TEACHERS OF TOMORROW LESSON PLAN FORMAT NAME New Teacher .docx

TEACHERS OF TOMORROW LESSON PLAN FORMAT
NAME: New Teacher SUBJECT: Grade 7 Language Arts
State Standard: (6) Reading/Comprehension of Literary
Text/Fiction. Students understand, make inferences and draw
conclusions about the structure and elements of fiction and
provide evidence from text to support their understanding.
Students are expected to:
(B) analyze the development of the plot through the internal and
external responses of the characters, including their
motivations and conflicts; and
(C) analyze different forms of point of view, including first-
person, third-person omniscient, and third-person limited.
LEARNING OBJECTIVE(S): The student will analyze the
development of the plot through the internal and external
responses of
the characters, including their motivations and conflicts, and
analyze different forms of point of view, including first-person,
third-person omniscient, and third-person limited by selecting
from a group of tasks that include creating a character analysis
cut-out or poster, acting out a character in a presentation, or
pretending to be the author of a book during an interview.

ASSESSMENT: With the assistance of a peer, students will
create a mock interview and presentation in which each student
will discuss how they created a character in the book. Students
must identify the four aspects of characterization and how
they pertain to the character. Students will submit the interview
and present to the class for evaluation.
MATERIALS and SETTING Small groups (3 – 4) determined by
the teacher
Notebook paper, pencil, colored pencils for ‘tweet sheet’, paper
sack, objects for the bag
Thirsty, Burger Wuss, The Chocolate Wars, Feed, and Refugee
books
KEY VOCABULARY and
ACADEMIC LANGUAGE
Review definitions for analyze, plot, internal/external
responses, character, characterization,
point of view
FOCUS ACTIVITY Students will create a character chart from
two poems (“The Peanut Butter King” and “Sarah
Cynthia Sylvia Stout Would Not Take the Garbage Out.” to
review ‘static’ and ‘dynamic’
characterizations.
CONNECTION TO PRIOR
LEARNING
Students will review the four different characterization concepts
we have learned in the last
two weeks.

OBJECTIVE STATEMENT Students, today we will continue
our study of characterization, plot development and point
of view. You will complete a project of your choice for the final
assessment of your
understanding of characterization and the role of plot and point
of view in characterization.
PURPOSE OF LEARNING This is important for us to know so
we can understand how writers utilize characters to
impact story lines, and in real life, helps us recognize how other
people impact our lives.
INSTRUCTIONAL STEPS
Include:
Step by step instructions
Key points
Directions to give
1. Review: I will review the different characterization concepts
with the students prior to
starting them on the activity. These concepts include antagonist
and protagonist,
dynamic vs. static, round vs. flat, and the difference in implied
and explicit character
traits.
2. Focus Activity: Students will complete the poetry activity to
help them distinguish
between static and dynamic characters.
3. Activity: Students will be completing three different learning
stations that solidify some

of the concepts of point of view and characterization. I will
explain the station
requirements for each station before releasing them to work.
**While students are working on this, I will be pulling some
students for a tier one re-teach
of the concepts before they complete an activity.
Station 1: Students will “become” a character from their group
independent reading
assignment (each group has been reading one of the following
books: Thirsty, Burger
Wuss, The Chocolate Wars, Feed, and Refugee). On a piece of
notebook paper,
students will write down 10 adjectives that describe themselves
as the character
from the book. Students will then list ten more adjectives for
two other characters in
the book from the point of view of the character they have
become.
Station 2: Students will be completing the “Tweet Sheet”
activity. Students have to
write tweets for different characters to point of view on the
different conflicts in the
short story. Students may choose any of the following short
stories: “Luck,” “Old
Man on the Bridge,” and “The Other Wife.” Students will
annotate these stories on
the iPads using Scrible. They can read independently to practice
their
comprehension, and then share their findings and notes as a
group. After groups
finish discussing, they will work on their “Tweet Sheets.”

Station 3: Students will write paragraphs from their personal
point of view about a
particular object. They will then write a second paragraph from
the point of view of
that particular object. These objects will be in a paper sack so
that they cannot see
what they are grabbing. Tomorrow, students will take turns
reading the paragraph
from the point of view of their object.
4. Station Completion: Following completion of the stations
activity, I will ask the Post-
Questions to clarify any misconceptions and prepare students
for their project choices.
This assignment will be due in two days.
5. Assessment: Handout project choices for students. Students
will be completing a project
of their choice for the final assessment of their understanding of
characterization and
the role of plot and point of view in characterization. Each
project listed is differentiated
to fit different learning styles. Here is a link to this assignment:
https://drive.google.com/file/d/1G8HfB059W4VKAiSB8z9AHX
T-
Ash5eJw4/view?usp=sharing
6. Closure: To review, we will list three types of point of view
and some of the
characteristics of each type. Students will also be sharing what
they remember about the
different characterization concepts before we leave class. They
will not have to write it

down for an exit ticket today. I will take notes on who seems
sure of their responses and
who else might need Tier1/Tier 2 instruction.
7. Connect to Future Learning: Students will be using the
concepts covered in this lesson as
we begin our novel study of A Wrinkle in Time.
T-Ash5eJw4/view?usp=sharing
T-Ash5eJw4/view?usp=sharing
QUESTIONS FOR
UNDERSTANDING
Identify levels of Blooms
Pre-Questions:
• What are some of the key differences between direct and
indirect characterization?
Analyze
• What are some ways to determine whether a trait is an implied
or explicit
characteristic? Evaluate, Create
• What are some of the different details that make up the
characteristics of a
character? Remember
Post Questions:
• What are you the things that you are most comfortable with
discussing about
characterization and its relationship to other literary elements

moving forward?
Evaluate
• What are some things that you think that we should practice
more before we begin
our study? Create
MODIFICATIONS/
ACCOMMODATIONS
Modifications: IEP and ELL students will have their sentence
stem lists for the writing
portions of the stations. IEP students will also work on their
paragraphs with the teacher
during study hall tutorials.
Accommodations: IEP/504 Students will be able to type the
written portion of these
assignments.
RETEACH/EXTENSION Reteach:
Students who are struggling with the Point of view and
characterization concepts will be
pulled during this lesson for tier one instruction. We will begin
by having students list
different adjectives to describe each of the members of the
group. After listing the different
adjectives, we will discuss whether these are implied traits or
explicit traits. Since most will
be explicit, I will be giving them some examples of implied
traits by helping them find ways
to assume certain traits (ex: they can assume that I am also a
coach because I generally come
to class in wind pants or they can assume that a class mate is on

the basketball team because
they wear tennis shoes every day).
The final aspect of this lesson will be for students to read the
short story “Old Man on the
Bridge.” We will read together and take our notes on Scrible
using the iPad. We will discuss
the different characters in the story and label them as flat/round
and tell whether they are
static or dynamic characters. After we finish this, students will
complete a “Tweet Sheet” for
one of the characters in the book.
Extension:
Students who are ready to move on will be completing the
creative writing characterization
activity. This assignment is NOT for a grade, but it can be used
to replace a student’s two
lowest grades. Here is a link to that assignment:
https://drive.google.com/file/d/1O8iP5ZjzhfOXuhISI24kaErOpe
nwl8ru/view?usp=shari
ng
CLOSURE
Review
Connect to future learning
Review: We will list out the three types of Point of View and
some of the characteristics of
each type. Students will also be sharing what they remember
about the different
characterization concepts before we leave class. They will not
have to write it down for an

exit ticket today. I will take notes on who seems sure of their
responses and who else might
need tier 1/tier 2 instruction.
Connection to Future Learning: Students will be using the
concepts covered in this lesson as
we begin our novel study of A Wrinkle in Time.
nwl8ru/view?usp=sharing
nwl8ru/view?usp=sharing
65
SPORTS HEALTHvol. 8 • no. 1
[ Primary Care ]
In the United States, nearly 72% of school-aged youth (69% of
girls and 75% of boys aged 8 to 17 years) participate in at least
1 organized sport team or club. This equates to nearly 29
million youth playing organized sports. Similar growth in sports
participation is increasing across the globe in children of all
ages,3,10,37 and it is recognized that sports participation has
many
benefits, including living a healthy lifestyle, having a positive
self-image, and building social relationships. In combination

614811 SPHXXX10.1177/1941738115614811Myer et alSports
Health
research-article2015
Sports Specialization, Part II:
Alternative
Solution
s to Early Sport
Specialization in Youth Athletes
Gregory D. Myer, PhD,*†‡§|| Neeru Jayanthi, MD,¶# John P.
DiFiori, MD,**
Avery D. Faigenbaum, EdD,†† Adam W. Kiefer, PhD,†‡‡‡
David Logerstedt, PhD,§§
and Lyle J. Micheli, MD||||||¶¶
Context: Many coaches, parents, and children believe that the
best way to develop elite athletes is for them to participate
in only 1 sport from an early age and to play it year-round.
However, emerging evidence to the contrary indicates that
efforts to specialize in 1 sport may reduce opportunities for all
children to participate in a diverse year-round sports
season and can lead to lost development of lifetime sports
skills. Early sports specialization may also reduce motor skill
development and ongoing participation in games and sports as a

lifestyle choice. The purpose of this review is to employ
the current literature to provide evidence-based alternative
strategies that may help to optimize opportunities for all
aspiring
young athletes to maximize their health, fitness, and sports
performance.
Evidence Acquisition: Nonsystematic review with critical
appraisal of existing literature.
Study Design: Clinical review.
Level of Evidence: Level 4.
Conclusion: Based on the current evidence, parents and
educators should help provide opportunities for free
unstructured
play to improve motor skill development and youth should be
encouraged to participate in a variety of sports during
their growing years to influence the development of diverse
motor skills. For those children who do choose to specialize
in a single sport, periods of intense training and specialized
sport activities should be closely monitored for indicators of
burnout, overuse injury, or potential decrements in performance
due to overtraining. Last, the evidence indicates that all

youth should be involved in periodized strength and
conditioning (eg, integrative neuromuscular training) to help
them
prepare for the demands of competitive sport participation, and
youth who specialize in a single sport should plan periods
of isolated and focused integrative neuromuscular training to
enhance diverse motor skill development and reduce injury
risk factors.
Strength of Recommendation Taxonomy (SORT): B.
Keywords: injury prevention; youth sports; athletic
performance; neuromuscular training
From †Division of Sports Medicine, Cincinnati Children’s
Hospital Medical Center, Cincinnati, Ohio, ‡Departments of
Pediatrics and Orthopaedic Surgery, University of
Cincinnati, Cincinnati, Ohio, §The Sports Health and
Performance Institute, OSU Sports Medicine, Ohio State
University Medical Center, Columbus, Ohio, ||The Micheli
Center
for Sports Injury Prevention, Waltham, Massachusetts,
¶Department of Orthopaedics, Emory University, Atlanta,
Georgia, #Department of Family Medicine, Emory University,
Atlanta, Georgia, **Division of Sports Medicine and

Nonoperative Orthopaedics, Departments of Family Medicine
and Orthopaedics, University of California, Los Angeles,
California, ††The College of New Jersey, Ewing, New Jersey,
‡‡Center for Cognition, Action, and Perception, Department of
Psychology, University of Cincinnati, Cincinnati,
Ohio, §§Department of Physical Therapy, University of the
Sciences, Philadelphia, Pennsylvania, ||||Division of Sports
Medicine, Department of Orthopaedics, Boston Children’s
Hospital, Boston, Massachusetts, and ¶¶Harvard Medical
School, Boston, Massachusetts
*Address correspondence to Gregory D. Myer, PhD, Cincinnati
Children’s Hospital, 3333 Burnet Avenue; MLC 10001,
Cincinnati, OH 45229 (email: [email protected]).
The authors report no potential conflicts of interest in the
development and publication of this article.
DOI: 10.1177/1941738115614811
© 2015 The Author(s)
Jan • Feb 2016Myer et al
66
with increased sport participation, it is now speculated that

sports specialization including year-round sport-specific
training,
participation on multiple teams of the same sport, and focused
participation in a single sport may be at an all-time high.37 In
the United States, youth sports specialization with intense year-
round training in a single sport may be potentially more
common, with a recent report indicating that nearly 30% of
young athletes were highly specialized from a sample of nearly
1200 young athletes.28,60 Factors such as the pursuit of
scholarships or professional contracts or the intense desire for
talent recognition by parents, coaches, or media appear to fuel
interest in specializing in a single sport. Many coaches, parents,
and children believe that the best way to develop elite athletes
is to participate in only 1 sport from an early age and to play it
virtually year-round.
Single-sport specialization was first reported in Eastern Europe
with athletes involved in individual sports such as gymnastics,
swimming, diving, and figure skating.19,37 International
Olympic
sports such as these likely contributed to increased sports
specialization, with selection processes that eventually reached
into the primary school years in an attempt to distinguish future
champions and initiate specialized training for enhanced
opportunity of success. The development programs for future

champions involved intense and high-volume training and
rigorous coaching that was often endorsed with parental
pressure for achievement. The relative success of these Olympic
development programs combined with the lure of professional
contracts likely influence young athletes to isolate their focus to
a single sport at younger ages across the globe. This is despite
the fact that only 0.2% to 0.5% of US high school athletes ever
make it to the professional level.37,53
This is why, at present, early sports specialization is
controversial. Concerns have been raised about the appropriate
age to begin as well as the risks and benefits of this type of
athletic participation.27,28,48 The Developmental Model of
Sport
Participation developed by Côté and colleagues9 provides a
schema of different pathways of involvement in sport,
specifically prescribing an early sampling as the foundation for
sport participation (both elite and recreational) for the first 2
pathways of the schema (Table 1). While pathway 3 plots a
course to elite performance via early sport specialization, a
recently published evidence-based review concluded that, for
most sports, intense training in a single sport to the exclusion of
others should be delayed until middle or late adolescence to
optimize success and minimize risk for injury and psychological
stress.27 Sport specialization is associated with overuse

injuries,
burnout, and social isolation3,25 and may be associated with
quitting sports at a young age. Possibly the worst outcome of
early sports specialization is injury and dropout, followed by a
sedentary lifestyle and increased risk of being overweight,
ultimately compounded with reduced enjoyment of physical
activity in youth. This potentially may lead to long-term
consequences in adulthood.
Another potential drawback to early sports specialization is that
youth are deprived of participation in a diverse year-round
sports
season, and this can possibly lead to lost development of
lifetime
sports skills. These lost opportunities for fun, focused physical
activity during youth likely contribute to deficits in current and
long-term physical activity and health.37 More specifically,
sports
specialization in youth may lead to reduced motor skill
development. Reduced motor skill proficiency may occur as
young athletes focus on the motor skills needed for their sport
Table 1. Seven postulates associated with the Developmental
Model of Sport Participationa

Postulate 1 Early diversification (sampling) does not hinder
elite sport participation in sports where peak
performance is reached after maturation
Postulate 2 Early diversification (sampling) is linked to a longer
sport career and has positive implications for long-
term sport involvement
Postulate 3 Early diversification (sampling) allows participation
in a range of contexts that most favorably affects
positive youth development
Postulate 4 High amounts of deliberate play during the sampling
years build a solid foundation of intrinsic
motivation through involvement in activities that are enjoyable
and promote intrinsic regulation
Postulate 5 A high amount of deliberate play during the
sampling years establishes a range of motor and cognitive
experiences that children can ultimately bring to their principal
sport of interest
Postulate 6 Around the end of primary school (around age 13
years), children should have the opportunity to either
choose to specialize in their favorite sport or to continue in

sport at a recreational level
Postulate 7 Late adolescents (around age 16 years) have
developed the physical, cognitive, social, emotional, and
motor skills needed to invest their effort into highly specialized
training in 1 sport
aReproduced with permission from Côté et al.9
67
but ignore the motor skills developed through a diversified
participation portfolio. As young athletes continue to progress
in
their level of play, their opportunities for participation in
various
sports continue to decline. The decline of participation in other
sports may be from coach or parental pressure, difficulties and
conflicts in scheduling, or ultimately, a loss of interest. There
may
be additional coaching pressures to encourage a young athlete to

only participate in a single sport and the promise of greater
opportunities in that single sport. If the cycle of sports
specialization occurs too early in youth, comprehensive motor
skill development will be stifled, which, in turn, increases the
risk
of future injury and potentially reduces opportunities for the
child
to achieve optimal sport performance.23,37 Thus, the purpose
of
this review is to present the potential pitfalls of early sports
specialization as well as alternative strategies to optimize
opportunities for all youth athletes seeking to maximize their
performance while building lifelong motor skills and
maintaining
their overall enjoyment for physical activity.
EARLY SPORT SPECIALIZATION DOES NOT
ENSURE SPORTS SUCCESS
An area where elite athletes stand out is in their family history
of sport success. Elite athletes are more likely than other
students to have a parent or sibling who played sports
collegiately or professionally.11 Although genes do play a role
in
athleticism, children of athletic parents may additionally get

substantial support and encouragement to pursue sports.
Regardless, it is important to point out that pushing a child to
specialize in a sport early in life in and of itself will not
compensate for a lack of athletic genes or guarantee success.11
The desire for children to succeed in sports is likely driven by
several additional factors, including garnering collegiate
athletic
scholarships, national and Olympic-level team selection, or
professional contracts. In many instances, the goals may be less
lofty, such as ensuring participation in scholastic sports more
generally. For these children (and their parents), the reason they
specialize is a fear that if they do not specialize, they will not
be
able to compete at the next level of competition—the next age
group of a club or the middle school or high school team.
Whether it is unrealistic goal setting or, more commonly, youth
just trying to “keep up” with their competing peers, convincing
children (and their parents) that sports diversification is
beneficial can be difficult.
A perception exists among many parents that to gain an edge
toward achieving success, having their child specialize in a
single sport at a young age is necessary. This may be best
epitomized by the example of Tiger Woods, whose early
introduction to golf, the highly structured training to which he

was subjected, and his eventual success in becoming perhaps
the best golfer of his generation is well known.12,18
Furthermore,
independent youth travel or select club teams are often seen as
essential to develop exceptional skills and provide exposure to
the recruiting process. These programs may encourage early
sport specialization from a training standpoint, often because
the expected time commitment makes participation in other
sports or activities logistically difficult.
Early single-sport specialization has been further advanced by
the theory of deliberate practice. Deliberate practice is defined
as a highly structured activity with the explicit goal to improve
performance. This concept states that the “level of performance
an individual attains is directly related to the amount of
deliberate practice.” The so-called “10 year/10,000 hour rule”
was subsequently coined based on studies of small numbers of
chess champions and highly selected elite musicians whose
success was attributed to very high volumes of training in their
disciplines.5,13 However, studies of athletes indicate that the
strategy of early single-sport specialization (performance in
these sports occurs at a young age before pubertal maturation is
complete) is not a guarantee for success, and in some cases,
may be detrimental to long-term achievement and associated

with increased injury risk.23,28
With the exception of a few sports such as gymnastics and
figure skating, the odds of excelling to the elite level in sports
do not appear to be increased by early sports specialization. A
study of 35,000 highly qualified young athletes selected to train
in Russian sports schools found that only 0.14% reached
high-level status.31 Similarly, a 7-year study of German
athletes
selected to train at young ages found that only 0.3% eventually
ranked among the 10 best international senior athletes.21
Another study of elite and near-elite athletes found that
successful elite athletes actually specialized at a later age and
trained less in childhood. The elite group, however, pursued
intensive training more during late adolescence than their
near-elite peers.36 Vaeyens and colleagues59 reviewed the
training history of 2004 Olympians and found that the mean age
of sport initiation was 11.5 years. In addition, the age of onset
of training was negatively correlated with the time differential
before the athlete achieved competition in an international
championship. They concluded that early, high-intensity,
sport-specific training and involvement in sports talent
programs
at a young age is not necessary for international-level success.
A

study of more than 1500 German national athletes in all
Olympic sports reported that those who achieved the
international level initiated training in their main sport at an
older age. This study also found that, on average, these athletes
participated in 2 other sports prior to or in parallel with their
main sport. These athletes also continued in other sports to a
later age. Importantly, adolescent success did not predict
senior-level success.21 At the collegiate level, a study of
National
Collegiate Athletic Association (NCAA) Division 1 athletes at 1
university found that 70% did not specialize in their sport until
at least age 12 years, and 88% had participated in more than 1
sport. Overall, these university athletes specialized at an older
age compared with students at the same university who were
not NCAA athletes (mean, 15.4 vs 14.2 years).55 This study
also
found that more than 40% had a parent who had competed at
the collegiate or professional level, suggesting that genetic and
environmental factors play a large role in long-term athletic
achievement.55

68
Overall, the available data among athlete populations indicate
that only a select few who specialize in a sport at a young age
achieve elite-level success. It is also important to note that
success at young ages does not predict long-term success, and
in some cases, early sport specialization may in fact be a
limiting factor to elite-level achievement.11 Furthermore, there
are numerous examples of athletes who became champions
after relatively short periods of time spent training in their sport
or who were part of talent crossover or talent “recycling”
programs.11 The current data lend support to the concept of
early sport diversification and recognize that while deliberate
practice is certainly necessary for success in sports, it is not
sufficient (Table 2). There are a few sports where it may be
acceptable to specialize during preadolescent stages because
peak performance is typically prior to full maturation. Previous
studies have suggested that elite performers in rhythmic
gymnastics had specialized prior to the age of 12 years.30
Middle-entry sports typically represent the far majority of
sports
where specialization occurs beyond the age of 12 years (or
during middle adolescence); these may involve individual sports
such as tennis and many team sports.31 Late-entry sports
typically include specialized training toward late adolescence or

full maturity, such as endurance or timed event sports. Elite
athletes accumulated more training hours only by the age of 21
years when compared with nonelite athletes in sports that are
“measured,” and not during adolescence.36
While this comprehensive review of single-sport specialization
and intensive training generally suggests that in the majority of
sports focusing on intense single-sport training generally occurs
after the age of 12 years, there are a number of limitations with
many of the studies. There are several retrospective survey
studies, including some with potential recall of >10 years and
some with small sample sizes, as well as varying definitions of
specialized training. Some studies include only single sports
while others include numerous sports with varying definitions
of specialized and intense training. There have been few, if any,
long-term prospective surveillance studies comparing the
potential benefits and risks of young athletes who are
specialized versus those who are diversified. Regardless, there
is
little scientific evidence that supports the notion that there is a
benefit toward success with earlier single-sport training.
ALTERNATIVES TO SPORT SPECIALIZATION

Young athletes are being subjected to training for sports at
earlier ages and are specializing in 1 sport with the goal of
attaining elite status.34,52 The opportunity for sport sampling
is
important for injury prevention. Without an opportunity to
“sample” different sports during childhood, young athletes are
less likely to acquire the foundational physical, psychosocial,
and cognitive skills that are important for long-term success in
sport.9
Additionally, modern day youth are likely not prepared for the
demands of sports practice and competition, as the grades for
indicators of youth physical activity around the world are low/
poor and suggest there is widespread evidence of a physical
inactivity crisis.58 Moreover, 44% of school administrators in
the
United States report having cut significant time from physical
education and recess to increase time for reading and
mathematics.8 Physical education is the only guaranteed
opportunity for most children to enhance their physical literacy
and experience a variety of sports—from field ball games to
resistance training—with appropriate instruction and
assessments. Children who are not exposed to meaningful
activities and different sports during physical education may be
more likely to specialize in 1 sport to exploit a narrow set of

motor skills that leverage their personal movement confidence,
experience early success, appease parents, and gain the support
of their youth coaches. Physical education provides the ideal
“alternative” mechanism for a specialized athlete to develop
physical literacy as well as broaden their opportunity for sports
sampling.
Despite the increasing number of youth sport participants, a
contemporary consequence of the sedentary nature of modern
day youth is a lower level of motor skill competency and
muscular fitness.7,24,57 The prevalence of competency in
fundamental movement skills in a large sample of school-aged
children was found to be low, and a clear and consistent
relationship existed between low competency in fundamental
movement skills and inadequate levels of cardiorespiratory
fitness.24 Other researchers examined secular trends in
muscular
fitness and found declines in bent-arm hang, sit-up
performance, handgrip strength, shuttle run performance, and
trunk flexibility in school-aged youth.7,57 Collectively, these
findings highlight the need to improve the preparedness of
modern day youth for the demands of sports training and
competition to enhance their motor skills performance, improve
their physical fitness, and reduce associated injury risks.
Without

directed movement practice and exposure to a variety of
skill-building games and activities early in life, children are
less
likely to maximize their physical development and capitalize on
their athletic abilities later in life.20,22,36
Children should participate in a variety of sports with qualified
youth coaches who, in turn, have the necessary knowledge and
Table 2. Recommendations for stage of specialization
and sporta
Type of Sport
Recommended Stage of
Specialization
Gymnastics, diving, figure
skating
Early adolescence
Team sports, tennis, golf Middle adolescence
Endurance sports, track,

distance events
Late adolescence
aAdapted from Jayanthi et al.27
69
skills to organize and monitor age-related training and
adaptations so that the children are more likely to experience
long-term success as competitive athletes. Developmental sport
programs need to match the anatomic, physiological, and
psychosocial uniqueness of children and adolescents and relate
to their long-term physical development to build a strong
foundation for future success.32,38 Some children may develop
advanced level or adult-level skills at a young age and may
create some coaching philosophies that are adult-driven and
possibly more appropriate for an older athlete. This may put
them at risk for general and serious overuse injuries23,28 rather
than enhance their physical fitness qualities, improve their
movement skill repertoire, and expand their sporting

knowledge.
Intense training may result in injury when weekly hours of
sports participation exceed a child’s age28 and when the total
weekly hours exceed 16.56 Specialized training itself may have
an independent risk for injury as it also limits the amount of
recreational and unstructured exercise. Young athletes may be
able to participate in similar volumes of physical activity
without additional injury risk, but the distribution of physical
activity is important. In a study of nearly 1200 young athletes in
a variety of sports, the ratio of weekly hours in organized sports
to weekly hours in unorganized free play (sports training ratio)
approached 2:1.28 Young athletes who exceed a sports training
ratio of 2:1 are more likely to suffer a serious overuse injury.28
These data seem to indicate that unstructured free play may
potentially have a protective effect from serious overuse injury.
While this needs to be further investigated, children may be
able to self-regulate their own physical activity volumes prior
to
serious overuse injury versus adult-driven organized practices.
Future evaluations of intensity and volume of organized training
in young athletes should also include the ratio of organized to
unorganized sports and physical activity participation.
In terms of physical conditioning during sports practice, youth

sport practice and games may not provide sufficient moderate
to vigorous physical activity to meet daily recommendations
since a large proportion of time is spent in sedentary or light
physical activities. Low levels of habitual physical activity
significantly increase injury risk during leisure-time physical
activity, physical education, and sports, and the children who
are least active appear to have the highest injury risk.2 A
youngster’s participation in sport should not start with
competition but rather evolve out of preparatory conditioning
and instructional practice sessions that address individual
deficits. At present, policies and strategies are needed to ensure
that youth are prepared for optimal engagement in organized
team sports and have the opportunity to enhance their physical
fitness while learning and practicing game tactics.
New insights into the design of youth physical development
programs may prove to be valuable for youth coaches who
need to integrate both health- and skill-related fitness
components into a time-efficient training session to alter
physical activity trajectories and associated injury risks.
Integrative neuromuscular training (INT) includes general (eg,
strength-building exercises) and specific (eg, exercise targeted
to motor control deficits) conditioning activities that are
designed to enhance both health- and skill-related fitness in a

socially supportive environment (Figure 1).4 INT provides a
much needed opportunity for inactive youth to enhance their
muscular fitness and improve their motor skill performance,
which form the foundation for future participation in context-
specific sports and games. This type of age-related training is
designed to promote the development of neurocognitive
processes and visual-motor abilities under the guidance of a
qualified coach who is able to deliver corrective feedback for
identified deficits (Figure 2).49
Including integrative neuromuscular programming as part of
participation in physical education and sports may provide a
mechanism to develop dynamic interceptive actions and to
increase physical activity levels and sports skills in youth.2,42
In
sports such as football, for example, being able to catch a ball
without being distracted by a defender can improve reaction
time and potentially decrease injury risk as well as enhance
motor skill performance.6 Of potential relevance, a multisport
approach provided with physical education curriculum that
introduces a sampling of varied experiences tied to multiple
sports in a coordinated fashion can induce more pronounced
improvements in aerobic fitness and kinesthetic discrimination
ability.40 When the sports sampling is matched to ability and
interest of youth, there are also improvements in task

orientation and self-efficacy compared with traditional physical
education.54 INT taught by trained specialists that incorporates
intermittent-type activities into a well-designed plan may offer
valuable health and fitness benefits to school-aged
youth.14,33,39,40,44 One INT program consisted of body
weight
exercises with punch balloons that focused on enhancing
muscular strength, muscular power, and fundamental movement
skills (Table 3). The programming that was added 2 times per
week during the first 15 minutes of a grade 2 physical education
class provided an effective and time-efficient addition to
physical education, as evidenced by improvements in health-
and skill-related fitness measures.14
The concept of requiring aspiring young athletes who are
deficient in habitual exercise to participate in an age-related
preseason conditioning program and sample a variety of sports
during the growing years could have significant benefits that are
consistent with lifelong health and well-being. If a child does
choose to specialize in sport, emergent evidence indicates that
integrative neuromuscular training may offer observable
benefits
over specific year-round sports programming.32,39,41,50,51
Single-
sport–specialized athletes may benefit from enhanced motor

competence with INT-focused training to improve physical
performance and diversify motor skill competence.14,15,44-
47,50
Implementation of INT training may provide important
supportive programming if implemented in the early years as it
capitalizes on the corticomotor plasticity in youth during
preadolescence.14,16,29,39-41,49,51 Based on the cumulative
evidence,
if a child chooses to specialize, early exposure to INT provides
an additional benefit that can help enhance motor skills,
improve sport performance, and reduce injury
risk.14,15,17,26,43,47
70
Given the known physical and psychosocial benefits of youth
sports participation, it is imperative to address contemporary
concerns regarding the preparedness of modern-day youth for
sport and the importance of multisport exposure for most
young athletes. Schools have a unique opportunity to enable
less-skilled boys and girls to enhance their skill competency

during physical education class while providing an opportunity
for others to focus on self-improvement in a dynamic
environment. Youth coaches and sport administrators should
ensure that young athletes are engaged in meaningful physical
activities during sports practice and need to be aware of the
limitations of early sports specialization during childhood.
Finally, pediatric health care providers have a responsibility to
ensure that young athletes develop a range of physical,
psychosocial, and cognitive abilities across a variety of sports
since the lingering effects of early sports specialization and
overuse injuries may deter youth from participating in other
forms of physical activity as an ongoing lifestyle choice later in
life.
RECOMMENDATIONS BASED ON THE
AVAILABLE EVIDENCE
•• Youth should be given opportunities for free, unstructured
play to improve motor skill development, and parents and
educators should encourage child self-regulation to help
limit the risk of overuse injuries.
•• Parents and educators should help provide opportunities for
free, unstructured play to improve motor skill development
during the growing years, which can reduce injury risk

during adolescence.
•• Youth should be encouraged to participate in a variety of
sports during their growing years to influence the
development of diverse motor skills and identify a sport, or
sports, that the child enjoys.
•• Children who do participate in more hours of sport per
week than their age, and for more than 16 hours per week
in intense training, and who are specialized in sport activities
should be closely monitored for indicators of burnout,
Figure 1. Qualified education and instruction support the
complex programming components for effective implementation
of
integrative neuromuscular training. Reprinted with permission
from Myer et al.49
71
overuse, injury, or potential decrements in performance due

to overtraining.
•• All youth (including inactive youth) can benefit from
periodized strength and conditioning (eg, INT) to help
them prepare for the demands of competitive sport
participation.
•• Youth who specialize in a single sport should plan periods
of isolated and focused INT to enhance diverse motor skill
development and reduce injury risk factors.
CONCLUSION
The current evidence-based review supports the contention that
children should be encouraged to take part in a variety of sports
at levels consistent with their abilities and interests to best
attain
the physical, psychological, and social benefits of sport.1,35
Children who specialize early (eg, prior to maturation) in a
single
sport may execute less age-appropriate sports skills, especially
when they do not participate in as much unstructured free play
Figure 2. Integrative training model indicating a focus on
integration of physical and cognitive training that is consistent

with
programming for youth. Adapted with permission from Myer et
al.40
Table 3. Structure of INT program with primary and secondary
exercises that were implemented into the first 10 minutes of
physical education curriculuma
Primary Secondary
Weeks 1-8 Weeks 1-2 Weeks 3-5 Weeks 6-8
Front squat SL balance SL balance and OH press SL balance
and CP
Squat jump OH press and catch SL OH press and catch Get up
and catchb
90° jump Knee tap and catch ALT knee tap and catch Knee tap,
turn, and catch
Plank Hip twister OH chop Diagonal chop
Balloon drop and catchc

ALT, alternate right and left knee; CP, chest press; INT,
integrative neuromuscular training; OH, overhead; SL, single
leg.
aReprinted with permission from Faigenbaum et al.14
bFrom a sitting position on the floor with a balloon in front of
the chest, children tossed the balloon into the air and stood up
as quickly as possible to catch
the balloon in an athletic stance.
cExercise was performed with eyes open weeks 1 through 4 and
eyes closed weeks 5 through 8.
72
as their peers. Without opportunities to experience sports
diversification, children may not fully develop neuromuscular
patterns that may be protective of injury. Alternative solutions
to
sports specialization, including diverse opportunities for motor
skill development during the growing years, combined with

planned integrative neuromuscular training may help optimize
the potential for success in young athletes. Further
opportunities
created in physical education can also help expose youth to
diverse sports and potentially greater opportunity to identify
sports of greatest potential for success and enjoyment.
SORT: Strength of Recommendation Taxonomy
A: consistent, good-quality patient-oriented evidence
B: inconsistent or limited-quality patient-oriented evidence
C: consensus, disease-oriented evidence, usual practice, expert
opinion, or case series
Clinical Recommendation
SORT Evidence
Rating
Children who participate in more hours of sport per week than
their age, and for more than 16 hours per week in intense
training, and who are specialized in sport
activities should be closely monitored for indicators of burnout,
overuse injury, or potential decrements in performance due to
overtraining. B

All youth (including inactive youth) can benefit from periodized
strength and conditioning (eg, integrative neuromuscular
training) to help them prepare for the
demands of competitive sport participation. C
Youth who specialize in a single sport should plan periods of
isolated and focused integrative neuromuscular training to
enhance diverse motor skill development and
reduce injury risk factors. C
Clinical Recommendations
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site at http://www.sagepub.com/journalsPermissions.nav.

437
[ Orthopaedic Surgery ]
Early sport specialization appears to be increasing in
young athletes,21,23 and the pressure to select 1 sport to
the exclusion of others is believed to come from coaches,
parents, and other youth athletes.27 There is concern that
engaging in year-round intense training programs in a single
sport at an early age may result in negative outcomes for some
young athletes, such as overuse injuries, burnout, and dropping
out of sport(s).2,17 This clinical review aims to synthesize the
current evidence to outline the potential negative outcomes
related to sports specialization in young athletes and to guide
alternative strategies that optimize enjoyment and safety of
youth sports.29

598747 SPHXXX10.1177/1941738115598747Myer et alSports
Health
research-article2015
Sport Specialization, Part I: Does Early
Sports Specialization Increase Negative
Outcomes and Reduce the Opportunity
for Success in Young Athletes?
Gregory D. Myer, PhD,*†‡§|| Neeru Jayanthi, MD,¶# John P.
Difiori, MD,**
Avery D. Faigenbaum, EdD,†† Adam W. Kiefer, PhD,†‡# David
Logerstedt, PhD,‡‡
and Lyle J. Micheli, MD||§§||||
Context: There is increased growth in sports participation
across the globe. Sports specialization patterns, which include
year-round training, participation on multiple teams of the same
sport, and focused participation in a single sport at a young
age, are at high levels. The need for this type of early
specialized training in young athletes is currently under debate.
Evidence Acquisition: Nonsystematic review.
Study Design: Clinical review.

Level of Evidence: Level 4.
Conclusion: Sports specialization is defined as year-round
training (greater than 8 months per year), choosing a single
main sport, and/or quitting all other sports to focus on 1 sport.
Specialized training in young athletes has risks of injury and
burnout, while the degree of specialization is positively
correlated with increased serious overuse injury risk. Risk
factors
for injury in young athletes who specialize in a single sport
include year-round single-sport training, participation in more
competition, decreased age-appropriate play, and involvement
in individual sports that require the early development of
technical skills. Adults involved in instruction of youth sports
may also put young athletes at risk for injury by encouraging
increased intensity in organized practices and competition
rather than self-directed unstructured free play.
Strength-of-Recommendation Taxonomy (SORT): C.
Keywords: injury prevention; youth sports; athletic
performance; neuromuscular training
From †Division of Sports Medicine, Cincinnati Children’s
Hospital Medical Center, Cincinnati, Ohio, ‡Departments of

Pediatrics and Orthopaedic Surgery, University of
Cincinnati, Cincinnati, Ohio, §The Sports Health and
Performance Institute, OSU Sports Medicine, Ohio State
University Medical Center, Columbus, Ohio, ||The Micheli
Center
for Sports Injury Prevention, Waltham, Massachusetts,
¶Department of Orthopaedics, Emory University, Atlanta,
Georgia, #Department of Family Medicine, Emory University
School of Medicine, Atlanta, Georgia, **Division of Sports
Medicine and Non-Operative Orthopaedics, Departments of
Family Medicine and Orthopaedics, University of
California, Los Angeles, California, ††The College of New
Jersey, Ewing, New Jersey, ‡‡Department of Physical Therapy,
University of the Sciences, Philadelphia, Pennsylvania,
§§Boston Children’s Hospital, Department of Orthopaedics,
Division of Sports Medicine, Boston, Massachusetts, and
||||Harvard Medical School, Boston, Massachusetts
*Address correspondence to Gregory D. Myer, PhD, Cincinnati
Children’s Hospital, 3333 Burnet Avenue, MLC 10001,
Cincinnati, OH 45229 (email: [email protected]).
The following author declared potential conflicts of interest:
Neeru Jayanthi, MD, is a paid consultant for American Academy
of Pediatrics and the Woman’s Tennis Association
Tour.
DOI: 10.1177/1941738115598747

© 2015 The Author(s)
Sep • Oct 2015Myer et al
438
SPORTS SPECIALIZATION RISKS AND
ETIOLOGIES
Definition and Volume Risk
Sports specialization can be defined as “intensive year-round
training in a single sport at the exclusion of other sports.”39
This
definition allows for a spectrum of sports specialization where a
highly specialized athlete may be able to (1) choose a main
sport, (2) participate for greater than 8 months per year in 1
main sport, and (3) quit all other sports to focus on 1 sport.40
Thus, the degree of sports specialization can be defined as low,
moderate, or high based on the number of definition
components to which a young athlete may respond in a positive
way.40 Historically, it has been difficult to separate the known
risks of intensive training based on high weekly volumes of
training from the independent risks of sports specialization in

overuse injuries. More recently, it has been shown that high
training volume carries its own risks for injury, and that
increased exposure has a linear relationship to adjusted injury
risk in high school athletes.38,45,60 Specifically, exceeding
16 hours per week of total sports participation, regardless of the
number of sports, seems to carry the greatest risk38,45,60;
however, age-adjusted recommendations for volume risk have
not been made for many sports. Nearly two-thirds of middle
school–aged children receiving medical treatment sustained an
injury during sports or physical activity, but the training and
rates of specialization were not included.57 Additionally,
athletes
who participate in more competitive levels or higher volumes of
training have an increased incidence of injury.20,48,60 For
example, adolescent baseball pitchers are at significant risk
(4-36 times) of sustaining an injury due to overuse and
fatigue.53
Until recently, these injury risks were not correlated with sports
specialization in young athletes.
Independent Risks of Sports Specialization
One study of 1190 young athletes, 7 to 18 years old, compared
training patterns of injured athletes at sports medicine clinics
versus uninjured athletes during a sports preparticipation

exam.40 Those athletes who met the definition of a highly
specialized athlete had 2.25 (range, 1.27-3.99) greater odds of
having sustained a serious overuse injury than an unspecialized
young athlete, even when accounting for hours per week sports
exposure and age. In fact, there was a continuum, with the
more specialized an athlete (per the 3 criteria proposed earlier)
the greater this risk of injury (Table 1). A separate retrospective
study of 546 high school athletes found a relationship between
the development of patellofemoral pain syndrome and single-
sport training in athletes in basketball, soccer, and volleyball.35
Exposures were estimated by seasons rather than by weekly
hours of participation. Patellofemoral pain was one of the most
common diagnoses in the study of 1190 athletes discussed
earlier,40 and this corroborates the findings that sports-
specialized training is an independent risk factor for injury in
young athletes.
Age-Related Play and Eligibility Rules
Age-adjusted training and competition volumes have not been
well studied in many youth sports. Nonetheless, youth sports
leagues have instituted rules designed to prevent injury and
promote age-appropriate levels of competition.47,54 USA youth
baseball has tried to utilize evidence for youth baseball leagues
to guide age-adjusted pitch counts.47 Unfortunately, there are

data to suggest that these guidelines are not followed by many
coaches, with the majority reporting additional pitching
instruction or camps.24 In addition, pitch count may be difficult
to monitor when pitchers participate on multiple teams over the
Table 1. Degree of sports specialization and risk of all-cause
injuriesa
Degree of Specialization Risk of Injury
Risk of Serious
Overuse Injury Risk of Acute Injury
Low specialization (0 or 1 of the following):
Year-round training (>8 months per year)
Chooses a single main sport
Quit all sports to focus on 1 sport
Low Low Moderate
Moderately specialized (2 of the following):
Year-round training (>8 months per year)
Moderate Moderate Low

Highly specialized (3/3 of the following):
Year round training (>8 months per year)
High High Low
aReproduced with permission from Jayanthi et al.40
439
course of a tournament or season. At present, there is no
effective model to develop appropriate age-related
recommendations. In response to early burnout and premature
retirements in young professional tennis players, the Women’s
Tennis Association (WTA) developed an age eligibility rule
(AER). At 10-year follow-up, this was effective in increasing
career lengths by about 2 years (43%) and reducing premature
sports dropout from 7% to 1% in young professional women’s
tennis players.54 The key component to this AER was a “phased

in” approach to the number of tournaments allowed, beginning
no earlier than the age of 14 years, with annual age-related
increases until 18 years as well as numerous player
development programs. In a separate study, a training rule
based on age (age vs hours) recently demonstrated increased
risk of injury and serious overuse injury if a young athlete
participated in more weekly organized sports hours than their
age.40 Potentially, volume recommendations for training and
competition should be age or developmentally adjusted across
all sports, and these rules may provide a model for other sports.
WHAT MAKES SPORTS SPECIALIZATION
A RISK VERSUS DIVERSIFIED SPORTS
EXPERIENCE?
The lack of diversified activity may not allow young athletes to
develop the appropriate neuromuscular skills that are effective
in injury prevention and does not allow for the necessary rest
from repetitive use of the same segments in the body. The
positive transfer of skill with diversification is important in the
successful development of a young athlete.15,28 Until recently,
we did not have enough evidence to support the concept of
sports specialization as an independent risk factor for injury,
apart from exposure or the combination of high volume and
intensity; however, the following theories may provide some

additional rationale for these risks.
Specialized Athletes Are More Likely to Have
Year-Round Exposure to a Single Sport
Year-round exposure to a single sport may be one of the
primary reasons for injury risk in specialized athletes. In youth
baseball pitchers, there was a greater risk for shoulder and
elbow surgery in those that pitched greater than 8 months per
year and in those that pitched regularly with arm pain or
fatigue.53 Another study of high school athletes found that
athletes who did not take at least 1 sport season off during the
year (eg, fall, winter, spring, or summer) were more likely to
sustain an injury independent of whether the athlete was
characterized as a single or multisport athlete.45 However, the
lack of difference in risks between the 2 groups may be due to
the fact that the weekly exposure hours were not monitored.
Thus, it makes it more difficult to draw firm conclusions with
regard to the risk of injury when exposure is already reduced.
The risk of injury or medical withdrawal was not demonstrated
in a population of 519 Midwest junior tennis players when using
a similar model.38 This might be due to the very high rates of
year-round training (93.4% at >9 months per year) that limited
the ability for a comparison with a control group.38 Regardless,

there seems to be emerging data that indicate increased risk of
injury with year-round training—a key component of
specialized training.
Repetitive Technical Skills and
High-Risk Mechanics
Highly specialized athletes who perform at an elite level
commonly participate in individual and technical sports. For
example, the majority of junior elite tennis players (70%)
specialized at a mean age of 10.4 years old, while 95% were
specialized by the age of 18 years.38 Other individual, technical
sports such as gymnastics, dance, swimming, and diving
typically require early specialization and high intense volumes
in prepubescent stages. While speculative, historical trends
indicate that athletes in team sports appear more likely to
diversify their sports, but even this trend has started to change.
Certain positions in team sports, such as a baseball pitcher, can
be trained as a specialized individual sport athlete. There is a
paucity of information on the biomechanical risks of sports for
overuse injury in young athletes, but some examples support
the potential for injury risk development in certain sports based
on mechanics and training. Specific to tennis, the mean age for
the introduction of the kick serve (a heavy topspin serve that
typically requires significant lumbar hyperextension and

extreme abduction and external rotation of the shoulder) to
adolescent athletes was approximately 13 years old.42
Associated
with this was a relatively high rate of shoulder and elbow
injuries.42 Similarly, increased forces to the back and shoulder
in
elite tennis players, but not in junior players, have been related
to the kick serve technique, and the mechanics of this serve
may put more stress on the adolescent body and thus increase
injury risk.1,61 Baseball pitchers are much more likely to have
overuse elbow injuries related to pitching volume, pitching
fatigue, and poor mechanics that result in increased elbow
torque and forces.25 Likewise, young gymnasts often have wrist
pain that is related to the volume of training intensity and skill
level, likely related to repetitive impact forces in wrist
dorsiflexion during growth periods.18,19
Overscheduling and Competition
The competitive demands are also typically higher for a
specialized athlete given the pressure for successful
performance during games, matches, meets, or tournaments. In
most sports, risk of injury is expected to be higher during
competition compared with training.36 These data have been
consistently demonstrated in a variety of National Collegiate

Athletic Association (NCAA) sports. There are a few sports
such
as gymnastics and figure skating where the intense and
voluminous (7 days a week) specialized technical training may
far exceed the exposure of a short competitive program in a
meet. Also, the level of specialized participation may involve
higher level competition (particularly at younger ages), which
again may be a risk factor for injury. Scheduled intense
competitions that can last 6 hours or longer without adequate
440
rest and recovery have been implicated as a risk factor for
potential injury as well.13,38 Suggested minimal rest periods
between repeated bouts of same-day competition have been
proposed,11,38 as well as limiting training 48 hours prior to
competition to help reduce injury risk.46 However, more
research is needed to understand the risk factors associated
with overscheduling competition and to establish formal
guidelines to optimize youth sport performance.

Psychological Burnout
There are increased pressures in intense, adult-driven
specialized training and competitions. The psychological risk of
burnout, depression, and increased risk of injury may be a
reason for withdrawal from sport in young athletes who took
part in early specialized training. Talent development research
on young athletes demonstrates that professionalized, adult-
style
practices are likely not optimal for fostering talent
development.16 Specifically, research has indicated that
adolescents need to enjoy the activities of their domain, and
that intrinsic motivators are key to maintaining participation
and
goal achievement.16 Unfortunately, this is often not the case as
the temptation of collegiate scholarships and stardom causes
thousands of adolescent athletes to specialize in single sports
and, subsequently, train year-round in sport-specific skills.
While this has resulted in more highly skilled, sport-mature
athletes at a younger age, it is isolating the child and has the
potential to lead to increased stress and pressure and an overall
feeling that the child lacks control or decision-making power
over their lives.68 It is important to understand the implications
of sport specialization at all levels of competition to better
manage athletes in a way that is in their best interest to prevent

burnout. In one such study on burnout, earlier specialization in
swimming resulted in less time on the national team and earlier
retirement compared with later specialization.10 There is also a
valid concern of sports attrition related to early, specialized
intense training. In ice hockey, players more prone to dropout
began off-ice training at a younger age, while they also invested
a larger number of hours in off-ice training at a younger age
compared with those who continued participation.66 Other
studies in sports such as swimming and tennis suggest that
retirement from sport may be the consequence of burnout,
which young athletes may experience with continued intense
and specialized participation.33,66
Burnout likely results from a combination of physical and
psychological factors. For example, a study of junior tennis
players indicated that the burned-out players had less input into
training and sport-related decisions and practiced fewer days
with decreased motivation compared with the players who did
not exhibit similar levels of burnout.31-33 This resulted in
athletes
who were more withdrawn and less psychologically prepared to
cope with the high stress realities of their sport.31-33
Moreover,
while a lack of fun is a more frequent reason for withdrawal
from sport at earlier ages, performance pressure seems to

become more central to withdrawal as athletes get older.14,30
Positive peer relationships also increase enjoyment and sport
commitment in youth. However, if there was a point that the
child felt that the sport conflicted with outside social
development, both their commitment to and motivation for that
sport decreased.56 Similarly, sport participation of a child’s
best
friend was a strong predictor of adolescent sport commitment
and involvement3,67; however, playing at a higher performance
level outside of the child’s age-specific peer group was linked
to
burnout in elite youth athletes.32,33 The potential interaction
between burnout, overtraining, and risk of injury has been
suggested as well.13 Young specialized athletes may be at risk
for either, and the specialization may magnify these potential
injury risk factors, which can create a cycle of recurrent injury.
Based on the current evidence, it may be best to limit intense
specialized training to less than 16 hours per week, and
instructors should employ strategies to prevent overscheduling
(eg, scheduled rest periods) and should monitor signs of
burnout or fear of reinjury. Improved communication between
those in management of youth sports participation (coaches and
parents) can help limit the potential risks of specialized
athletes.

Primary Injury and Effects of Fear of Reinjury
While many athletes will recover after an injury,59 injuries that
occur during sports or physical activity may deter some athletes
from further participation. One year or more after an injury or
surgery, approximately 65% of athletes returned to their
previous level of sporting activities, despite functional recovery
from the injury.7,8,26,49 Twenty percent of elite athletes have
reported injury as a reason for quitting their sport,14 and up to
8% of adolescents drop out of sporting activities due to injury
or fear of injury.34 Many athletes within 12 months of an injury
report lower levels of physical and mental health,5 with a
significant reduction in their physical activity.4 This reduction
in
physical activity can have negative health consequences,9,22,63
and insufficient physical activity is one of the top 5 reasons for
global deaths from noncommunicable diseases.50 This pattern
of
physical inactivity can persist into adolescence and
adulthood.12,37,51,52
Psychological readiness to return to sport after an injury does
not always correspond with physical readiness.58 Fear of
reinjury is a frequently cited reason athletes do not return to

sport or reduce their level of physical activity.6,41,43,44,62
Fear of
injury is associated with pain-related anxiety and self-reported
and behavioral impairments in patients with chronic low back
pain.65 Higher levels of pain and pain catastrophizing after
injury to the shoulder is associated with fear of reinjury/
movement.55 A large meta-analysis found a strong, positive
association with pain-related fear and disability.69 The
cumulative effects of fear of reinjury in the specialized sport,
with the lack of diversified exposure to a variety of sports, may
limit a child from successfully reintegrating into any form of
sporting activity.
Young specialized athletes who exhibit characteristics of fear
of reinjury may need strategies and techniques to adequately
address these issues if they aim to return directly back to the
same sport in which they were injured. In addition, some
441
specialized athletes may have low personal coping skills to deal

with psychological aspects of the injury.64 Educating the
athlete
and identifying inaccurate information about the injury and
rehabilitation process may reduce the emotional stress
associated with the injury. This may include adequately
counseling the athlete about the recovery process and the
challenges of rehabilitation. Effective strategies to help young
athletes combat fear of reinjury may enhance their ability to
successfully return to sports and continue life-long activity
participation.
CONCLUSION
The emerging evidence indicates that intense, year-round
training specialized to a single sport can be a risk factor for
various issues, and parents and coaches need to be cautious
about encouraging early sport specialization in youth. Three
components that define early sports specialization include
year-round training (>8 months per year), choosing a single
main sport, and quitting all other sports to focus on 1 sport.
Increased degree of specialization is positively correlated with
increased serious overuse injury risk. Some of the current
literature regarding the relationship between sport
specialization

and injury (ie, association does not equal causation) could
simply be a marker for excessive training volume in youth. The
volume of training defined by hours per week of organized
sports can increase injury risk either by exceeding 16 hours per
week of organized sports or hours per week of organized sports
greater than the athlete’s age. Specialized young athletes may
be
at increased risk for injury since they may be more likely to
participate in year-round training and may be involved in
individual sports that require the early development of technical
skills. Adults involved in instruction of youth sports should be
vigilant about noting any signs of stress, burnout, and physical
symptoms in these athletes and be prepared to take corrective
action such as backing off training intensity and frequency.
SORT: Strength of Recommendation Taxonomy
A: consistent, good-quality patient-oriented evidence
B: inconsistent or limited-quality patient-oriented evidence
C: consensus, disease-oriented evidence, usual practice, expert
opinion, or case series
Clinical Recommendation
SORT Evidence

Rating
Youth should be given opportunities for free, unstructured play
to improve motor skill development and parents and educators
should
encourage child self-regulation to help limit the risk of overuse
injuries. C
Parents and educators should help provide opportunities for
free, unstructured play to improve motor skill development
during the growing
years, which can reduce injury risk during adolescence. C
Youth should be encouraged to participate in a variety of sports
during their growing years to influence the development of
diverse motor
skills and identify a sport, or sports, that the child enjoys. C
Clinical Recommendations
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9
SPORT ACTIVITY
IN CHILDHOOD
Early specialization and diversification
Paul R. Ford and A. Mark Williams
Sport activity in childhood takes place in formal and informal
settings. Formal settings involve
adults planning, organizing and leading activity for children,
such as in coaching or physical
education sessions and in competitions. Informal settings
involve children leading the sport
activities themselves without adult intervention, such as in
playgrounds, parks, streets, gardens,
car parks, homes, and beaches (Ford, 2016). In some sports in
certain countries, children who
are considered proficient or with potential are identified to
engage in formal, competitive and
systematic talent development programmes. In these

programmes, children often specialize
solely in the sport which has become known as early
specialization (for a review, see Malina,
2010). Early specialization is defined as starting in the primary
sport during childhood (5 to 12
years of age), starting in a talent development programme in
childhood, and during that period
engaging in one sport only, or at least primarily (Baker, Cobley,
& Fraser-Thomas, 2009).
Moreover, early specialization involves engaging in a relatively
high volume and intensity of
training in that sport, as well as in competition in that sport
through tournaments, matches
and/or leagues (Baker et al., 2009).
Many children engage in sport outside of these formal
programmes, such as in informal
activity in a single sport, perhaps with some engagement in
other sports and/or some formal
recreational activity sport, which is known as early engagement.
Informal playful sports activities
are self-directed and are engaged in with the intention of fun
and enjoyment (Côté & Hay,
2002). This activity is hypothesized to lead to benefits such as
increasing intrinsic motivation

(cf. Hendry, Crocker, & Hodges, 2014; Imtiaz, Hancock, &
Côté, 2016) and acquiring skills,
such as decision-making (e.g., Roca, Williams, & Ford, 2012).
Other children engage in sport
mainly in formal, recreational settings. At the opposite end of
the continuum from early
specialization, is a pathway termed early diversification. Early
diversification is defined as engage-
ment in a number of different sports during childhood in mainly
informal, but also formal
settings, with late or delayed specialization into formal activity
in a single primary sport in
adolescence (Côté, Baker, & Abernethy, 2007). In adolescence,
these pathways appear to
converge to contain increasing specialization for talented
athletes in a single sport through a
high volume and intensity of training and competition. The
predicted characteristics of the
early specialization, engagement, and diversification pathways
are shown in Table 9.1. The
predicted and confirmed outcomes associated with and
following early specialization, engage-
ment, and diversification can be found in Table 9.2.
117

Researchers appear to have generally decided that, to
paraphrase the renowned English
author George Orwell in his book Animal Farm (1946), ‘early
diversification good, early specializa-
tion bad’. The latest incarnation of this idea was forwarded in
an International Olympic
Committee Consensus Statement on youth athletic development
(Bergeron et al., 2016). It
states that ‘youth should avoid early specialisation, as diverse
athletic exposure and sport
sampling enhance development and athletic capacity, reduce
injury risk and increase the oppor-
tunity for a child to discover the sport(s) that he/she will enjoy
and possibly excel at’ (p. 845).
Several other key review papers published in scientific journals
have taken a similar position
(Baker, 2003; Baker et al., 2009; Côté, Lior, & Hackfort, 2009;
Côté & Hancock, 2016; Jayanthi,
Pinkham, Dugas, Patrick, & LaBella, 2012; Mostafavifar, Best,
& Myer, 2013; Wojtys, 2013). In
contrast to this position, coaches and practitioners appear to
have decided in Orwell’s terms

that while ‘early diversification is good, early specialization is
better’. In some countries a large
Paul R. Ford and A. Mark Williams
118
Table 9.1 The predicted characteristics of early specialization,
engagement, and diversification
Early specialization Early engagement Early diversification
Childhood
Start age in primary sport Childhood Childhood Not specified
Start in ‘talent programme’ Yes No No
Play in primary sport Low High Low to medium
Practice in primary sport High Low to medium Low or no
Competition in primary sport High Low or no Low or no
Other sports Low Low to medium High
Adolescence
Play in primary sport Decreases to zero Decreases to zero
Decreases to zero
Practice in primary sport High Increases to high Increases to
high

Competition in primary sport High Increases to high Increases
to high
Other sports Decreases to zero Decreases to low Decreases to
low
Table 9.2 The predicted and confirmed outcomes associated
with and following early specialization,
engagement, and diversification
Early specialization Early engagement Early diversification
Positive outcomes in primary sport
Performance improvement Yes Yes Possibly through
transfer
Expert performance Yes Yes Yes
Other positive outcomes
Continued participation Some Yes Yes
Intrinsic motivation Lower Increased Increased
Enhanced social skills Lower Possibly medium Increased
Negative outcomes
Overuse injury incidence Higher Possibly medium Lower
Burnout and dropout Higher Possibly medium Lower

industry has been built around youth development programmes
that employ thousands of
experienced adults to work with children (and adolescents) who
specialize in a single sport in
well-resourced and expensive facilities.
In this chapter, we present a critical review of research, theory
and practice on sport activ-
ity in childhood. We support the views of others that childhood
sport activities should contain
positive features and lead to several positive outcomes (for
reviews, see Côté et al., 2009; Côté
& Hancock, 2016; Fraser-Thomas, Côté, & Deakin, 2005;
Vierimaa, Erickson, Côté, & Gilbert,
2012). However, in this chapter, we mainly limit assessment of
the evidence to the develop-
ment of skill or talent, as is the focus of this book. From this
perspective, we seek to identify
youth sport activities that cause the development of expert
performance at the highest levels
of professional sport without the occurrence of any negative
consequences, such as overuse

injuries or burnout. First, we review evidence for and against
early specialization and diversifi-
cation, which we focus on because these are the two main
developmental activity pathways
identified by researchers. To our knowledge, there is no single
research study that contains
children in controlled groups who either specialize or diversify,
which measures between-group
differences in variables and outcomes of interest at key time
points from their current engage-
ment in childhood into adulthood. Such longitudinal research is
difficult to undertake for many
reasons. Scientists have tended to use case-control and cross-
sectional studies from which the
quality of evidence is lower because of decreased internal
validity when compared to cohort
studies or randomized control trials (Petticrew & Roberts,
2006). Nevertheless, in the second
part of the chapter, we forward evidence-based
recommendations seeking to resolve research
and practical issues in this area.
Assessing evidence for early specialization
The main rationale used to support early specialization is the

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