Sports Medicine Research: In the Lab & In the Field: More (Sport) is NOT Better (Sports Med Res)
Wednesday, August 30, 2017

More (Sport) is NOT Better

A Prospective Study on the Effect of Sport Specialization on Lower Extremity Injury Rates in High School Athletes

McGuine TA, Post EG, Hetzel SJ, Brooks MA, Trigsted S, & Bell DR. Am J Sport Med. 2017; Online Ahead of Print July 23, 2017.  DOI: 10.1177/0363546517710213

Take Home Message: An athlete who specializes in sport is more likely to have a lower extremity injury than an athlete with a low level of sport specialization. 

Young athletes are beginning to play one sport year round to focus on sport-specific skills and become a better athlete within that one sport.  Prior investigators have found that sport specialization may be related to a young athlete’s landing mechanics, movement patterns, and history of injury.  However, without following athletes over time it is hard to offer evidence that an athlete who specializes in a sport is more likely to get injured.  Therefore, the authors of this study prospectively investigated lower extremity injuries over the course of a year among 1544 athletes in 29 Wisconsin high schools with various sport specialization categories.  The authors categorized athletes based on a 3-point scale that accounted for quitting another sport to focus on a primary sport, considering the primary sport more important than their other sports, and training more than 8 months per year in their primary sport.  They found that 60% of the athletes were low specialized (0 or 1 of the prior criteria), 27% were moderately specialized (2 of the prior criteria), and 13% were highly specialized (all 3 criteria).  High school athletic trainers recorded the number of coach-directed sessions (conditioning, practices, and competitions) as well as any lower extremity injury (acute-, gradual-, or recurrent) that occurred in an interscholastic-sport activity and required medical attention. Soccer was reported to have more highly specialized athletes than other sports.  Over the course of 1 academic year, 235 athletes suffered 276 lower extremity injuries.  Sport specialization was found to be a risk factor for lower extremity injury.  Athletes who were highly specialized had an 85% higher incidence of lower extremity injury than those who were categorized as low specialization. Athletes who were moderately specialized had a 50% higher incidence than those who were low specialization.  Based on injury classification (acute or chronic), the authors revealed that chronic lower extremity injuries were higher based on level of sport specialization.

These authors confirmed prior retrospective studies (see below) that linked sport specialization to injury risk.  They found that as sport specialization increased, so did the rate of injury.  Interestingly, as the authors teased out acute versus chronic lower extremity injuries the largest difference seemed to be with chronic lower extremity injuries.  So the question becomes, whether sport specialization increases the risk of injury because of a lack of recovery/rest time instead of poor neuromuscular control?  Among highly specialized athletes, the same muscles/joints get used in the same way for prolonged periods, which may prevent those anatomical structures from having time to appropriately recover.  The method for sport specialization classification seems appropriate as it is self-reported, and the authors also reported on training volume based on the number of competitions over the interscholastic year.  There are so many highly specialized athletes that participate in non-school related sports teams or leagues, such as AAU or Little League.  Unfortunately, most of these teams lack an athletic trainer so there may be a significant number of injuries or exposures that are not being captured among these athletes.  It would be interesting to see if there was a way to monitor how much rest highly specialized athletes got over the course of the year, as well as to possibly monitor patient reported outcomes or other variables such as strength, balance, and fatigue over the course of that year.  The authors of this study show us that sport specialization is associated with higher injury risk, and that we should be mindful of athletes’ specialization level in trying to prevent or manage lower extremity injuries. 

Questions for Discussion:  What do you think we can do as clinicians about athletes’ increasing interest in sport specialization?  Is there anything that you do differently for athletes who you know are highly specialized in a sport?

Written by: Nicole Cattano
Reviewed by: Jeffrey Driban

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