Sport-Specific Associations of Specialization and Sex With Overuse Injury in Youth Athletes

Post EG, Biese KM, Schaefer DA, Watson AM, McGuine TA, Brooks MA, Bell DR. Sports Health. 2019 Nov 14:1941738119886855. [Epub ahead of print]

Take-Home Message

Sports specialization and not following the youth sport participation recommendations may increase the chance of overuse injuries in soccer and volleyball.


Female athletes more frequently specialize in a sport at earlier ages and sustain more injuries than males. It remains unclear if the relationship between sports specialization and overuse injury is sport specific. Several different recommendations aim to reduce the risk of overuse injuries in sports; however, there is limited research on whether these recommendations are effective and if they need to be sport specific. Therefore, the authors used a questionnaire to examine sport-specific relationships between sex, sport specialization, and exceeding sport volume recommendations with an overuse injury among adolescent athletes. In brief, 716 youth athletes between the ages of 12-18 years (70% female, ~14 years of age) reported their demographics and history of sport specialization, sports participation volume, and overuse injury in the past 12 months that required medical care. All athletes participated in a basketball, soccer, or volleyball club team within the 2016-2017 school year. An athletic trainer reviewed a completed questionnaire with each participant to ensure accuracy.

Most of the athletes participated in basketball (43%) followed by women’s volleyball (37%) and soccer (19%). About 4 in 10 athletes reported being highly specialized (basketball = 36%, soccer = 35%, and volleyball = 52%). Female basketball athletes were 4 times more likely to report an overuse injury compared to male basketball athletes. Similarly, female soccer players may be twice as likely to report an overuse injury compared to their male peers; however, we need more soccer players to confirm this. Only athletes in volleyball were more likely to have an overuse injury if they highly specialized or trained for more than 8 months per year. Similarly, athletes in volleyball and soccer were about twice as likely to report an overuse injury if they participated in more hours per week than their age or played more than 5 days/week; however, we need more soccer players to confirm this.


The authors of this study offer a detailed picture of the relationship between sport specialization and overuse injury. Sports specialization was common in all three sports. However, sports specialization related to overuse injury only among female volleyball athletes. While this relationship was absent among basketball and soccer players, it remains unclear if it would have emerged if the authors only looked at the female athletes in those sports. If so, then we need to be more proactive about educating female athletes about the possible risk of overuse injury when highly specialized. Besides sport specialization, not following the recommendations (e.g., sports more hours/week than age, organized sport >5 days/week) also contributed to an increase in previous overuse injury among soccer and volleyball athletes. It would be interesting to better understand why specialization and weekly sports volume in basketball failed to relate with overuse injury. Finding the relationship among volleyball and soccer athletes support the belief that the current recommendations could be helpful to promote an active lifestyle without increasing the risk of an overuse injury among some athletes. Currently, medical professionals should be aware of the youth sport participation recommendations and educate athletes, coaches, and parents on how to encourage youth sport participation in a safe manner, especially for soccer and volleyball. Furthermore, clinicians may need to carefully monitor highly specialized volleyball and soccer athletes for signs of overuse.  

Questions for Discussion

How do you educate your athletes on the safe participation recommendations? Have you seen more overuse injuries in technical sports like volleyball? Have you seen a trend in females specializing more than males and reporting more overuse injuries?

Written by: Jane McDevitt
Reviewed by: Jeffrey Driban

Related Posts

Even Elite Athletes Suffer the Backfire of Sport Specialization
Is It Wise for Youth Athletes to Specialize?
AOSSM Early Sport Specialization Consensus Statement
Athlete before Athletic: Consequences of Sport Specialization on Youth Athlete Health 
Sports Specialization and Intensive Training in Young Athletes

7 evidence-based practice courses