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Sports-Related Injuries in Youth Athletes: Is Overscheduling a Risk Factor?

Luke, Anthony MD, MPH*; Lazaro, Rondy M BSc*; Bergeron, Michael F PhD; Keyser, Laura BSc, DPT; Benjamin, Holly MD§; Brenner, Joel MD, MPH¶∥; d'Hemecourt, Pierre MD**; Grady, Matthew MD††; Philpott, John MD‡‡; Smith, Angela MD§§

Clinical Journal of Sport Medicine: July 2011 - Volume 21 - Issue 4 - p 307-314
doi: 10.1097/JSM.0b013e3182218f71
Original Research

Objective: To examine the association between “overscheduling” and sports-related overuse and acute injuries in young athletes and to identify other potential contributing factors to create a working definition for “overscheduling injury.”

Design: Survey.

Setting: Six university-based sports medicine clinics in North America.

Participants: Athletes aged 6 to 18 years (13.8 ± 2.6) and their parents and pediatric sports medicine-trained physicians.

Interventions: Questionnaires developed from literature review and expert consensus to investigate overscheduling and sports-related injuries were completed over a 3-month period.

Main Outcome Measures: Physician's clinical diagnosis and injury categorization: acute not fatigue related (AI), overuse not fatigue related (OI), acute fatigue related (AFI), or overuse fatigue related (OFI).

Results: Overall, 360 questionnaires were completed (84% response rate). Overuse not fatigue-related injuries were encountered most often (44.7%), compared with AI (41.9%) and OFI (9.7%). Number of practices within 48 hours before injury was higher (1.7 ± 1.5) for athletes with OI versus those with AI (1.3 ± 1.4; P = 0.025). Athlete or parent perception of excessive play/training without adequate rest in the days before the injury was related to overuse (P = 0.016) and fatigue-related injuries (P = 0.010). Fatigue-related injuries were related to sleeping ≤6 hours the night before the injury (P = 0.028).

Conclusions: When scheduling youth sporting events, potential activity volume and intensity over any 48-hour period, recovery time between all training and competition bouts, and potential between-day sleep time (≥ 7 hours) should be considered to optimize safety. An overscheduling injury can be defined as an injury related to excessive planned physical activity without adequate time for rest and recovery, including between training sessions/competitions and consecutive days.

From the *Department of Orthopaedic Surgery, University of California, San Francisco, California; †Department of Pediatrics, Sanford School of Medicine, The University of South Dakota, Sioux Falls, South Dakota; ‡Department of Physical Therapy, University of California, San Francisco, California; §Department of Pediatrics, University of Chicago, Chicago, Illinois; Departments of ¶Pediatrics and ‖Orthopaedic Surgery, Children's Hospital of the King's Daughters, Norfolk, Virginia; **Department of Sports Medicine, Children's Hospital Boston, Boston, Massachusetts; ††Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; ‡‡Department of Pediatrics, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada; and §§Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.

Submitted for publication May 26, 2010; accepted April 26, 2011.

The authors report no financial disclosures or conflicts of interest.

Corresponding Author: Anthony Luke, MD, MPH, Department of Orthopaedic Surgury, University of California, San Francisco, 500 Parnassus Ave, MU-320W, San Francisco, CA 94143-0728 (

© 2011 Lippincott Williams & Wilkins, Inc.