Sport specialization is associated with upper-extremity overuse injury in high school baseball players
Post EG, Struminger AH, Hibberd EE. J Shoulder Elbow Surg. Epub Ahead of Print.

Take-Home Message

A majority of high school baseball athletes reported being highly specialized. Highly specialized athletes were 4 times more likely to report an upper extremity overuse injury in the prior year. 


The rise in upper extremity injuries in baseball may be in part due to sport specialization becoming increasingly common. While sports specialization is a risk factor for lower extremity overuse injury, it remains unclear if sport specialization is associated with arm health in youth baseball athletes. Therefore, the authors surveyed high school athletes in 3 states to test whether specialization in baseball related to poor arm health and upper extremity overuse injury. Their survey consisted of 3 sections: 1) demographic details, 2) baseball participation, including sport specialization status using the 3-point sport specialization scale, and 3) throwing arm health using the Youth Throwing Score and self-reported overuse upper extremity injury within the prior 12 months. Overall, 551 high school baseball athletes (~16 years of age) from 15 different high schools completed the survey (5 high schools per each state; Alabama, California, Michigan). The authors defined overuse injury as an injury to a throwing shoulder or elbow related to “overuse from playing or practicing too much or too often” that caused the athlete to miss at least 1 day of baseball participation. Over half of the participants were highly specialized (~52%), and the most commonly reported primary position was pitcher (~24%). The authors found that highly specialized athletes were nearly 4 times more likely to report an upper extremity overuse injury in the past year compared to those that reported low sport specialization. Additionally, athletes reporting both playing baseball for 8 or more months and being a pitcher were twice as likely to report a history of an upper extremity overuse injury compared to those that reported playing less than 8 months a year and not being a pitcher. Finally, highly specialized athletes also reported poorer arm health scores compared with athletes reporting low sport specialization. However, pitchers that reported pitching year-round scored better in arm health compared to pitchers that did not pitch year-round.


The authors found evidence that highly specialized high school baseball athletes were more likely to report an upper extremity overuse injury in the past year. Highly specialized athletes and pitchers also had poorer arm health scores compared with low specialization athletes. It was interesting to note that year-round pitchers had better arm health scores compared to pitchers that did not pitch year-round. This could be due to other unmeasured risk factors (sleep, better mechanics, better arm care routine) or an example of reverse causation. Specifically, only someone with good arm health could pitch all year. Hence, it is important to recognize that the authors are unable to state that sport specialization or pitching causes upper extremity overuse injuries.  Prospective research that follows an athlete overtime will be needed to validate these findings. In the meantime, coaches, parents, and athletes need to understand the risk of sport specialization as well as the rules and regulations put in place for adolescents participating in baseball to dissipate these risks.

Questions for Discussion

What do you do to educate your athletes on the pitfalls of sports specialization? Do you think injury prevention warm-ups and strengthening plans would help reduce rates of injury?

Written by: Jane McDevitt
Reviewed by: Jeffrey Driban

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