Dr Feldman's Movement Blogs) that move in relation to each other. They move via muscles that become tendon and attach to bones. Bones attach to each other via ligaments. If you move the same parts in the same way over and over, those parts get stronger relative to other areas that aren’t activated. This is training and is good to a certain extent because it means we get stronger, faster and better. Take this to the extreme, you can over-train certain areas or cause functional imbalances that put strain on other parts of the connected system leading to injury.
Now comes my second problem with single sport specialization: the almost inevitable injury. Just like when the tires on your car are out of balance, your body will wear down in certain spots if it is out of balance. This can lead to stress fractures, tendon injuries, arthritis, etc. If your whole identity is being the gal who runs to work every day, when you’re hurt it may feel like you don’t exist anymore! If you go to a fun run every week for social interaction, when you’re hurt you will not be able to run and you will feel like you’re missing your social activity for the week as well. A study from the Mayo Clinic of college athletes showed the more severe the injury, the more tension, depression, anger and lethargy an athlete would experience (4).
So now you’re hurt and depressed. How did we get here? Personal or parental pressures, unrealistic goal setting, and habit formation can all contribute. After we heal you, and we will, we need to go back and prevent the same mistakes. Most of the time it involves avoiding overdoing certain aspects of training via a responsible build up, variation and moderation. In Buddhism, there is the teaching of the middle way, in which moderation between two extremes leads to enlightenment. Aristotle discussed that virtue (IE "the right thing") was the mean between two vicious extremes. Additionally, he discussed that virtue is not always exactly in between those extremes or the same for different people. For example, the extreme between greed and poverty is not a truly definable middle spot. There are also many middle positions that work for each person. Nothing helps you feel like you’re improving your health like tricking yourself into thinking it is both the enlightened and virtuous thing to do!
In the day to day, this means encouraging kids and adults to participate in multiple sports or multiple positions for the same sport if that is their passion. If a coach thinks otherwise, it’s your right to disagree for the health of yourself or your child. Little Timmy might be the best pitcher on the team, but his health is more important than winning that extra game in Little League for the coach by throwing 100 curveballs. You might have a big race coming, but if you’re starting to hurt, it might be time to change up the training. In addition to the physical benefits of mixing up activities, for children, unstructured play is important for social development. Pick-up basketball games, Frisbee, soccer, spikeball all require some rules. When these are performed with only peers and no adult or referee supervision, additional social and emotional skills develop with the broadening of their physical skills. From Pediatrics 2007, “Undirected play allows children to learn how to work in groups, to share, to negotiate, to resolve conflicts, and to learn self-advocacy skills(5).”
To make a long story short, playing multiple sports or multiple positions within the same sport is good for you. Single sport/position specialization can lead to injuries without adding much benefit to the athlete, particularly at a young age. Certainly spending more time running will make you a better runner, but only to a point. At some point, you will begin to break down. Find ways to benefit your sport of choice with other activities. Runners can bicycle for increased cardiovascular training and can rock climb for generalized strength training. Basketball players can do yoga for increased tissue pliability and proprioceptive training. Everyone should learn to swim because it is low impact and a great cardiovascular and strength workout. Find the virtue and excitement of moderation and your improved health.
1- Orthop J Sports Med. 2017 Sep 22;5(9) Early Sport Specialization: Effectiveness and Risk of Injury in Professional Baseball Players. Wilhelm A, Choi C, Deitch J.
2- Am J Sports Med. 2017 Nov 1: The Effects of Playing Multiple High School Sports on National Basketball Association Players' Propensity for Injury and Athletic Performance. Rugg C, Kadoor A, Feeley BT, Pandya NK
3- Am J Sports Med. 2017 Oct;45(12):2706-2712. A Prospective Study on the Effect of Sport Specialization on Lower Extremity Injury Rates in High School Athletes. McGuine TA, Post EG, Hetzel SJ, Brooks MA, Trigsted S, Bell DR.
4- Mayo Clin Proc. 1990 Jan;65(1):38-50. Emotional responses of athletes to injury. Smith AM, Scott SG, O'Fallon WM, Young ML.
5- Pediatrics 2007;119;182 The Importance of Play in Promoting Healthy Child Development and Maintaining Strong Parent-Child Bonds Ginsburg KR.
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