Orthopaedic Surgeons Play a Role in Addressing Burnout and Attrition in Single-Sport Youth Athletes

Single-sport youth athletes have long been known to be at increased risk for overuse injuries, but recent data from the American Academy of Pediatrics (AAP) suggest they are also at higher risk for burnout and sports attrition.

Overuse injuries among youth athletes in the United States have risen, largely due to an increase in sport specialization and early intensive training. Studies show that single-sport youth athletes face significantly higher risks of stress fractures, tendinitis, and other repetitive strain injuries compared to their multi-sport peers. Specializing in a single sport at a young age is associated with substantially higher risks of both acute and chronic injuries, and survey data have shown that adolescent athletes engaging in rigorous, single-sport training frequently exceed safe thresholds. Orthopaedic surgeons are now encountering more youth patients with chronic injury patterns traditionally seen in adults. For many of these young athletes, participation in multiple sports would likely have been preventive, and for most overuse injuries, rest remains the first-line therapy.

However, as orthopaedic surgeons treating young athletes know, obtaining patient and family buy-in for rest can be challenging. For years, pressures and incentives for youth athletes to focus on a single sport have stemmed from the pursuit of highly competitive college scholarships. The NCAA’s recent Name, Image, and Likeness (NIL) policy took effect on July 1, 2021. This policy allows college athletes to monetize their personal brands and has amplified the incentive to specialize for young athletes. Financial compensation in these deals has reportedly been as high as $8 million over 3 years for Tennessee quarterback Nico Iamaleava, with reports of several other seven-figure deals. Now, even before reaching college, young athletes and their families may see single-sport dedication as a pathway to not only scholarships but also potential endorsement opportunities. This increased financial potential has heightened the urgency to reach elite levels, often encouraging year-round specialization.

The recent review published by the AAP investigated the growing issue of overuse injuries, overtraining, and burnout in single-sport youth athletes. In addition to the increase in overuse injuries noted above, the findings underscore the prevalence of burnout. Burnout manifests physically and psychologically, often driven by unbalanced, intense training regimens. It can also lead to emotional exhaustion, reduced performance, and loss of motivation, prompting many young athletes to quit sports altogether. The study shows that burnout is a critical factor in high attrition rates in youth sports, with an estimated 70 percent of athletes withdrawing before high school.

Burnout in youth sports is particularly problematic because it not only impacts immediate well-being but also affects long-term attitudes toward physical activity. High attrition rates in specialized youth sports are especially concerning, as children who withdraw early miss out on physical, social, and psychological benefits. For orthopaedic surgeons, understanding burnout’s role in attrition is crucial, as high dropout rates correlate with increased sedentary behavior and associated health risks. These risks are evident in rising obesity rates: Nearly 20 percent of children and adolescents (ages 2 to 19 years) in the United States meet clinical criteria for obesity, a rate that has more than tripled since the 1970s. Pediatric obesity also increases the likelihood of adult obesity, which is linked to chronic diseases such as diabetes and hypertension. As a result, creating a balanced, supportive training environment is essential to encourage sustained engagement in physical activity and to help mitigate these growing public health concerns.

Orthopaedic surgeons across specialties, including sports medicine, pediatrics, and general orthopaedics, are likely to encounter single-sport youth athletes in their practices. Given the rising prevalence of burnout and overuse injuries, the role of orthopaedic surgeons can extend beyond treatment to include injury prevention and education for families, coaches, and sports organizations. Evidence suggests that identifying burnout symptoms early and encouraging rest or cross-training can reduce injury risk and improve athlete retention. Surgeons working with teams may consider advocating for balanced training schedules, which can help prevent overuse injuries and support long-term athletic engagement.

The increase in single-sport specialization among youth athletes in America, coupled with pressures from college recruitment and new financial incentives, has created a challenging environment. For years, orthopaedic surgeons have recognized the dangers of overuse injuries; however, new evidence suggests additional risks in the form of burnout and sports attrition. With pediatric obesity rising in recent years, early sports attrition has a high potential for lasting societal harm. For orthopaedic surgeons, this shift underscores an opportunity for a proactive, educational approach to patient care that emphasizes prevention, early intervention, and holistic training recommendations. By advocating for safe practices, encouraging multi-sport participation, and supporting balanced training regimens, orthopaedic surgeons can play a crucial role in reducing injury risks and promoting a lifelong commitment to healthy physical activity among young athletes.

Sarah Rogers, MD, MPH, is a fourth-year orthopaedic resident at Oregon Health and Science University. Her orthopaedic interests include upper-extremity topics, health policy, and public health.

Robert M. Orfaly, MD, MBA, FAAOS, is a professor in the Department of Orthopaedics and Rehabilitation at Oregon Health and Science University. He is also the editor-in-chief of AAOS Now and chair of the AAOS Now Editorial Board.

References

1. Jayanthi N, Pinkham C, Dugas L, et al: Sports specialization in young athletes: evidence-based recommendations. Sports Health 2013;5(3):251-7.
2. Jayanthi NA, LaBella CR, Fischer D, et al: Sports-specialized intensive training and the risk of injury in young athletes: a clinical case-control study. Am J Sports Med 2015;43(4):794-801.
3. Brenner JS, Watson A; Council on Sports Medicine and Fitness: Overuse injuries, overtraining, and burnout in young athletes. Pediatrics 2024;153(2):e2023065129.
4. Hosick MB: NCAA adopts policy allowing college athletes to profit from name, image and likeness. Available at: https://www.ncaa.org/news/2021/6/30/ncaa-adopts-interim-name-image-and-likeness-policy. Accessed Dec. 15, 2024.
5. Fryar CD, Carroll MD, Afful J: Prevalence of overweight, obesity, and severe obesity among children and adolescents aged 2–19 years: United States, 1963–1965 through 2017–2018. Available at: https://www.cdc.gov/nchs/data/hestat/obesity-child-17-18/obesity-child.htm. Accessed Dec. 15, 2024.