Preventing and Treating Overuse Injuries, Overtraining, and Burnout in Young Athletes: Evidence-Based Recommendations

By Julia Haimovich, Accredited Practicing Dietitian.

The increasing participation of young athletes in organised sports brings numerous benefits, including physical fitness, social development, and discipline. However, this participation can also lead to overuse injuries, overtraining, and burnout, particularly when proper precautions are not taken. These conditions can have long-term consequences on both physical and mental health, making it essential for clinicians, parents, coaches, and athletes to collaborate in preventing and addressing these issues. This article outlines evidence-based recommendations for preventing and treating overuse injuries, overtraining, and burnout in young athletes.

Recommendations for Prevention and Treatment

1. Conduct Preparticipation Examinations.
Preparticipation examinations (PPEs) can offer a comprehensive approach to young athlete care. These examinations can integrate guidance on preventing overuse injuries, overtraining, and burnout. According to the American Academy of Pediatrics (AAP), PPEs are crucial for identifying risk factors and providing anticipatory guidance on safe sports participation (1).

2. Promote Athletic Autonomy and Intrinsic Motivation.
Encouraging athletic autonomy and intrinsic motivation while measuring success based on participation and effort can help prevent burnout. A study published in the Journal of Sport and Exercise Psychology emphasises that fostering positive experiences with parents, coaches, and peers is critical for sustaining long-term athletic participation without adverse effects (2).

3. Focus on Skill Development and Balance in Physical Activities.
Skill development and engaging in various physical activities are key to avoiding overtraining and overscheduling. Early specialisation in a single sport increases the risk of overuse injuries and burnout. Diverse physical activity can reduce these risks by promoting overall physical and psychological well-being (3).

4. Modify Causative Factors and Involve Mental Health Professionals.
Identifying and modifying the factors contributing to overuse injuries or burnout is crucial. Involving mental health professionals when necessary can provide additional support. Early intervention with mental health professionals can help address the psychological aspects of burnout and overtraining (4).

5. Encourage the Use of Mindfulness Tools.
Mindfulness tools are effective in reducing stress and improving focus in athletes. Integrating mindfulness into sports training programmes helps athletes manage stress and enhance recovery (5).

6. Keep Workouts Fun and Age-Appropriate.
Maintaining interest through age-appropriate games and training is essential for keeping practice enjoyable. Research indicates that positive and enjoyable training experiences are crucial for long-term athletic engagement and preventing burnout (6).

7. Ensure Adequate Time Off from Structured Sports.
Regular time off from organised sports is essential for physical and psychological recovery. Young athletes who take at least one day off per week and several months off yearly have lower rates of overuse injuries (7).

8. Promote Wellness and Body Awareness.
It is vital to teach athletes to listen to their bodies and prioritise wellness over performance. Encouraging self-awareness can help prevent overtraining and promote long-term health (8).

9. Support Further Research on Social Determinants of Health.
Understanding how social determinants of health, such as access to healthcare and diverse sports experiences, influence the risk of overuse injuries, overtraining, and burnout is crucial. Further research can inform more targeted interventions to protect young athletes (9).

Guidance for Clinicians

1. Integrate Overuse and Burnout Information into PPEs.
Clinicians should include information about overuse injuries, overtraining, and burnout risks in PPEs and well-child visits. Counselling on these topics should also be provided to young athletes presenting with related symptoms or concerns (10).

2. Recommend Regular Rest from Sports.
Athletes should have at least one to two days off per week from competition and sport-specific training. This rest is critical for recovery and reducing the risk of overtraining and burnout (1).

3. Advocate for Seasonal Breaks from Specific Sports.
Encourage athletes to participate in only one team per season and take two to three months off from any sport annually. This break should involve engaging in other activities or unstructured play, which promotes recovery and prevents burnout (11).

4. Emphasise Fun, Skill Acquisition, and Sportsmanship.
Clinicians should remind athletes, parents, and coaches that the focus of sports participation should be on having fun, acquiring skills, ensuring safety, and practising good sportsmanship (12).

5. Monitor for Signs of Burnout and Overtraining.
Be vigilant for symptoms of burnout, such as nonspecific muscle or joint pain, fatigue, mood changes, or poor academic performance. Asking about the athlete’s motivation for sports can provide insight into potential burnout (13).

6. Balance Stress and Recovery.
Clinicians should emphasise the importance of balancing stress and recovery to prevent overtraining. Proper nutrition, sleep, and stress management strategies are essential for optimal recovery and long-term athlete health (14).

7. Gradually Increase Training Intensity.
Training intensity, including weekly time, repetitions, and total distance, should be increased gradually to avoid overtraining and reduce the risk of injury (7).

8. Support Medical Advisory Boards for Athletic Tournaments.
Medical advisory boards for athletic tournaments can provide education on safe sports practices and the risks of overtraining. Clinicians should advocate for the establishment of these boards (15).

9. Develop educational opportunities for sports safety.
Educating athletes, parents, and coaches about appropriate nutrition, hydration, supplement use, and the importance of avoiding overtraining is crucial. These educational opportunities can promote optimal performance and long-term health (16).

10. Warn Against Over-Scheduling in Young Athletes.
Parents of younger athletes participating in multi-game tournaments should be advised with special caution (17). Clinicians should advise on the risks of overscheduling and the importance of adequate rest.

Preventing overuse injuries, overtraining, and burnout in young athletes requires a collaborative approach involving clinicians, parents, coaches, and athletes. By promoting wellness, encouraging diversity in physical activities, and ensuring proper recovery, we can safeguard young athletes’ physical and mental health while supporting their long-term engagement in sports.

References

Brenner JS. Overuse injuries, overtraining, and burnout in child and adolescent athletes. Pediatrics. 2007;119(6):1242-5.
Fraser-Thomas JL, Côté J, Deakin J. Understanding dropout and prolonged engagement in adolescent competitive sport. Psychol Sport Exerc. 2008;9(5):645-62.
Jayanthi N, LaBella C, Fischer D, Pasulka J, Dugas L. 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.
Rice SM, Purcell R, De Silva S, Mawren D, McGorry PD, Parker AG. The Mental Health of Elite Athletes: A Narrative Systematic Review. Sports Med. 2016;46(9):1333-1353. doi:10.1007/s40279-016-0492-2
Noetel M, Ciarrochi J, Van Zanden B, Lonsdale C. Mindfulness and acceptance approaches to sporting performance enhancement: A systematic review. Int Rev Sport Exerc Psychol. 2019;12(1):139-75.
Renaghan E, Wishon MJ, Wittels HL, et al. The effects of relaxation techniques following acute, high intensity football training on parasympathetic reactivation. Front Sports Act Living. 2023;5:1267631. Published 2023 Nov 28. doi:10.3389/fspor.2023.1267631
Myer GD, Jayanthi N, Difiori JP, Faigenbaum AD, Kiefer AW, Logerstedt D, et al. Sports specialization, part II: Alternative solutions to early sport specialization in youth athletes. Sports Health. 2016;8(1):65-73.
Robinson K, Harris AL. Racial and Social Class Differences in How Parents Respond to Inadequate Achievement: Consequences for Children’s Future Achievement. Soc Sci Q. 2013;94(5):1346-1371. doi:10.1111/ssqu.12007
Taber DR, Stevens J, Evenson KR, Ward DS, Poole C, Maciejewski ML. State policies targeting junk food in schools: Racial/ethnic differences in the effect of policy change on soda consumption. Am J Public Health. 2011;101(9):1769-75.
DiFiori JP, Benjamin HJ, Brenner JS, Gregory A, Jayanthi N, Landry GL, et al. Overuse injuries and burnout in youth sports: A position statement from the American Medical Society for Sports Medicine. Br J Sports Med. 2014;48(4):287-8.
Brenner JS. Sports specialization and intensive training in young athletes. Pediatrics. 2016;138(3).
LaPrade RF, Agel J, Baker J, Brenner JS, Cordasco FA, Côté J, et al. AOSSM Early Sport Specialization Consensus Statement. Orthop J Sports Med. 2016;4(4):2325967116644241.
Mountjoy M, Armstrong N, Bizzini L, Blimkie C