of Competition Volume, Club Sports, and Sport Specialization With Sex and Lower
Extremity Injury History in High School Athletes
Post EG, Bell DR, Trigsted SM, Pfaller AY3, Hetzel
SJ, Brooks MA, McGuine TA. Sports Health. 2017; Ahead of Print
Take Home Message: An athlete
who participates in more than 60 games per year, is a member of a club sport, or
highly specialized is more likely to have a lower extremity injury.
Additionally, girls are more likely to participate on a club team and be highly
specialized potentially increasing their risk of injury.
school athletes are increasingly participating in year-round school and club sport,
which can increase competition volume throughout the year. This could increase
the risk of injury. However, there are no studies examining whether females or
males are more likely to compete in a club sport and if sport specialization
increases risk of lower extremity injury. Therefore, the authors sought to
evaluate the association between competition volumes, club sport participation,
and sport specialization with sex and lower extremity injuries. For this study,
1,544 high school athletes (girls 51%) from 29 different Wisconsin high schools
completed a paper-and-pencil questionnaire at the start of their competitive
season (between 2015-2016 academic year) regarding their sport specialization, sport
participation (primary sport, how many competitions did they participate in
during the year) and history of previous injury (which was validated by
athletic trainer’s records). The authors used a 3-point specialization scale
(1=low specialization, 2=moderate specialization, 3=high specialization), which
was based on year-round training in a single sport. The authors found that 20%
of the athletes reported high volume of competition (more than 60
competitions), while 50% of the athletes reported low competition volume (less
than 30 competitions). Additionally, 50% of athletes reported participating on
both a club and school sport in the same sport. Club participation was greatest
for soccer (22%), baseball/softball (19%), and volleyball (17%). Girls were
more likely to compete in a higher competition volume and participate on a club
sport compared with boys. Girls were also more likely to report previous lower
extremity injury compared with boys when considering all sports and when restricted
to sex-equivalent sports. Athletes with high or moderate competition volume
were more likely to report previous lower extremity injury, even after
accounting for sex. Similarly, athletes who were highly or moderately
specialized had greater odds of reporting a previous lower extremity injury
compared to low-specialization athletes.
is an increasing pattern of participating year-round in sports; however, this
may not be the best for young athletes. The authors found that participating in
many competitions (high sport volume) and being highly specialized is related with
a history of lower extremity injury. Girls were also more likely to participate
in high volumes and be a member of both school and club teams, which exposes them
to a higher risk of lower extremity injury compared with boys. It should be
noted that the authors did not compare athletes who competed in the same sport
all year to athletes who competed in different sports all year. Hence, it is
difficult to determine from this study if specialization is bad or if simply
participating in more practices and games just leads to more injury. Regardless,
these year-round athletes may benefit from injury prevention programs that
decrease the risk of injury. Unfortunately, many teams are not performing these
simple programs. It would be interesting to see if highly specialized athletes
that perform preventive programs sustain fewer injuries than highly specialized
athletes that do not preform preventative programs. Medical professionals should
be aware and educate youth athletes, parents, and coaches of the potential
risks associated with year-round participation in organized sport and take
steps to reduce the risk of injury (for example, implement injury prevention
Question for
Discussion: Do you notice a trend that the more specialized an athlete the more
injuries they sustain? Do you think placing preventive injury programs would
help decrease risk of injury in these year-round athletes? 
Written by: Jane McDevitt, PhD
by: Jeff Driban
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