James Andrews on ParentingAces

Summary

Dr. James Andrews, one of the most prominent orthopedic sports medicine surgeons in the United States, joins Lisa Stone to discuss his book “Any Given Monday: Sports Injuries and How to Prevent Them.” Dr. Andrews documents a tenfold increase in overuse injuries in youth sports since 2000, which he attributes primarily to early specialization and year-round participation in a single sport. He outlines a framework for parents and coaches to distinguish serious injury signals from normal soreness, emphasizes that fatigue is the single biggest injury risk factor, and describes the Stop Sports Injuries program he helped launch. The episode closes with a frank discussion of burnout — which Andrews ties to overtraining and coach pressure — and the 70% dropout rate in youth sports by age 13.

Guest Background

Dr. James Andrews is a board-certified orthopedic surgeon at the American Sports Medicine Institute in Birmingham, Alabama. He is one of the most decorated sports surgeons in the United States, having treated thousands of professional and youth athletes. He served as president of the American Orthopedic Society of Sports Medicine, through which he launched the Stop Sports Injuries (stopsportsinjuries.org) national education program. His father’s parallel training to Lisa Stone’s own father — both at Tulane and LSU Medical School — became a personal connection that Lisa highlighted in her opening remarks.

Key Findings

1. Tenfold Increase in Youth Overuse Injuries Since 2000

Andrews’s institute began tracking youth sports injuries in 2000. Since then, they have documented a tenfold increase — 1,000% — in overuse injuries across youth sports. This is not a marginal trend. It tracks directly to the rise of single-sport specialization and the professionalization of youth training. Tennis is explicitly named alongside baseball, the sport where Andrews’s original research was concentrated.

2. Pain in Young Athletes Should Always Be Taken Seriously

Andrews draws a clear line: pre-pubescent athletes “should not participate when they have any significant pain at all.” Unlike adults, who can sometimes play through minor soreness, young athletes whose growth plates are still open face compounding risk. He specifically warns against the “no pain, no gain” coaching culture: “The younger they are, the more vigilant you should be.” His practical recommendation — when in doubt, sit them down, use RICE, and see a sports medicine professional — is a low-threshold standard most junior tennis families do not apply.

3. 62% of Sports Injuries Happen in Practice, Not Competition

A counterintuitive statistic: most youth injuries occur at practice, not in matches. Andrews attributes this to the sheer ratio of practice minutes to competition minutes, and more importantly to practice-induced fatigue. Fatigued athletes have drastically higher injury rates — in baseball, throwing with any form of fatigue (event fatigue, seasonal fatigue, or year-round fatigue) creates a 3,600% increase in injury risk to the throwing shoulder and elbow. The tennis application is direct: hitting with fatigued arms, shoulders, and legs is where overuse injuries compound.

4. Fatigue Is the Central Risk Variable — and It Has Three Forms

Andrews defines fatigue in three dimensions: event fatigue (too many reps in a single session), seasonal fatigue (too many matches or training blocks in a season), and year-round fatigue (no off-season). He argues that year-round single-sport participation — standard practice in high-level junior tennis — is a structural injury risk that the sport has normalized. The absence of genuine off-seasons for competitive junior players is the single most addressable cause of the overuse injury epidemic.

5. Emergency Action Plans Are a Parental Responsibility

Andrews describes the Stop program (Sports Trauma and Overuse Prevention) and its practical tool: the emergency action plan. He argues that parents and booster clubs — not just athletic trainers — must take ownership of written, posted emergency protocols covering concussions, cardiac events, and catastrophic injuries. Practical failures he cites: AED batteries running out because no one was assigned monthly checks, and no clear chain of command for calling EMTs when a child collapses at a club practice.

6. Burnout Is Primarily Caused by Overtraining and Coach Pressure — Not Lack of Talent

Andrews attributes the 70% dropout rate in youth sports by age 13 to two causes: overtraining, which he links directly to specialization, and coach pressure, which is especially damaging to late bloomers. Late-maturing athletes at 12–13 who cannot yet keep pace with early developers are the most likely to be pushed out by coaches who interpret developmental lag as lack of potential. Andrews argues these are often the athletes who become the best players by 19 — and the system loses them by 13.

7. Grandparents Are an Untapped Safety Resource

Andrews makes an unusual observation: grandparents often pay closer attention to youth athletes than parents do, because they have “been around the horn a little bit more.” He wrote parts of his book specifically for grandparents, arguing they can serve as a moderating influence on both over-training parents and aggressive coaches. This is a cultural insight about who has standing to intervene when a junior athlete is being pushed past safe limits.

Actionable Advice for Families

• Any pain complaint from a pre-pubescent athlete should be treated as significant — err toward rest and a sports medicine professional visit, not toward “push through it”
• Tennis families should build genuine off-seasons into their calendar — year-round play without recovery cycles is a structural risk, not a devotion to the sport
• Every tennis club and tournament program should have a written emergency action plan, posted and updated, with assigned owners for each component (AED battery checks, concussion protocol, emergency contacts)
• Parents should actively track their child’s cumulative fatigue load across practices, tournaments, and travel — not just monitor individual workouts
• Late bloomers in the 12–14 age range should not be written off — their developmental timeline may simply differ, and removing them from competitive exposure at that age can permanently end their athletic career

INTENNSE Relevance

• Player welfare as league infrastructure: INTENNSE’s unlimited subs format and mic’d coaches create an environment where player fatigue signals can be acted upon in real time — the league architecture should include explicit athlete health monitoring protocols, not just competitive ones
• Overuse injury prevention as a player development differentiator: A professional league that builds genuine recovery cycles and load management into its player contracts and training agreements would be meaningfully differentiated from a system that has produced the overuse epidemic Andrews documents
• Coaching culture and coach education: Andrews’s critique of “no pain, no gain” coaching and coaches who push late bloomers out of the sport is a direct brief for INTENNSE’s investment in coach education — coaches at the INTENNSE level set the culture that trickles down through the pathway
• Community tennis access and safety: INTENNSE’s community engagement work — particularly any programming for youth players — should include emergency action plan frameworks as a baseline standard, not an afterthought
• Late bloomer identification: The 70% dropout rate among 12–13-year-olds, often driven by late-maturation misread as lack of talent, means the player development pipeline INTENNSE draws from is systematically losing potential elite athletes. A pathway model that identifies and retains late developers would access talent the current system discards

Notable Quotes

“The younger they are, the more vigilant you should be, and the more conservative you should be — none of that ‘suck it up, no pain no gain’ type attitude.”

“Since year 2000 we’ve noted in some of the individual youth sports a tenfold increase — tenfold — in these mostly overuse injuries.”

“The major reason for dropout is overtraining — which can be related to specialization. Parents that think they can take their kid and over-train them as if they were professionals at a young age will either have an overuse injury and drop out because of that, or they’ll burn them out.”

“Late bloomers by the way may wind up being your best athletes — and you hate to see them drop out because they’re physiologically younger than everybody else they’re competing against.”