Editor’s note: This is the second story in a two-part series on youth sports in America.
SALT LAKE CITY — Kyle Keliipuleole heard a pop.
He was 23 then, back in March 2014. He’d played soccer and baseball as a toddler and continued into childhood — just recreationally, until he turned 11 and decided to ditch rec baseball for competitive club soccer. He embraced a standard workload: two or three practices per week, two games per week, and during the summer, a tournament of up to five games most weekends.
He eventually played for Weber State’s club team. As a sophomore, he tried out for the Real Monarchs — Real Salt Lake’s reserve squad. In the second half of the scrimmage, he challenged someone. The opposing player made a move. Keliipuleole’s cleats chewed into the artificial turf; he tried to follow; most of his body went with him.
His knee did not.
Pop.
“The pain really didn’t start right away,” he said. “I just put my foot down and had no stability.”
He’d torn his ACL. The standard comeback time frame, he was told, was six months. He figured with his work ethic, he could return sooner. Instead, his road to return stretched through three surgeries (his first replacement ligament became septic) and a full calendar year.
During rehab, he spoke with his physical therapists about recovery — and his lack thereof. After years of year-round soccer participation, he had some time — finally — for reflection.
“We talked a lot about those weekend tournaments,” he said. “Your body just does not recover properly with the amount of minutes being put on. That puts a lot of stress on your ligaments.”
It’s possible Keliipuleole’s injury was an accident; torn ACLs happen in sports. But orthopedic surgeons across the country are sounding the alarm about overuse injuries in kids with similar specialization histories.
But the potential consequences of youth sports specialization also aren’t limited to physical injuries. As America’s youth sports programs continue to drift toward specialization and professionalization, the physical injuries seem more pressing — they’re immediately obvious, make sports participation impossible and have been addressed at length. Less discussed are the psychological consequences of the pressures and expectations that accompany early specialization.
Like physical injuries, psychological wounds can accumulate over time and appear later in childhood or into adulthood. But unlike broken bones or torn ligaments, mental ailments can fester undetected, even to the child, said Northwestern University professor of psychiatry and behavioral sciences Jenny Conviser. And there’s no timetable for recovery.
Keliipuleole didn’t face psychological difficulties right away. He admits he was lucky; when he neared 13, a new coach took over his club team and eased back on tournaments and the rigorous practice schedule. This coach made soccer fun. So when Keliipuleole — now 28 and coaching at Wasatch Soccer Club — suffered his injury, rather than worry about his soccer career being over, or an important part of his identity being robbed, he remained excited and enthusiastic.
Many kids aren’t as fortunate.
Knee surgeries for 8-year-olds
Overuse injuries are more common in specialized youth athletes not necessarily because an athlete specialized, but because certain sports stress certain muscles/joints/ligaments. And over an entire childhood of playing nothing but basketball, for example, certain body parts will take much more of a beating than someone who played some basketball, wrestled and golfed.
Dr. Neeru Jayanthi, a researcher at Emory University who studies safety risks among young athletes, published a paper in 2013 that tried to understand the physical consequences of early specialization. He found that some specialization was required for athletes to reach elite status, but concluded that “intense training in a single sport to the exclusion of others should be delayed until late adolescence.”
If not, young athletes are put at greater risk of injury despite “no evidence” that early specialization will lead to top-level performance.
In another study from 2015, Jayanthi and colleagues evaluated over 1,200 athletes ranging from ages 7-18 — the largest study of its kind ever done. “There is an independent risk of injury,” they wrote, “and serious overuse injury in young athletes who specialize in a single sport.”
Early specialization, it turned out, was one of the strongest predictors of overuse injuries. Highly specialized athletes doubled their risk, Jayanthi told the Deseret News. The risk decreases with moderately specialized athletes, but it’s still higher for them than for nonspecializers. He worries about the culture surrounding early specialization and urges parents and kids alike to be careful with the sports they choose. He recommended the Healthy Sport Index as a helpful tool; without careful consideration, it’s easy to fall into an injury-promoting culture.
“It’s a culture that tells kids they don’t have a choice,” he said. “If they want to make the travel team, they need to dedicate themselves now.”
In a paper presented to the American Orthopaedic Society for Sports Medicine earlier this year, Dr. Brian Cash, an orthopaedic surgery resident at UCLA, further strengthened the link between early specialization and overuse injuries. He and his team of researchers showed athletes who specialized in their sport before age 14 were more likely to report a history of injuries, multiple injuries, multiple college injuries, total injuries and total time out for injuries.
“You’re not keeping the rest of your body in shape,” he said, “and you’re not showing the variety that creates well-balanced athletes.”
He also, however, showed that among surveyed athletes at UCLA, those who specialized before age 14 were more likely to earn a college scholarship (82.8%) and be recruited (93.9%) than those who didn’t (83.1% and 67.5%, respectively).
“It’s tough to comment on the significance of that,” he admitted, noting the limited sample size and the need for more research. The early specialization trend, he added, necessitates it. “It’s a different world than it was 20 — even 10 years ago.”
The most common significant overuse injury he sees among young specializers is baseball pitchers requiring reconstructive elbow surgery, or “Tommy John.” They seem to be getting younger and younger, Cash said, and more frequent.
“It happens,” he said, “and it’s something that’s new.”
In Part 1 of his recent two-part series, ESPN’s Baxter Holmes examined the plague of injuries afflicting today’s NBA players. He sifted through evidence from two years of reporting — evidence that leaves little doubt that today’s NBA is suffering more injuries than ever to younger players — and found a “possible answer” that emerged over and over: “Players,” sources told him, “are physically broken down by the time they reach the NBA.”
An NBA general manager called the condition “grave”; NBA Commissioner Adam Silver called it “the highest priority for the league”; an AAU coach called it “an epidemic”; and Jayanthi told Holmes that many talented teens he works with are “broken by the time they get to college.”
In Part 2, Holmes explained how youth basketball culture and the industry surrounding it have made severe injuries common — not just to NBA and college players, but to children. Jayanthi was clear that early specializers can be successful. They can get ahead in certain sports. But those advantages come with maximized risk. Since early specialization is still a relatively new movement, time will reveal whether the future of elite athletics is populated by early specializers, or whether the injuries overcome them.
“It’s kind of a Darwinism type philosophy,” Jayanthi said. “Over the next 10 years, we’ll find out.”
A Rorschach test… on Twitter
The video begins with a father and son walking toward their car under an overcast sky. The boy’s age is unclear, though he’s not old enough to sit in the front seat. He looks to be 7 or 8. Once he’s in the back and his sportcoat-sporting dad is in the driver’s chair, the screen turns black, and a white title appears: “The Ride Home.”
“So. Not your best practice,” the dad says. “Can we agree on that?”
After grinching about how his son would rather play with his friends than practice, the dad suggests he skip his next game if he’s so uninterested in soccer. The child is also selfish, he’s told, for wasting his dad’s and his coach’s time.
“You don’t care about other people,” the dad continues. “You don’t care about hard work. You don’t care about teamwork. That’s why you’re always one the bench every time it matters.”
Words again flash across the screen: “70% of kids quit sports before high school because it isn’t fun anymore.”
The video was shared on Twitter on June 26 by Chicago White Sox hitting analytics instructor Matt Lisle. The video producers — and Lisle — intended it to be a public service announcement to overbearing parents. In a thread, Lisle commented, “as parents...what is the BEST way to create accountability and teach life lessons AND make it a great & fun experience? This isn’t it.”
Many disagreed.
The comments became a de-facto Rorschach test — the psychological evaluation where participants are shown ink blots and asked what they see. In this case, two groups saw two very different things.
Steve Autry, a semi-pro baseball coach, wrote “... The rule was this: when we got back in the vehicle to leave practice or a game…We took our baseball caps off…and he was once again my son…and I was again his father…and the game was behind us. Period. No exceptions.”
It garnered more than 200 likes.
Sam Stratton, an Army-bound lacrosse recruit, had a different take: “If you don’t like being told your not working hard enough, then maybe competitive sports isn’t for you. My dad had these talks with me all the time as a kid and I can’t thank him enough, because it turned me into the athlete and person I am now. This is part of sports!”
It also garnered more than 200 likes.
In addition to the “conversations like this made me the person I am today” sentiment, many lamented how “soft” the country is becoming if this dad’s comments are being labeled inappropriate. But among youth development researchers, the opinion of the video is nearly universal.
University of Utah sports psychology professional Nick Galli, who sometimes observes “the ride home,” said the key is a question: “What does the athlete want it to look like? That’s what matters most.” Presumably, a 7-year-old would not answer, “Getting chewed out by my dad.”
Jean Côté, a preeminent researcher of kids sports performance and participation at the Queen’s University School of Kinesiology and Health Studies in Canada, was more explicit: “There’s absolutely no association with these types of behaviors from adults — from parents or coaches — with success in sport,” he said. “It’s zero. Correlation of zero.”
What about helping develop life skills? Like toughness? Not according to sports psychology professional Nicole Detling. “It doesn’t,” she said. “At all. Sports can help develop toughness, but only if they’re taught mental toughness skills. … A lot of people are just uneducated about youth development.”
Conviser went even further. Not only is the conversation useless for promoting athletic motivation or developing life skills, but dad “has no idea the damage that kind of conversation can have.”
That’s because it can lead to burnout — a condition experts and coaches alike agree is more common than it ought to be. Marco de Ruiter, technical director at Salt Lake City’s Sparta United Soccer Club, said he sees it often. Contributing factors include parents rating their kids’ performances and pushing them to play year-round and coaches telling kids they’ll get cut if they don’t play better or show more dedication.
The signs of burnout, Côté said, are when normally engaged kids lose interest and motivation in their sport. Parents, he added, should always communicate with kids about whether they really still want to participate, and at what level. That isn’t to suggest a kid not wanting to attend a 5 a.m. workout is suffering from burnout. But it does raise questions about how parents can best avoid becoming burdensome.
Ryan Robinson coaches at Wasatch Soccer Club and has teenagers. He believes in kids leading the way, dictating their own participation in sports. But at a recent forum for soccer parents in Davis County, he posed a question: What does he do when his kid assures him he wants to play club soccer, then decides to sleep in?
“They’ve shown interest,” he explained. “They’ve committed to a competitive team.
“Then you wake them up for practice.”
His philosophy is to check in every few months rather than before every practice. If his son commits for a season, he reasons, he will attend practice, whether he wants to sleep in that day or not.
“I think by doing that,” he said, “we’ve been able to keep them on the right path.”
It’s about balance. But when balance is off and kids burn out, they can grow resentful of physical activity of any kind.
“If we’re driving kids into the ground,” Galli said, “and they’re sick of sports by the time they’re 15,” obesity and inactivity as adults are more likely.
Lee Davis, technical directer of Wasatch Soccer Club, has seen a similar scenario to the video play out. He once had a player suffer an injury. The player needed to be carried off the field. The player’s father, meanwhile, yelled at the referees about a free kick.
“This is all they see,” he said of parents. “And before we know it, kids are quitting.”
Depression and deliberate play
Isabella started playing lacrosse in first grade. Her talent was obvious, and she soon abandoned soccer and basketball to focus on the sport where she had the most potential. Not only did it give her the best chance at a potential athletic scholarship, it gave her identity.
“Lacrosse was a way to get attention,” she told Linda Flanagan for a piece in the Atlantic earlier this year. “It filled that need.”
Isabella (her middle name — Flanagan chose not to identify her to protect her privacy) emerged as a star early in high school. She signed autographs in her “lacrosse-obsessed hometown,” Flanagan wrote, and was recruited as a sophomore by elite Division I NCAA lacrosse programs. But in the summer before her junior year, she met the same fate as Keliipuleole; she tore her ACL.
She had to stay away from lacrosse for eight months. She’d spent the majority of her life working hard to get ahead of the competition. Now, she watched her teammates work out and compete in tournaments. She worried about falling behind. After school, she couldn’t hang out with her friends; she was stuck in physical therapy. And without lacrosse, she didn’t know what to do with her free time. She started eating more to fill the void and developed an eating disorder.
“I’d grown up playing lacrosse, and I had no other hobbies,” Isabella told Flanagan. “So when you don’t have it, you’re like, What am I going to do?”
Flanagan’s piece didn’t stop at Isabella. She noted that although youth sports can be good for both physical and mental health, serious high school athletes appear to be at greater risk of developing mental illnesses.
“The professional consensus is that the incidence of anxiety and depression among scholastic athletes has increased over the past 10 to 15 years,” Marshall Mintz, a New Jersey-based sports psychologist, told Flanagan.
A 2015 study by the National Athletic Trainers’ Association reported student athletes experience “higher levels of negative emotional states than non-student-athlete adolescents.” Student-athletes have also shown higher “incidence rates” for sleep disturbances, short tempers, burnout, decreased self confidence and other troubles.
And increasingly, dedicated high school athletes start young, like Isabella. They take a light-at-the-end-of-the-tunnel approach: Sure, it’s hard in high school, but it’s still fun to compete, and it’ll be worth it if they earn a college scholarship. But Côté said early specialization is unlikely to help in this regard, even if it seems counterintuitive.
“Eventually, kids will burn out and drop out.”
“Eventually,” he said, “kids will burn out and drop out. So achieving too much at an early age is not not a good thing psychologically.”
Take Joey Erace, a 10-year-old baseball phenom who was featured on the cover of Time in 2017, for example. He played on travel teams across the country; he had a private hitting instructor and his own backyard batting cage; and according to Sean Gregory, author of the Time piece, he had unusual skills: “Joey has talents that scouts covet,” he wrote, “including lightning quickness with a rare knack for making slight adjustments at the plate–lowering a shoulder angle, turning a hip–to drive the ball.”
Joey could end up playing college or professional baseball. But again, he was 10 at the time; it’s not hard to imagine him going through puberty, realizing he doesn’t like baseball anymore but feeling guilty about giving it up when his parents have invested so much and he’s developed a legion of fans. Or worse — he could go through puberty and his body could betray him. He could stop growing at 5-foot-4 and watch his fans flock to the next big child baseball prodigy.
The latter is the more likely outcome. Early specialization — at least at this point in its evolution — rarely translates to next-level success in team sports. In a study released earlier this year, Columbia University orthopedic researchers surveyed 303 college athletes and found that “early sports specialization is uncommon among NCAA Division I athletes for most team sports,” although it’s more common for players in individual sports. The study also tells pediatricians to prepare to discuss the “misconception” that early specialization leads to lasting success.
Some coaches and athletes have caught on. Urban Meyer and Clemson’s Dabo Swinney told The New York Times they prefer recruiting multisport athletes, though they acknowledged they’re “swimming against a tide of specialization in youth and high school sports.” Drew Brees has also encouraged young athletes to take a multisport approach.
Côté’s research supports them. Rather than promoting “deliberate practice” — the idea that intense, focused, regimented practice from a young age will lead to lasting success — he encourages “deliberate play” — a term he coined to encompass games organized by children with no referees, no observation and no adult-induced pressure. Think street soccer or pond hockey. He said many make the mistake of assuming children should train like Olympians if they want to reach the Olympics, rather than doing what current Olympians did when they were children.
“We did about three or four studies that showed that deliberate play at a very early age was part of the type of activities that kids do that professional athletes did,” Côté said. “And they do a lot of deliberate play from 6, 7 years old to about 14, 15 years old. And then deliberate play is replaced by deliberate practice later on.”
Identity Crisis
When Keliipuleole returned from injury, he earned minor league soccer contracts in Seattle, Reno and Portland over about a year and a half. When Portland cut him, he decided to walk away. He was resentful at first. He judged clubs that didn’t think he was good enough, and for another year and a half, he avoided watching MLS games.
“Just because you get to the point,” he said, “where you feel like, ‘Hey, I was good enough to be there.’”
He also didn’t play pickup soccer with his buddies for several years. He felt like doing so was wasting time. There was no ladder to climb, no new tryout to look forward to, no meaningful game to win. But now, he’s back. And he’s loving it.
“The way most of the guys I play with describe it is, ‘If you’re gonna play for fun like we do now, don’t take it very seriously,’” he said. “If there’s a bad pass, we’re just not even gonna go try and get it. Before, it would always be about trying to win the game.”
Keliipuleole suffered a loss of identity similar to Isabella’s. He was no longer a soccer player — something that defined him for the majority of his life — and coping was difficult. Davis has seen it in kids, too.
“It becomes their identity,” he said. “When that’s taken away from them, they don’t know who they are anymore.”
Detling said this identity crisis has led many athletes she’s worked with to depression, whether via injury, retirement after a successful career or retirement long before a career has begun, such as a kid not making his high school varsity team.
She works with Real Salt Lake and Utah Royals, and one of the first questions she asks players is what they’re going to do after the game is inevitably taken from them. “We’ve gotta find some other activity that gives you that serotonin release,” she tells them, “those endorphins.” And she urges parents to do the same with their kids. If they like soccer, great! Let them play soccer. But make sure they have other hobbies and interests, like music or art or theater. That way, sports don’t comprise their entire identity.
“If the kid self-selects into it, it’s really hard to get them out of it,” she admitted. “But they can do something else.”
Lauren Loberg, who runs Pyramid Performance Consulting in Park City, knows how difficult it can be to have a balanced identity when you’re an athlete. She competed on UCLA’s diving team, and 15 years after her final plunge, she was recognized at a wedding as “the diver.”
“That can be very fulfilling,” she said. “But what happens when it ends?”
“There’s this misinformation about how earlier and more is better. There’s a downside.”
Before starting at Northwestern, Conviser spent seven years coaching Northern Illinois’ gymnastics team. Gymnastics is an interesting sport when it comes to early specialization. Since the peak age is so young, early specialization is viewed as mandatory. So Conviser would know — perhaps better than anyone — about the drawbacks.
If a kid starts too soon, she explained, they don’t get an opportunity to develop an identity outside of sports. It’s not just that their identity is a sport — they didn’t have the agency to choose the sport and make it central. So if they end up disliking gymnastics or soccer or whatever else, and they specialized early, there’s no identity there.
“There’s this misinformation about how earlier and more is better,” Conviser said. “There’s a downside.”