The association of sport specialization and training volume with injury history in youth athletes.
Post EG, Trigsted SM, Riekena JW, Hetzel S, McGuine TA, Brooks MA.
Bell DR. Am J Sports Med. March 2017; [Epub ahead of print] https://www.ncbi.nlm.nih.gov/pubmed/28288281
Take Home Message: An athlete engaged in highly specialized sport participation was more likely to report an injury within the previous year.
The positive benefits of youth sport participation are well-documented, but an emergence of specialized training among youth athletes has led to volume and frequency recommendations by professional medical organizations. These recommendations were well-intended but generated on limited evidence. The authors aimed to establish a relationship between sport specialization and injury history in youth athletes and identify the association of training volume recommendations and injury history. The investigators recruited 2011 participants from summer athletic tournaments, competitions, and practices. The participants completed a questionnaire that captured demographic information, sport participation, self-reported injury history, and amount of specialization. The authors determined a participant’s level of specialization using a tool that asked 3 questions: (1) if the athlete quit other sports to focus on their main sport, (2) if their primary sport was considered more important than other sports, and (3) if they trained or participated in their primary sport for more than 8 months per year. Each “yes” response was given 1 point and “no” responses 0 points. Participants with scores 0-1 were categorized in the low specialization group, scores of 2 in the moderate group, and scores of 3 in the high specialization group. Participants in the high specialization group reported earlier ages of initial sport participation, including their primary sport, and participated in sport activity more months per year and hours per week. Additionally, a highly-specialized athlete was roughly 59% more likely to report a history of an injury, including overuse and upper extremity injuries. This was true even though the authors accounted for the number of hours per week that an athlete participated in their primary sport. In general, an athlete who exceed published recommendations of organized sport participation was more likely to report history of injury. Sport specialization peaked around 15 years of age among participants. A female athlete was more likely to be highly specialized compared with a male athlete.
The authors recommended that unstructured activity may improve overall performance and minimize risk of injury during adolescence. To apply these findings to other athletes it is important to consider who the authors surveyed. They included athletes participating in summer sport activities. Hence, this population was representative of high school athletes who also participate in non-interscholastic/developmental teams. When stratifying by age, 47% of respondents were classified as highly specialized at age 15. This age represents a critical time for an athlete because varsity-level expectations and training volume likely increase interscholastically. If coaches and athletic trainers recognize overtraining early it could stave off injury. Given a lack of a consistent presence of athletic trainers in our nation’s high schools and recreational teams/leagues, this responsibility falls to the coach. It is important to encourage coaches to be aware of what other competitions their players are participating in. It will be valuable to see future prospective studies could clarify the risk of injury among highly specialized athletes and if specialized athletes are at greater risk during certain periods of an athletic career. Sports medicine clinicians need to recognize when an athlete is in a cycle of specialization and at risk for injury that may impact their long-term health, and consider interventions such as athlete education, coach/parent consultation, and prevention programs.
Questions for Discussion: Does injury data in your setting support the link between youth sport specialization and increased risk for injury? How do you determine that an athlete is highly specialized?
Written By: Laura McDonald
Reviewed by: Jeffrey Driban