Sports Medicine Research: In the Lab & In the Field: Athlete before Athletic: Consequences of Sport Specialization on Youth Athlete Health (Sports Med Res)


Monday, April 17, 2017

Athlete before Athletic: Consequences of Sport Specialization on Youth Athlete Health

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]

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

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Haley said...

Great article...this is becoming a hot topic in sports medicine and prevalence of early sport specialization is increasing. I believe early sport-specialization includes individuals in high school or younger participating in only one sport for longer than a traditional sport season (including summer, club, and recreational). When athletes are only using specific sport movements for greater than 3 months, overuse injuries will develop more easily due to a shorter or no off-season. Repetitive movements will also cause overuse injury, so by switching to a different sport each season, new movements will be used most of the time. I believe that at least through the high school level, individuals should not be allowed to play only one sport all year round. I understand that this will give them a better shot at playing in collegiate athletics, but this will definitely increase their risk for injury in the long-term.

Laura M. McDonald, PhD, ATC said...

Thanks for your comment, Haley. You raise an excellent point about introducing new, different movement patterns by varying sport participation. Seems counter-culture to current attitudes about three-sport athletes!

Christopher Gregory said...

I agree with Haley with this being a hot button issue in the sports medicine and athletic realms. I was actually surprised that this study found that a majority of respondents reported high sports specialization at the age of 15. Anecdotally, it feels to be occurring at an even younger age. I wonder if the structure of athletics around the country was the cause or the result of sports specialization. Unstructured activities are on the decline which would decrease the risk of overuse injuries and potentially improve performance by practicing different skills. We are seeing increased numbers of younger, highly specialized baseball pitchers sustaining acute and chronic injuries requiring the introduction of pitch limits. If the goal of athletics is to become the best athlete possible, wouldn't it be counter-intuitive to specialize in one specific field? Some of the greatest athletes were considered the best in more than one sport and only specialized when it was their time to turn professional. Participating in a variety of different sports can hone a multitude of skills, and as Haley said different movement patterns, which may be translatable from one sport to another. Its troubling to watch youth athletes transform into a for-profit industry at the disservice of the children.

Laura M. McDonald, PhD, ATC said...

Thanks for your contribution, Christopher. I echo your question whether the structure of athletics is the victim or culprit. I have a nagging suspicion that rising costs of college tuition is another underlying factor as athleticism can serve as a route to subsidized college degree.

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