PsychEd4Peds: child mental health podcast for pediatric clinicians

34. Preventing #Burnout in Youth Sports with Dr. Joel Brenner

• Elise Fallucco, Joel Brenner • Season 2 • Episode 34

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Did you know almost 70% of kids drop out of sports by age 13?  We talk with Dr. Joel Brenner,  pediatric sports medicine physician and national expert in youth sports, about how to keep kids involved in sports.  Dr. Brenner is the co-author of the  American Academy of Pediatrics' recent Clinical Report on on overuse injuries over-training and burnout in young athletes. He shares practical strategies to  reduce burnout and over use injuries in our young athletes. Most importantly, we're going to find out how early is too early for kids to specialize in one sport. 

Our Guest:  Dr. Brenner is a pediatric sports medicine physician and Director of the Sports medicine, Sports concussion, and Dance medicine programs at Children's Hospital of the King's daughters in Norfolk, Virginia. 

Check out our website PsychEd4Peds.com for more resources.
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Dr. Elise Fallucco:

Welcome back to PsychEd4Peds, the child mental health podcast for pediatric clinicians and for all of you who take care of kids. We're helping you help kids. Today we're very excited to have Dr. Joel Brenner on the pod. He is a national expert in youth sports. Dr. Brenner is a pediatric sports medicine physician and Director of the sports medicine, sports concussion, and dance medicine programs at children's hospital of the King's daughters in Norfolk, Virginia. Dr. Joel Brenner is the co-author of the recent report released by the American academy of paeds on overuse injuries over-training and burnout in young athletes. Today, we're going to talk to Dr. Brenner about how to help keep kids in sports. And how we can reduce burnout and over use injuries in our young athletes. Most importantly, we're going to find out how early is too early for kids to specialize in one sport. So please join me in giving a warm welcome to Dr. Joel Brenner.

Dr. Joel Brenner:

Thanks for having

Dr. Elise Fallucco:

me, Elise. So excited to have you here. So as a pediatric sports medicine doctor, what would you say are the major benefits that you see in participating in youth

Dr. Joel Brenner:

sports? I think there's three different components. There's a physical component, a mental and a social component. Youth sports is one way for kids to meet the physical activity guidelines that have been set out. It also can help them socially just to acquire a peer group and learn how to manage interactions and sometimes Conflict. and then just mentally with physical activity- it can help with mood that help with stress reduction. So just a variety of benefits.

Dr. Elise Fallucco:

Yeah. And speaking from the mental health benefit, I'm a huge fan of sports and youth sports in general, but we have really great studies that have shown that people who participate in movement and sports activities, they are actually experience a benefit in terms of mild depression and anxiety. So it's can be very helpful for your mood and for anxiety. In addition for your physical health and all the social components. So the sad news that I was really shocked to hear from the clinical report is that 70 percent of youth athletes drop out of organized sports by age 13. Wow. What do you think are some of the main causes or reasons for this high dropout rate?

Dr. Joel Brenner:

So we highlighted that burnout and injury are some of the causes, but actually most of the attrition is not from burnout. It's really from kids no longer having fun, not having time to do other activities outside of sports like, theater, like art, like just going outside and having fun with their friends, with their family. Also just lack of skill development. And just no longer enjoying it. And those are really the major reasons. And so those are some of the things that we need to change.

Dr. Elise Fallucco:

I love this idea that it's so important to make sure that kids are having fun and that they're enjoying what they're doing and that we don't start, pushing them or that it doesn't become too serious too early because then you lose the potential benefit of participation in sports with these kids. Your clinical report, as you mentioned, focused on the role of injury and burnout and how that affects participation in youth sports. And I'm thinking about, when I hear about injury and overuse injuries, I think about things like little league shoulder or in my sport of choice, which is swimming. I think about swimmer's shoulder. Are there any things that pediatric clinicians can do to counsel parents and families to try to prevent or reduce the risk of overuse injuries in sports?

Dr. Joel Brenner:

Yes, I think there's a a variety of factors that we can counsel on, and that's also one of the reasons why we recommend that sports physicals or the PPE be done in the medical homes so that we can be counseling both the athlete and the family. about preventing overuse injuries, about preventing burnout. so when we're talking about overuse injuries, it's all about balancing volume and versus rest and recovery. And we want to make sure there's enough rest and recovery. So we want to look at how much somebody is doing and how fast they're doing it. So making sure that if they're just starting out doing an activity such as running, Maybe only increasing the volume by 10 to 20 percent per week, but also looking at their weekly volumes. So making sure they're having at least one to two days off per week from their particular sport and two to three months off throughout the year from their particular sport. And a lot of people don't understand how they can do that, but. The key is that two to three months off, it can be broken up a month here, a month there. And during that time, we're not telling kids to be a couch potato. We still want them to be physical, physically active, whether it's doing another sport, cross training, just getting outside, having fun. So we can look at the volume there. We also want to look at their technique to so especially, with swimming with baseball with dance I take care of a lot of dancers. So if their technique is off, that's going to put them at risk for overuse injuries. Also, if they have a history of a prior injury, we want to really look at what caused that injury. And if we don't really take care of the underlying, problem, the causative factor, then they're going to be at risk for getting injured. Another injury. Lastly, and just as importantly, two other things to always be counseling on and to be recommending is sleep and nutrition. We know that kids and most adults don't get enough sleep and sleeps so important. As it's so important for the brain to clear out all the debris that we've acquired through today. But by getting proper sleep, it actually helps us perform better and it can help us decrease injuries to you.

Dr. Elise Fallucco:

The recommendations make a lot of sense, obviously sleep and nutrition and gradually increasing your training loads by less than 10 to 20 percent per week. I imagine that potentially a big sticking point would be the issue of time off. And I'm thinking there's such a push in youth sports now to be playing year round sports and to be traveling every weekend. And so I think this clinical report comes at a good time because it's really emphasizing, we need to think about the balance between how much stress we're putting on our body and how much time we're giving our bodies to recover and rest and repair. I liked your practical tip about taking time off that this idea of taking two to three months off per year from sports doesn't have to be in one big block and doesn't have to be mean taking time off from all physical movement and activity. It sounds like what you guys are suggesting is more, participating in an organized sports league where there's multiple practices per week or, regular weekend tournaments is something that should not be year round, but ideally, you should have a one month break a couple of times of year from that. Is that right?

Dr. Joel Brenner:

Yeah. Whether it's a one month or even up to two months depends. The other thing is that parents really want this information because it's not just the kids who are getting stressed out and burned out. The parents are too, because they're trying to juggle, the whole family. If they have multiple kids, they're driving in different places. They also have to juggle their own career and everything else that goes along with being a parent. So the biggest problem and that what we've been trying to do for 20 years is change youth sports culture. So working with national governing bodies, the NCA, because all this stuff trickles down. If we can change culture where kids do not have to specialize at nine years of age, kids do not have to play year round that they can be multi sport athletes. I think that can help a lot, but it's in since our first edition back in 2007, we've made a little progress, not as much as we'd like. So hopefully, we'll continue to push the envelope and continue to educate and hopefully we'll make some more improvements.

Dr. Elise Fallucco:

Yeah, and jumping off what you just said about the potential risks of early specialization. One of the things that I found really interested, interesting that I don't think most parents know is that early specialization is not necessarily helping these kids to be better athletes longterm, that in fact, playing multiple sports throughout the year creates better athletes overall.

Dr. Joel Brenner:

Yeah, I think that's really key. If we look at the statistics and in our AP paper on sports specialization, we have a one page infographic that I give out to all my patients and it's freely downloadable and pediatricians can give it out. But if we look at statistics, only up to 10 percent of high school athletes will play in college. Only 1 percent of high school athletes will get any college scholarship. That's not a full ride that could just be 1,000 dollars. But less than 1 percent of high school athletes will actually play professionally. We don't want to squash dreams, but we want to be realistic and we want to look at ways to promote lifelong physical activities at the same time.

Dr. Elise Fallucco:

I can think of some of my own peers and some, people in my friend group who have kids even nine year olds and 10 year olds who are being told Potentially by their own coaches, like your daughter has a lot of talent or your son is really great. And so we really just need to get in there and invest in them and help them to be the best that they can be. as a pediatrician, if you had a parent in your office, who's saying, my child has talent and I want them to become the next Michael Phelps or Olympic gymnast, what would you say to keep them balanced?

Dr. Joel Brenner:

Yeah, I would say the most important things are what we know from the current research is that multi sport athletes are more successful for a variety of reasons. They're learning skills in different sports that transfer over. They're also mentally going to be fresher by the time they get to college. And it's actually come up more college coaches are speaking out that, by the time they're getting their athletes in college, most of them are not hungry anymore. They're burned out. They've been injured. There's one college basketball team this year who had a lot of injuries and the coach said, by the time they're getting to him, they've already had catastrophic injuries like ACL tears. If you're you believe that your child is special then promoting multi sports, but also always communicating with your child and seeing what their goals are. So it should be the intrinsic motivation. It's not the motivation of the parent or of the coach because, this child might be good at baseball. But might have really no desire to play this in college or even in high school, might want to do something else, might want to be a dancer or anything. So I think the more you can expose a kid when they're younger the better off they're going to be, not just in college, but

Dr. Elise Fallucco:

beyond. Yes, and exposing them to multiple different disciplines and having the long view of. If let's say the child's goal is to keep playing this sport for as long as they possibly can. And the parent's goal is to help them excel. Then really the recipe isn't the traditional, let's practice four hours a day of this sport, six to seven days a week, starting at age seven, but rather let's try to keep, stay involved in this sport and other sports. And then, when you talk about specialization, I like that you guys gave a little bit of an. Age cutoff saying, there's a certain age at which it doesn't make sense to just play one sport. When does that change? Like, when do you think it benefits the athletes to switch over and just focus on one sport?

Dr. Joel Brenner:

So that is a key question that even within the sports medicine world, we have not been able to come to a complete agreement with because of the research is lacking there. When we came up, I worked with the NBA on some NBA guidelines for youth basketball and worked with American Medical Society of Sports Medicine, the AP. So what we've said just in generalities is, mid to late adolescence. But again, You don't have to specialize, that might be an okay time if you really want to, there's no other sports you want to do. But, if you look at so many of the NFL athletes, most of them played Multiple sports into college to there's some sports where there's more pressure and sometimes you need to specialize earlier, such as gymnastics, especially in female gymnast, because once you develop physically, then it's less optimal but for the majority of sports we would say at least wait till mid to late

Dr. Elise Fallucco:

adolescence. You should not specialize before mid to late adolescence, unless you're one of those, exclusions like female gymnasts Going back to what you talked about with burnout. I've seen this in my friends that these incredible athletes have been driving themselves or have been externally motivated by parents, coaches, et cetera. And then they get to the point where they're tired of it and they know they're not interested in seeing a swimming pool or going out on the field anymore. And it's interesting because a lot of the symptoms of burnout in sports seem to overlap with those for depression. And I'm thinking about fatigue, irritability, losing interest in something that you formerly loved, maybe sleep problems maybe anxiety, and decreased performance. I imagine you potentially see a fair amount of burnout in your clinics. What advice would you give pediatric clinicians to help them distinguish between burnout and depression in an athlete?

Dr. Joel Brenner:

Well, I would say it is not clear cut and, speaking with the experts on depression, anxiety it's first and foremost, we need to keep it on our radar we talk about, physicians getting burned out, but if you're not thinking about it, you're not going to see it. You're not going to diagnose it. And it's important to remember that you could be depressed but still not burned out because your depression is related to other factors and your sport might be the one thing that's really keeping you going too. So I think we need to keep it on the radar. We want to rule out any organic causes such as thyroid problems, anemia a variety of other things. And then just really comes down to just having a conversation with the child every child adolescent comes in, I always ask them, are they still enjoying their sport? And what is their goals? And I think those are two important questions. And I asked that right in front of the parent. And if they tell me they're not enjoying it but they're still playing, I ask them why. And sometimes they're then looking over at the parent there and saying, that's why. And so then we'll have a discussion with the family, myself and mom, dad and an athlete and talk about what the goals are and how we can, help from either prevent more burnout or to just change the trajectory with it, but it's not always clear cut, but I think we just need to think about it and have a conversation.

Dr. Elise Fallucco:

Yeah I love these questions and I want to, I think these are great clinical pearls for our listeners. So I'm going to highlight them again. But the two big questions to ask your athletes in the office are one, are you still enjoying the sport? And then the second question, what are your goals in the sport? And then a followup for, are you still enjoying the sport? If the answer is no. In front of the parents or, the caregivers asking why, what is it about it that makes you not enjoy it? Is this something as simple as, I'm practicing six days a week. And so I can't spend time with my friends and I'd like to cut back to five days a week or four days a week, or is it just, I'm done. I've had my own child tell me, I understand that you think that I'm good at this sport and I don't like it. I just don't want to play it. And. It's funny because we push our kids in other directions. Mainly academically, I'm thinking Even if they don't feel like doing their math homework, they have to do their math homework. But it's a different world when it comes to the world of sports and that child preference really matters. We want them to find something that they love, some form of movement, some form of exercise, some activity so that they can stick with it and continue to get the mental and physical health benefits from exercise in the longterm. And I love this idea of just trying to align your child's interests and passions in a direction that, that's going to stick.

Dr. Joel Brenner:

And I think just to go off of what you said too, and we've said it a couple of times, is movement and physical activity is so important, and it's not just Organize sports because in my field in sports medicine, we treat everyone as an athlete. Some people think you have to play a sport to be an athlete. But in my mind, everyone's an athlete. We want everyone to be physically active. So I think movement is really the key and getting it. In some way that the child enjoys. So I don't want to prescribe, okay, you've got to do it this way. I want them to come up with a way they're going to do it so they can continue to do it.

Dr. Elise Fallucco:

Do you have any special tricks? Cause I've had some of these conversations when we're trying to motivate, to get outside, to exercise, to do something. And sometimes I'll run into a brick wall and they're like, I don't want to take a walk. Do any programs or activities that you think are sort of outside of the box that sometimes kids respond to?

Dr. Joel Brenner:

I think one is finding an exercise buddy. So maybe their parent or their sibling and getting out, I always ask, is it safe where they are so that they can get out or, the recreational centers around here are fairly inexpensive too. I think an exercise buddy is good for everybody because it keeps us accountable. And it helps get us out there. And then I think just starting with small quantities, even getting out for 10 minutes that's better than zero minutes. So I think starting small and then working

Dr. Elise Fallucco:

from there. That reminds me of, I don't know if you've read Atomic Habits by James Clear, but he talks about trying to create a culture of change and motivate somebody into movement and exercise. And that the first step is a small step, like you said, and it's just going to the gym, being there for one minute, and you can go home and that's it. But the goal is just creating a new habit and a pattern. And part of that also, is facilitated when you have a buddy, when you have some sort of friend or family member who will motivate you on the days when you're not feeling like it. Exactly. I also like rewards, And just this idea of, okay, we went outside and we did our movement for the day. And, give even a reward as simple as I'm so proud of you. I'm like just the verbal praise of that was excellent and this is part of your goal and I'm a big fan of sticker charts. Everyone makes fun of me and this does not work for most people, but sometimes a little sticker can go a long way.

Dr. Joel Brenner:

Yeah. So the other thing is, if we go new age instead of stickers, we can just be using technology. Like the different, the fitness app on iPhones where you can see how many days a week you've exercised and how many miles or how many steps. So just seeing that visual recognition for some people is really exciting. And then you can almost set up a, in-house competition. Or maybe not a competition, but just goals as a family of, okay, we're gonna do this. Five days a week, who's going to get the most steps, a friendly competition. Yes.

Dr. Elise Fallucco:

I love that. Yeah. Just like a family challenge. We all have our goals for the week and we're going to keep track. And I love the idea of just using technology to provide feedback. And that, that helps motivate behavior change. So our goal ultimately is to try to help these kids stay in sports without injuries, without pain or with minimal pain and without burning out. And so keeping that in mind, what take home messages would you like to share with our pediatric clinicians to help them promote healthy involvement in youth sports?

Dr. Joel Brenner:

So I think there's a few take home messages here, and I'll try to keep it short, but first and foremost, the goals of sports should be having fun and learning lifelong physical activity skills. So we need to promote that. Remembering that. If they're a football player, there's not many football players at the age of 50 or 60. But there's plenty of ex football players who are running, who are playing tennis, who are doing other things. Also, just making sure we're always asking what is the intrinsic motivation. What does the child and adolescent want to do? Make sure we're not measuring success by wins, but more by effort and participation. And then also trying to promote more free play, just getting out just being active going hiking, getting out with nature, which can help so much from a physical and mental standpoint, also As I said before trying to promote getting the PPE or sports physical in the medical home, where we can be asking these questions and we can be counseling. And then lastly, we didn't talk about it as much, but just another avenue that can be helpful from a stress standpoint is mindfulness. There's a variety of apps out there. Some of the apps that I like, there's the 10 percent happier app and there's the balance app.

Dr. Elise Fallucco:

The balance app and 10 percent happier app, we'll go ahead and put those on our website. And we're also going to put a link to the one page info Graphic that you mentioned earlier that just helps people understand realistic goals for youth athletes. Thank you so much, Dr Brenner for taking your time and sharing your expertise and for all the work that you're doing to try to help support young athletes and more importantly, to support continued involvement in movement and exercise and fitness to promote physical and mental health.

Dr. Joel Brenner:

Thanks for having me, Elise. Hopefully we can make a difference together.

Dr. Elise Fallucco:

Sounds good. All right.

And as a brief recap of our conversation, we talked about different ways to promote healthy involvement in youth sports, by keeping things fun. By balancing the volume of training with time for rest and recovery, and specifically taking one to two days off per week and two to three months off per year of organized sports to allow the body to recover. Of course, we talked about the importance of sleep and nutrition. And of making sure that the PPE or the sports physical takes place in the medical home so that we have the opportunity to talk to athletes and families about this. We reviewed the importance of intrinsic motivation in sports. And Dr. Brenner gave us two really helpful questions to ask kids one being, do you still enjoy playing this sport? And two, what are your goals in this sport? And finally Dr. Brenner and the American academy of paeds advocated that we delay sports specialization until at least mid to late adolescents. So, if you want copies of the one-page handout or information about other resources, check out our websites, psyched the number four paeds.com. Please go ahead and share this podcast with anyone you think might be interested. And please click follow or subscribe in your podcast player app, so that you'll make sure to get ongoing content relevant to child mental health. Thanks again for listening. See you next time.