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Overuse injuries and burnout in youth sports: a position statement from the American Medical Society for Sports Medicine
  1. John P DiFiori1,
  2. Holly J Benjamin2,
  3. Joel S Brenner3,
  4. Andrew Gregory4,
  5. Neeru Jayanthi5,
  6. Greg L Landry6,
  7. Anthony Luke7
  1. 1Division of Sports Medicine and Non-Operative Orthopaedics, Departments of Family Medicine and Orthopaedics, University of California, Los Angeles, California, USA
  2. 2Departments of Pediatrics and Orthopaedic Surgery, University of Chicago, Chicago, Illinois, USA
  3. 3Department of Pediatrics, Eastern Virginia School of Medicine, Norfolk, Virginia, USA
  4. 4Departments of Orthopedics and Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
  5. 5Departments of Family Medicine and Orthopaedic Surgery and Rehabilitation, Stritch School of Medicine, Loyola University Chicago, Chicago, Illinois, USA
  6. 6Departments of Pediatrics and Orthopedics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
  7. 7Departments of Orthopaedics and Family Medicine, University of California, San Francisco, California, USA
  1. Correspondence to Dr John P DiFiori, Division of Sports Medicine and Non-operative Orthopaedics, Departments of Family Medicine and Orthopaedics, University of California, 1920 Colorado Ave, Santa Monica, CA 90404, USA; jdifiori{at}

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Youth sport participation offers many benefits including the development of self-esteem, peer socialisation and general fitness. However, an emphasis on competitive success, often driven by goals of elite-level travel team selection, collegiate scholarships, Olympic and National team membership and even professional contracts, has seemingly become widespread. This has resulted in an increased pressure to begin high-intensity training at young ages. Such an excessive focus on early intensive training and competition at young ages rather than skill development can lead to overuse injury and burnout.


To provide a systematic, evidenced-based review that will (1) assist clinicians in recognising young athletes at risk for overuse injuries and burnout; (2)delineate the risk factors and injuries that are unique to the skeletally immature young athlete; (3) describe specific high-risk overuse injuries that present management challenges and/or can lead to long-term health consequences; (4) summarise the risk factors and symptoms associated with burnout in young athletes; (5)provide recommendations on overuse injury prevention.


Medical Subject Headings (MeSHs) and text words were searched on 26 March 2012 from MEDLINE, CINAHL and PsycINFO. The search yielded 953 unique articles. Additional articles were found using cross-referencing. The process was repeated on 10 July 2013 to review any new articles since the original search. Screening by the authors yielded a total of 208 relevant sources that were used for this article. Recommendations were classified using the Strength of Recommendation Taxonomy (SORT) grading system.

Definition of overuse injury

Overuse injuries occur due to repetitive submaximal loading of the musculoskeletal system when rest is not adequate to allow for structural adaptation to take place. Injury can involve the muscle-tendon unit, bone, bursa, neurovascular structures and the physis. Overuse injuries unique to young athletes include apophyseal injuries and physeal stress injuries.


It is estimated that 27 million US youth between 6 and 18 years of age participate in …

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