The association of sport specialization and training volume with
injury history in youth athletes.
EG, Trigsted SM, Riekena JW, Hetzel S, McGuine TA, Brooks MA.
DR. Am J Sports Med. March 2017;
[Epub ahead of print]
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?  
By:  Laura McDonald
by: Jeffrey Driban