When Is It Too Early for Single Sport Specialization?

The Importance of Physical Fitness Parameters in Rhythmic Gymnastics: A Scoping Review

This scoping review presents an overview of physical fitness parameters in rhythmic gymnastics as well as the association of fitness with gymnasts' performance, competitive level, and age. PubMed, Scopus, and Sport Discus databases were searched. Of the 586 records retrieved, 41 studies met the inclusion criteria (n = 1915 participants). The included studies examined flexibility, aerobic capacity, muscle power, muscle endurance, muscle strength, sprint speed, agility, balance, and coordination. Performance was associated with flexibility, aerobic capacity, lower-limb muscle power, agility, muscular endurance, balance, and coordination from a young age. Flexibility, aerobic capacity, and muscle power were, in general, higher in high-level gymnasts than in low-level gymnasts or controls. Older rhythmic gymnasts demonstrated higher scores than the younger ones in flexibility, aerobic capacity, balance, and sport-specific coordination but not in muscle endurance, while some studies reported a decline in muscle power with age. Supplementary physical fitness training improved all physical abilities irrespective of the gymnasts' level. Rhythmic gymnastics training alone improved muscle power, agility, speed, muscular endurance, and balance to a lesser extent than targeted fitness training. Muscular strength, speed, and agility are largely under-researched in rhythmic gymnastics. Emphasis should be given to targeted strength and power training due to the high mechanical loads placed on skeletally immature athletes.

Graft choice and techniques used in elbow ulnar collateral ligament reconstruction over the last 20 years: a systematic review and meta-analysis

BACKGROUND

Elbow medial ulnar collateral ligament (mUCL) injuries have become increasingly common, leading to a higher number of mUCL reconstructions (UCLR). Various techniques and graft choices have been reported. The purpose of this study was to evaluate the prevalence of each available graft choice, the surgical techniques most utilized, and the reported complications associated with each surgical method.

METHODS

A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysesguidelines. We queried PubMed/MEDLINE, Embase, Web of Science, and Cochrane databases to identify all articles that included UCLR between January 2002 and October 2022. We included all studies that referenced UCLR graft choice, surgical technique, and/or ulnar nerve transposition. Studies were evaluated in a narrative fashion to assess demographics and report current trends in utilization and complications of UCLR as they pertain to graft choice and surgical techniques over the past 20 years. Where possible, we stratified based on graft and technique.

RESULTS

Forty-seven articles were included, reporting on 6671 elbows. The cohort was 98% male, had a weighted mean age of 21 years and follow-up of 53 months. There were 6146 UCLRs (92%) performed with an autograft and 152 (2.3%) that utilized an allograft, while 373 (5.6%) were from mixed cohorts of autograft and allograft. Palmaris longus autograft was the most utilized mUCL graft choice (64%). The most utilized surgical configuration was the figure-of-8 (68%). Specifically, the most common techniques were the modified Jobe technique (37%), followed by American Sports Medicine Institute (ASMI) (22%), and the docking (22%) technique. A concomitant ulnar nerve transposition was performed in 44% of all patients, with 1.9% of these patients experiencing persistent ulnar nerve symptoms after ulnar nerve transposition. Of the total cohort, 14% experienced postoperative ulnar neuritis with no prior preoperative ulnar nerve symptoms. Further, meta-analysis revealed a significantly greater revision rate with the use of allografts compared to autograft and mixed cohorts (2.6% vs. 1.8% and 1.9%, P = .003).

CONCLUSIONS

Most surgeons performed UCLR with palmaris autograft utilizing a figure-of-8 graft configuration, specifically with the modified Jobe technique. The overall rate of allograft use was 2.3%, much lower than expected. The revision rate for UCLR with allograft appears to be greater compared to UCLR with autograft, although this may be secondary to limited allograft literature.

Perceived competence in ice hockey and its associations with relative age, early sport specialization, and players' position

Introduction

Ice hockey is a sport that has gained much attention in recent times, particularly concerning the development of young players. In the domain of youth sport development, one significant factor that must be considered is the perceived competence of players. This variable is closely linked to positive psychological outcomes and sustained practice. However, there is a lack of understanding about how other important developmental factors such as age, early sport specialization, players' position and relative age affect players' perceived competence. Therefore, the objective of this study is to explore the relationships between these developmental factors, perceived ice hockey competence and a global measure of perceived sport competence.

Methods

Data was drawn from 971 players (14.78 ± 1.61 mean age), who completed on-line questionnaires, from which we conducted path analyses involving all variables.

Results

Younger players tend to display higher perceived competence scores than older players. Additionally, players who opted to specialize earlier also reported higher perceived competence. Furthermore, forwards and defensemen had differing perceptions of their competence, which was in line with their respective roles on the ice. The study also showed relative age effects, in which players who were born earlier relative to the selection period tend to perceive themselves more advantageously in three components of perceived competence.

Discussion

Based on these findings, several recommendations are proposed for coaches and decision-makers to encourage the positive development of ice hockey players. The study highlights that ice hockey-specific competencies are influenced by various factors, such as early sport specialization, relative age effect, player age, and position.

Early single sport specialization does not improve pitching velocity, motion, strength, or utilization in high school baseball pitchers

Background

The impact of single-sport specialization on performance and injury risk in youth and adolescent athletes remains debated. The purpose of this study was to determine the incidence of single-sport specialization and its association with pitch velocity, pitcher utilization, range of motion, strength, and injury history.

Methods

High school pitchers in the Northeastern, Southeastern, Midwestern, and Western Regions of the United States were prospectively recruited. Prior to the season, pitchers were surveyed about their basic demographics, sport participation history, and injury history. At this timepoint, a standardized physical examination was performed and max pitch velocity was measured. They were then prospectively followed over the ensuing high school season, where pitch utilization and counts were followed and injuries were tracked.

Results

Across the study, 115 pitchers were recruited, of whom 53% played baseball as their only sport and 47% played other sports. Single- position specialization within baseball was uncommon as 90% of athletes played positions other than pitcher. There were no differences in range of motion, strength, or pitch velocity between multisport athletes and single-sport specialists. Within the multisport group, 26% reported a history of injury, while 38% of the single-sport specialists reported a history of injury (P = .179). There were no significant differences in pitcher utilization between multisport athletes and single-sport specialists. Only a single prospective injury occurred in the 115 players.

Conclusion

Although single-sport specialization is common, nearly half of all high school pitchers in this study were multisport athletes. While injury history was generally similar between the two groups, single-sport baseball players did not have the following: improved motion, increased strength, higher ball velocity, or greater pitching volumes during the high school baseball season compared to multisport athletes. Accordingly, single-sport specialization did not have a competitive advantage for these high school pitchers based on the performance factors studied. Further prospective studies are necessary to understand the association between single-sport specialization and injury risk in high school baseball players.

Developmental activities of elite junior hockey players: an analysis of early sport specialization

Early sport specialization is a popular and contentious topic in the scientific literature and popular media. The lure of extrinsic rewards has led to increasing rates of specialization among young athletes, while expert recommendations promote multisport participation. The purpose of this study was to describe and analyze developmental activities of a group of elite junior hockey players in Canada. Within this context, elements of specialization were investigated in accordance with existing theoretical frameworks and long-term athlete development models to enhance the literature. Fifteen participants from the Ontario Hockey League completed quantitative retrospective interviews, detailing past sport and recreational activities. Thirty-one developmental milestones were assessed. Accumulated hours of activity were categorized in accordance with Côté's (1999) Developmental Model of Sports Participation, along with the number and types of sports in which they participated during childhood. Jayanthi et al.'s (2015) continuum was utilized to determine the age at which the athletes became moderately and highly specialized. Accrued hours of deliberate practice reported by participants increased from ages 6 to 16 years, as did competition in organized hockey games. Reported hours of deliberate play peaked at 9 years of age and decreased thereafter. Participants played a combined 16 sports other than hockey, ranging from an average of 2.0 at age 6, to a maximum average of 5.6 at 12 years old, and decreasing each year to 2.3 by age 15. The greatest number of hours in other sports was accumulated at 12 years of age. Using a three-point scale, participants considered themselves "highly specialized" at 14 years old; however, other quantitative indicators suggested this may have occurred at 12 years of age. Relative to previous research on early sport specialization, participants in this study spent more time practicing hockey, while ceasing hockey-specific play and other sports at younger ages. Despite a diverse sport history, hockey competition was initiated earlier than recommended, showing high levels of sport commitment as young as 9 years old. The early specialization path remains a popular trajectory among coaches, parents, and athletes in Canadian ice hockey.

Effect of the COVID-19 Pandemic on Injuries Related to Individual and Team Sports: An Analysis of the NEISS Database Between 2017 and 2021

Background

The first 2 years of the coronavirus 2019 (COVID-19) pandemic had a profound effect on youth sports participation.

Purpose

The primary aim of this study was to explore the effect of the COVID-19 pandemic on youth sports injury patterns, with a secondary aim of comparing organized team and individual sport-related injuries in diverse age groups.

Study Design

Descriptive epidemiology study.

Methods

The National Electronic Injury Surveillance System (NEISS) was searched to identify injuries sustained by patients aged 11 to 23 years while playing organized team or individual sports from 2017 to 2021. We investigated reports of concussions, dislocations, fractures, and sprains/strains.

Results

Between 2017 and 2021, there were 58,721 and 3778 team and individual sport-related injuries, respectively. When compared with the prepandemic years, there was a 57.07% decrease in 2020 and 22.31% decrease in 2021 for the number of organized team sport-related injuries. Organized individual sport-related injuries had a 56.24% and 35.18% decrease in number in 2020 and 2021, respectively. Male patients were most likely to be injured in team sports (81.0%), and female patients were most likely to be injured in individual sports (67.1%). High school athletes sustained the majority of injuries in team (57.0%) and individual (51.2%) sports. The years 2020 and 2021 saw a decrease in proportion of sprains/strains and an increase in proportion of fractures.

Conclusion

The number of organized sport-related injuries reported to emergency departments decreased in 2020, and despite vaccinations and easing of social distancing, the 2021 value did not return to what it was prepandemic. As coronavirus-related restrictions have eased, there should be careful monitoring of sports injuries among youth athletes.

Athlete Burnout Is Associated With Perceived Likelihood of Future Injury Among Healthy Adolescent Athletes

We examined perceived risk of future sports injury and athlete burnout among uninjured adolescent athletes. Uninjured high school athlete participants completed the Athlete Burnout Questionnaire (ABQ) and a questionnaire assessing attitudes toward likelihood of sustaining a future sport-related injury. We compared ABQ responses between injury risk perception groups: those who expected injury versus those who did not. Half of the participants reported a somewhat/very high likelihood of future sport-related injury (n = 98; 52% female; age = 15.3 ± 1.9 years), while the other half reported it was unlikely/not possible (n = 98; 45% female; age = 15.3 ± 1.3 years). A significantly greater proportion of those in the expected injury group reported a history of bone/muscle/ligament/tendon injury (56% vs 24%; P < .001). Those in the expected injury group reported higher athlete burnout scores (median = 28 [interquartile range = 25-34] vs 25 [23-30]; P = .002). Adolescent athletes who reported they were likely to experience a future injury in their sport also reported greater levels of burnout.

Early Success is not a Prerequisite for Success at the Adult Age in Spanish Sprinters

The aim of the study was to describe the relationship between success in junior and senior categories in sprint events. An observational and longitudinal analysis was carried out using rankings of the Royal Spanish Athletics Federation database. We analysed 547 sprinters (238 women and 309 men) from their U14 to senior stage who ranked in top-20 on at least one occasion during the period 2004 to 2021. The first entry in top-20 occurred mostly in U14 (44.4%, 243), and the frequency was progressively lower: 26.7% (146) in U16; 20.8% (114) in U18; 5.1% (28) in U20; 2% (11) in U23; and 0.9% (5) in the senior category. A similar tendency was observed in male and female athletes. Only 3.8% (9) of top-20 U14 athletes reached the senior elite stage, increasing this percentage in subsequent categories: 7.4% (15) in U16; 10.6% (24) in U18; 20.9% (32) in U20, and 31.4% (32) from U23 to the senior category. Data from female athletes showed higher maintenance of top-20 status from early categories to senior age. We conclude that even though the first entry into the national top-20 in sprint events occurs early in most cases, success in these initial stages is not a prerequisite for reaching top-20 positions in the senior category.

School's out for summer-Differences in training characteristics between adolescent biathletes of different performance levels

The purpose of this study was to retrospectively describe the longitudinal changes of training variables in adolescent biathletes based on performance level. Thirty biathletes (15 men and 15 women) were included in the study and categorized as either national level biathletes (NLB, n = 21) or national team biathletes (NTB, n = 9). Retrospective training data was collected from training diary covering the biathletes' four years (Y1-Y4) as student-athletes at upper secondary school. Training data was divided into physical and shooting training variables. A linear mixed-effect model was used for comparing the difference of the performance group and year of upper secondary school on training characteristics. The NTB group achieved a greater annual training volume than the NLB group, especially during Y4 (594±71 h·y-1 vs 461±127 h·y-1, p < 0.001), through an increase in duration of each session and by completing more weekly training volume during the general phase (13.7±4.6 vs 10.0±4.9 h·w-1, p = 0.004). No difference was observed in relative training intensity distribution between the groups. The total number of shots fired was also greater for the NTB (9971±4716 vs 7355±2812 shots·y-1, p = 0.003). There was an equal frequency in illness and injury for both the NLB and NTB. Accordingly, the results of the present study describe longitudinal changes of biathlon training in adolescent biathletes that also may affect performance development.

Injury Prevalence among Young Elite Baseball Players

This study aimed to describe the injury profiles of young Korean baseball players according to position and age as the proportion and distribution of injuries based on playing position and age remains unclear. A total of 271 elite youth baseball players aged 8 to 16 years were divided into two groups: elementary school (ES) (n = 135) and middle school (MS) (n = 136). The participants' basic, baseball practice, and injury information were collected. Injuries in the MS group were not limited to the elbow and shoulder, and injury prevalence varied by age group and baseball position. The most injured body region in the ES group was the elbow joint, regardless of the position. In contrast, the most injured body region in the MS group was the lower back, except for infielders whose elbows were the most injured. Additionally, the MS group was more likely to experience injuries to the lower back (OR = 4.27, 95% CI = 2.47-7.40), shoulder (OR = 1.93, 95% CI = 1.08-3.43; p = 0.024), and knee (OR = 2.15, 95% CI = 1.17-3.94; p = 0.012). Our findings indicate that excessive practice and a lack of rest during MS (growth spurt period) can significantly increase the risk of lower back problems in young baseball players.

The associations of early specialization, sports volume, and maturity status with musculoskeletal injury in elite youth football players

Background: Youth football in schools has experienced rapid growth in China. Despite the increase of players engaging in more frequent, intensive, and organized sports training at their early ages, the controversy over early specialization (ES) still exists. This study aims to: a) investigate the training situation of players in the Chinese School Football Programme and b) examine the associations of early specialization, sports volume, and maturity status with musculoskeletal injury. Methods: A cross-sectional survey was used. Players who participated in the National School Football Winter Camp were invited to fill out a questionnaire that included the data of maturity, ES, sports volume, and injury history (n = 88 boys and n = 90 girls). Results: The results have shown that 80.3% of the athletes were classified as ES, while 19.7% of them were classified as non-ES. Almost all athletes (96%) participated in a sport for more than 8 months in a year. Most athletes (75.8%) spent more than twice of the time on organized sports than leisure activities. 30.3% of the athletes trained on average more hours per week than the number of their ages. Binomial logistic regression models reflected the significant differences in the odds ratios (OR) of reporting a history of injury among athletes with different levels of specialization (p = 0.024) and the OR of reporting a history of leg injury among players with different weekly sports volumes (p = 0.038). Significant differences were also shown in the OR of players reporting foot injuries between players with different maturity states (p = 0.046), and the Chi-squared test showed significant differences in the OR of reporting acute injuries between players with different levels of specialization (p = 0.048) and weekly activity (p = 0.022). No significant differences were found between the remaining variables. Conclusion: Most school football elite players follow the ES pathway even though ES increases the risk of injury, especially acute injury. Pre-pubertal and early pubertal players have a higher incidence of foot injuries. Players who train more hours per week than their ages have more leg injuries and acute injuries. Therefore, priority protection and intervention should be carried out for populations with a high risk of injury.

Multicenter Analysis of the Epidemiology of Injury Patterns and Return to Sport in Collegiate Gymnasts

Background

Gymnastics requires intense year-round upper and lower extremity strength training typically starting from an early age. As such, the injury patterns observed in these athletes may be unique.

Purpose

To characterize the types of injuries and provide return-to-sport data in male and female collegiate gymnasts.

Study Design

Descriptive epidemiology study.

Methods

A conference-specific injury database was utilized to perform a retrospective review of injuries for male and female National Collegiate Athletic Association (NCAA) Division I gymnasts within the Pacific Coast Conference between 2017 and 2020 (N = 673 gymnasts). Injuries were stratified by anatomic location, sex, time missed, and injury diagnoses. Relative risk (RR) was used to compare results between sexes.

Results

Of the 673 gymnasts, 183 (27.2%) experienced 1093 injuries during the study period. Injuries were sustained in 35 of 145 male athletes (24.1%) as compared with 148 of 528 female athletes (28.0%; RR, 0.86 [95% CI, 0.63-1.19]; P = .390). Approximately 66.1% (723/1093) of injuries occurred in a practice setting, compared with 84 of 1093 injuries (7.7%) occurring during competition. Overall, 417 of 1093 injuries (38.2%) resulted in no missed time. Shoulder injuries and elbow/arm injuries were significantly more common in male versus female athletes (RR, 1.99 [95% CI, 1.32-3.01], P = .001; and RR, 2.08 [95% CI, 1.05-4.13], P = .036, respectively). In total, 23 concussions affected 21 of 673 athletes (3.1%); 6 concussions (26.1%) resulted in the inability to return to sport during the same season.

Conclusion

For the majority of musculoskeletal injuries, the gymnasts were able to return to sport during the same season. Male athletes were more likely to experience shoulder and elbow/arm injuries, likely because of sex-specific events. Concussions occurred in 3.1% of the gymnasts, highlighting the need for vigilant monitoring. This analysis of the incidence and outcomes of injuries observed in NCAA Division I gymnasts may guide injury prevention protocols as well as provide important prognostic information.

Athletic children: Guidelines and monitoring in pediatric orthopedic surgery

In day-to-day practice pediatric orthopedic surgeons often come up against the question of sport. The aim of the present study was to analyze the relationship between sport and childhood, with 3 questions: (1) What are the benefits of sport for children? (2) How to manage high-level child athletes? And (3) What sports are possible after major orthopedic surgery? Sports provide many benefits for children, and are to be encouraged. Sixty minutes' moderate to intense physical activity per day benefits motor development and bone mineralization and reduces the risk of obesity. On the other hand, excessive sports activity, as encountered in high-level sport, can be harmful for the child's development. The amount of training should not exceed a certain threshold in terms of hours per week according to age. Surgical treatment of sport-related traumatic lesions does not necessarily accelerate return to sport: indications need to be reasonable, despite pressure from the patient's circle. Sports are possible after major orthopedic surgery, although return to sport tends to be delayed and the level is lower than preoperatively.

Osteochondritis Dissecans of the Capitellum of the Elbow: Improved Outcomes in Surgically Treated Versus Nonoperatively Treated Patients at Long-Term Follow-up

Purpose

To (1) report the long-term outcomes associated with both operative and nonoperative management of capitellar osteochondritis dissecans (OCD), (2) identify factors associated with failure of nonoperative management, and (3) determine whether delay in surgery affects final outcomes.

Methods

All patients who received a diagnosis of capitellar OCD from 1995-2020 within a geographic cohort were included. Medical records, imaging studies, and operative reports were manually reviewed to record demographic data, treatment strategies, and outcomes. The cohort was divided into 3 groups: (1) nonoperative management, (2) early surgery, and (3) delayed surgery. Delayed surgery (surgery ≥6 months after symptom onset) was considered failure of nonoperative management.

Results

Fifty elbows with a mean follow-up period of 10.5 years (median, 10.3 years; range, 1-25 years) were studied. Of these, 7 (14%) were definitively treated nonoperatively, 16 (32%) underwent delayed surgery after at least 6 months of failed nonoperative treatment, and 27 (54%) underwent early surgical intervention. When compared with nonoperative management, surgical management resulted in superior Mayo Elbow Performance Index pain scores (40.1 vs 33, P = .04), fewer mechanical symptoms (9% vs 50%, P < .01), and better elbow flexion (141° vs 131°, P = .01) at long-term follow-up. Older patients trended toward increased failure of nonoperative management (P = .06). The presence of an intra-articular loose body predicted failure of nonoperative management (P = .01; odds ratio, 13). Plain radiography and magnetic resonance imaging had poor sensitivities for identifying loose bodies (27% and 40%, respectively). Differences in outcomes after early versus delayed surgical management were not observed.

Conclusions

Nonoperative management of capitellar OCD failed 70% of the time. Elbows that did not undergo surgery had slightly more symptoms and decreased functional outcomes compared with those treated surgically. The greatest predictors of failure of nonoperative treatment were older age and presence of a loose body; however, an initial trial of nonoperative treatment did not adversely impact the success of future surgery.

Level of Evidence

Level III, retrospective cohort study.

Association of sports sampling and training frequency with injury among school-age athletes in Japan

BACKGROUND

This study evaluated the status of sports participation and training frequency during school years to identify related factors for injuries in the general Japanese population.

METHODS

A total of 1,533 adult participants (762 males, 771 females) retrospectively completed a questionnaire assessing sports participation (single/multisport), training frequency (weekly days of sports participation), and injury history (acute and overuse) at each stage of school (elementary, junior high, and high school).

RESULTS

In total, 41.1% of participants reported playing multiple sports in elementary school; this rate decreased to 17.4% in junior high school and 8.9% in high school. Weekly days of sports participation were associated with almost all injuries at each age. Participants who still played multiple sports in junior high school had fewer overuse injuries in junior high school and high school (P = 0.017; odds ratio (OR) = 0.69; 95% confidence interval (CI) = 0.51-0.94; P = 0.006, OR = 0.66, 95% CI, 0.49-0.89, respectively). The ratio for sports sampling differed between elementary school and older ages. This trend was associated with the prevalence of overuse injuries.

CONCLUSION

Promoting sports sampling through junior high school ages and controlling the training frequency may decrease the occurrence of injuries in young athletes.

Differences in Lower Extremity Coordination Patterns as a Function of Sports Specialization

The practice of early sport specialization, defined as intense year-round training in a single sport at the exclusion of others, is increasing in youth athletics. Despite potential benefits, sport specialization may be detrimental to the health of young athletes, as specialization may increase the risk of musculoskeletal injuries-particularly overuse injuries. However, there remains limited knowledge about how sports specialization uniquely alters underlying sports-related motor behavior. The purpose of this study was to compare the variability of movement patterns exhibited by highly sports specialized youth athletes to that of nonspecialized athletes during performance of a sport-specific, virtual reality based cutting task. It was hypothesized that highly specialized athletes would display different patterns of movement coordination compared to nonspecialized athletes during both the run-up phase and cut-and-decelerate phase. In support of the hypothesis, specialized athletes exhibited both intra- and inter-limb coordination that were significantly different than unspecialized athletes. Overall, the results indicate that the highly specialized athletes tended to exhibit greater degrees of coordination but also the ability to break the coordinated patterns of joint angle changes to execute a cutting maneuver, which requires asymmetric demands on the lower extremities while planting on one leg and changing direction.

Incidence and Epidemiology of Symptomatic Capitellar Osteochondritis Dissecans of the Elbow: A United States Population-Based Study Over a 25-Year Period

Background

There are limited data on the incidence of capitellar osteochondritis dissecans (OCD) in the United States (US) population.

Purpose

To determine the incidence of symptomatic capitellar OCD in a representative US subpopulation and identify changes in its incidence over time and to investigate the relationship between the incidence of capitellar OCD and patient sex and age.

Study Design

Descriptive epidemiology study.

Methods

A retrospective review was performed of patients aged ≤24 years from Olmsted County, Minnesota, with symptomatic capitellar OCD over a 25-year period (1995-2019). Patients with acute osteochondral injuries, Panner disease, and hereditary arthropathy were excluded. Poisson regression was utilized to identify the predictors of a capitellar OCD diagnosis. Incidence rates (per 100,000) were assessed for changes over time. Age groups of younger (10-15 years) versus older (16-24 years) patients were compared.

Results

A total of 45 patients (78% male) were identified. The mean age was 14.5 years (range, 10-24 years); 31 patients were in the younger group, and 14 patients were in the older group. Sport participation was seen in 89%of patients; 90% were overhead athletes, and 58% were throwing athletes. The incidence of capitellar OCD was 6.0 per 100,000 overall, 9.5 per 100,000 for male patients, and 2.6 per 100,000 for female patients. The incidence was highest for male patients in the younger group (15.3/100,000) and lowest for female patients in the older group (0.8/100,000). The estimated incidence rate ratio for younger versus older patients was 3.3 (P < .001), and the incidence rate ratio for male versus female patients was 3.5 (P < .001). There were no changes in the incidence of capitellar OCD over time as a continuous or 5-year categorical variable (P = .290 and P = .460, respectively). Overall, 82% of patients were treated surgically. There were no significant changes in surgical rates over time.

Conclusion

In this US subpopulation, the overall incidence of symptomatic capitellar OCD between the ages of 10 and 24 years was 6.0 per 100,000 over the 25-year period studied, which is higher than previously reported US estimates. Incidence rates and treatment strategies did not change significantly over time.

Youth Sports Specialization and Its Effect on Professional, Elite, and Olympic Athlete Performance, Career Longevity, and Injury Rates: A Systematic Review

BACKGROUND

Limited data are available on the long-term consequences of early sports specialization in high-level athletes.

PURPOSE

To evaluate the existing literature on the effects of sports specialization among professional, Olympic, and other elite athletes.

STUDY DESIGN

Systematic review; Level of evidence, 3.

METHODS

We performed a systematic review of studies from 1990 to 2021 on youth sports specialization in professional, elite, and/or Olympic athletes following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. An elite athlete was defined as one who performed at the highest level of his or her sport, beyond college level. Data were summarized according to 6 objectives: (1) definitions of specialization, age at specialization, and participation in other sports; (2) motivation for specialization; (3) athlete perspectives on specialization; (4) performance data; (5) specialization and injury risk; and (6) career longevity.

RESULTS

From 8756 articles, 29 studies were included, of which 17 (58.6%) were survey-based studies. Of the 8 articles that commented on injury risk, all demonstrated reduction in injury risk in athletes who delayed specialization. Performance benefits were apparent with later specialization in 7 of 9 articles; the remaining 2 showed benefit with earlier specialization in marathon runners and soccer players. There were less definitive results on career longevity, with 5 of 9 articles finding no association between career longevity and sports specialization.

CONCLUSION

Although current data on sports specialization in elite, professional, and Olympic athletes are mostly retrospective and survey-based evidence, most sports demonstrate better performance after youth multisport engagement, and youth sports specialization was linked with increased injury risk in athletes at the highest levels of competition.

Analysis of stress tolerance, competitive-anxiety, heart rate variability and salivary cortisol during successive matches in male futsal players

BACKGROUND

This study aimed to compare the stress tolerance, competitive anxiety, heart rate variability and salivary cortisol before and during successive futsal competitive matches (3 matches in 4 days) in young male futsal players.

METHODS

10 young male futsal players (16.9 ± 0.7 age; 71.0 ± 5.1 kg; 174.9 ± 4.3 cm) were monitored during one training session and across a competitive period with 3 successive matches. External load was determined by the PlayerLoad method, while session rating of perceived exertion was used to calculate the internal training and competitive load. The stress tolerance was examined using Daily Analysis of Life Demand in Athletes questionnaire and the Competitive State Anxiety Inventory was used to analyze the competitive anxiety. The Time and frequency monitoring parameters were used to analyze the vagal cardiac autonomic marker. sC was analyzed using enzyme-linked immunosorbent assay.

RESULTS

A generalized estimating equation showed a significant difference for PlayerLoad from M1 to TS, M2 and M3, from M2 to M3 (p < 0.05), and for session rating of perceived exertion from M1 to Ts and M3 (p < 0.05). A difference for sources [χ² ₍₃₎ = 1.481, p = 0.68] or symptoms [χ² ₍₃₎ = 3.893, p = 0.27] was not found. There was no significant difference in any of the competitive anxiety [cognitive anxiety (F _{(1.644; 14.799)} = 4.6, p = 0.73, ŋ² p = 0.28), somatic anxiety (F _{(2,09; 18,85)} = 26.07 p = 0.057; ŋ²_p = 0.27) or self-confidence (F_{(2.07; 18.85)} = 15.875 p = 0.152; ŋ²_p = 0.18)] domains. The HRV parameters (time domain and frequency) and Salivary Cortisol (sC) (χ² ₍₃₎ = 4.320 p = 0.229) did not significantly change during the successive matches.

CONCLUSION

The competitive scenario in which the players were evaluated did not significantly modify the stress tolerance, or the athletes' state of anxiety, which in turn was not able to promote changes in the cardiac vagal modulation or in the sC levels before the matches.

Rhythmic gymnasts' injuries in a pediatric sports medicine clinic in the United States: a 10-year retrospective chart review

OBJECTIVES

Rhythmic gymnastics injuries have not been studied thoroughly especially in the United States. Existing research studies are predominantly from Europe or Canada or from more than 15 years ago. The purpose of our study was to provide an updated description of injury patterns among rhythmic gymnasts in the United States.

METHODS

A retrospective chart review was conducted of 193 rhythmic gymnastics injuries in 79 females, ages 6-20. Patients were seen between January 2010 and March 2020 in a hospital-based pediatric sports medicine clinic. Gymnast demographics, injury locations, and injury types were collected as available. Descriptive and bivariate statistical analysis was performed using general linear mixed models.

RESULTS

Our cohort had a mean age of 14.61 ± 2.61 years. Overuse injuries (76.7%) were more common than acute injuries (23.3%). The most common injury types were strain (20.7%), nonspecific pain (15.5%), and tendinitis/tenosynovitis (10.36%). The most frequently injured body regions were lower extremity (75.1%), followed by trunk/back (19.2%), upper extremity (4.7%), and head/neck (1.0%). The most common injured body parts were foot (24.9%), ankle (15.5%), knee (15.0%), lower back (14.0%), and hip (13.0%). General linear mixed models revealed that older age (p = 0.001) and higher competitive level (p = 0.016) were associated with a greater number of diagnoses. Gymnasts with foot injuries were older than gymnasts with ankle (p = 0.026), hip (p < 0.0001), and knee (p = 0.002) injuries. Gymnasts with higher BMI-for-age percentile were more likely to have acute injuries than overuse (p = 0.035).

CONCLUSION

Our data showed that injuries among rhythmic gymnasts were most frequently located in the lower extremities, specifically the foot, followed by trunk/back. Additionally, the most frequent injury types were strains and nonspecific pain, and overuse was the most prevalent mechanism. Gymnasts with foot injuries were older than gymnasts with ankle, hip, and knee injuries. Higher BMI is a predictor of acute injuries.

Prospective evaluation of sport activity and the development of femoroacetabular impingement in the adolescent hip (PREVIEW): results of the pilot study

Background

The purpose of this pilot study was to validate the feasibility of a definitive study aimed at determining if high-intensity physical activity during adolescence impacts the development of femoroacetabular impingement (FAI).

Methods

This prospective cohort pilot study had a sample size target of 50 volunteers between 12 and 14 years old at sites in Canada, South Korea, and the Netherlands. Participants were evaluated clinically and radiographically at baseline and at 2 years. The participants’ sport and physical activity were evaluated using the Habitual Activity Estimation Scale (HAES) and the American Orthopaedic Society for Sports Medicine (AOSSM) criteria for sport specialization. The primary outcome was feasibility and secondary outcomes included the incidence of radiographic FAI and hip range of motion, function (Hip Outcome Score, HOS), and quality of life (Pediatric Quality of Life questionnaire, PedsQL) at 24 months. Study groups were defined at the completion of follow-up, given the changes in participant activity levels over time.

Results

Of the 54 participants enrolled, there were 36 (33% female) included in the final analysis. At baseline, those classified as highly active and played at least one organized sport had a higher incidence of asymptomatic radiographic FAI markers (from 6/32, 18.8% at baseline to 19/32, 59.4% at 24 months) compared to those classified as low activity (1/4, 25% maintained at baseline and 24 months). The incidence of radiographic FAI markers was higher among sport specialists (12/19, 63.2%) compared to non-sport specialists (8/17, 47.1%) at 24 months. The HOS and PedsQL scores were slightly higher (better) among those that were highly active and played a sport compared to those who did not at 2 years (mean difference (95% confidence interval): HOS-ADL subscale 4.56 (− 7.57, 16.70); HOS-Sport subscale 5.97 (− 6.91, 18.84); PedsQL Physical Function 7.42 (− 0.79, 15.64); PedsQL Psychosocial Health Summary 6.51 (− 5.75, 18.77)).

Conclusion

Our pilot study demonstrated some feasibility for a larger scale, definitive cohort study. The preliminary descriptive data suggest that adolescents engaged in higher levels of activity in sports may have a higher risk of developing asymptomatic hip deformities related to FAI but also better quality of life over the 2-year study period.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40814-022-01164-3.

A Comparison of Pitching Biomechanics and Sport Specialization in High School Pitchers

Background

The prevalence of sport specialization in high school athletes continues to rise, particularly among baseball players. Previous research has focused on the incidence of injury among specialized and non-specialized athletes but has yet to examine the level of sport specialization and pitching biomechanics.

Hypotheses/Purpose

The purpose of this study was to investigate differences in pitching volume and biomechanics between low-, moderate-, and high-level specialized baseball pitchers. It was hypothesized that high-level specialized pitchers would have the most pitching volume within the current and previous years while low-level specialized pitchers would exhibit the least amount. The second hypothesis states that kinematics and kinetics commonly associated with performance and injury risk would differ between low-, moderate-, and high-level specialized pitchers.

Study Design

Case-Control Study.

Methods

Thirty-six high school baseball pitchers completed a custom sport specialization questionnaire before participating in a three-dimensional pitching motion analysis. Sport specialization was based off current guidelines and categorized as low-, moderate-, and high-level specialized based upon self-reported outcomes. Pitchers then threw ≈10 fastballs from a mound engineered to professional specifications. Data averaged across fastballs was used for biomechanics variables. Key pitching biomechanical and pitching volume variables were compared between low-, moderate-, and high-level specialized pitchers.

Results

High-level specialized pitchers were older (p = 0.003), had larger body mass (p = 0.05) and BMI (p = 0.045), and threw faster (p = 0.01) compared to low-level specialized pitchers. Pitching volume and pitching biomechanics were similar across groups.

Conclusions

Pitching biomechanics were similar across groups, although high-level specialized pitchers threw with significantly higher throwing velocity compared to low-level pitchers. The low amount of pitching volume throughout the season may be responsible for the lack of additional observed differences. Further research should examine the relationship between pitching biomechanics, upper extremity strength and flexibility, and sport specialization.

Level of Evidence

Level III.

Early Sport Specialization and Past Injury in Competitive Youth Rock Climbers

INTRODUCTION

Sport specialization has been shown to have negative effects on athletes but has not been studied within rock climbing. This study seeks to evaluate the proportion and impact of specialization in pediatric climbers.

METHODS

Climbers (ages 8-18 y) were recruited from throughout the United States to complete a 1-time survey regarding climbing experience, training patterns, and injury history. The main outcome of proportion of climbers suffering an injury was assessed within the last 12 mo and within their entire climbing experience (defined as "lifetime" injury). Early specialization was defined as exclusive participation in climbing, with training for >8 mo‧y^-1, prior to age 12 y (late specialization if after age 12 y).

RESULTS

Participants (n=111, 14±3 y [mean±SD], 69 females) were high-level climbers. Fifty-five percent of participants specialized in climbing, and 69% of those specialized early. Hand and ankle injuries occurred most commonly. Seventy-eight percent of late specialized climbers had a lifetime injury. Late specialized climbers were 1.6 times (95% CI: 1.1-2.3) more likely than early specialized climbers to have had a lifetime injury and 1.8 times (95% CI: 1.1-2.8) more likely to have had an injury in the last 12 mo. No difference in overuse injuries was found between specialization groups.

CONCLUSIONS

Early specialization is common among youth climbers but was not associated with an increase in injuries. Late specialization was associated with a higher likelihood of having had a climbing injury in the last 12 mo and during an entire climbing career.

National Football League (NFL) quarterbacks who were multisport high school athletes have better in-season performance statistics and career success

OBJECTIVES

To determine (1) the proportion of National Football League (NFL) quarterbacks (QBs) who were multisport high school athletes (2) whether performance metrics in NFL QBs differed by playing multiple high school sports versus the single sport of football.

METHODS

A comprehensive online search identified NFL QBs from 1995 to 2020, classifying them as single or multisport high school athletes. Performance data were collected for regular season and playoffs when applicable and were calculated as rates. Regular season comparisons were limited to players playing at least eight games. Accolades (Pro Bowls, MVP awards, and Super Bowl victories) were also recorded. Mann-Whitney U was utilized to compare performance metrics between multisport and single sport athletes.

RESULTS

403 QBs (223, 55.3% multisport) were included. In the regular season, multisport QBs played in more games (median 6.8, IQR 4-10.6 vs median 5, IQR 2.5-8.3; p = 0.0001), and had higher touchdowns/game (median 0.87, IQR 0.5-1.25 vs median 0.67, IQR 0.42-1; p = 0.0063), pass yards/game (median 159.4, IQR 103.9-206.7 vs median 139.4, IQR 96.3-179.6; p = 0.0392), and QB rating (median 78.5, IQR 69.4-85.2 vs median 74.4, IQR 66.7-81.2; p = 0.0063). There were no differences in pass completion %, interceptions/game, or rush yards/game. Multisport QBs played in more playoff games (median 0.5, IQR 0.22-0.81 vs median 0.33, IQR 0.2-0.62; p = 0.027), and had more Pro Bowl appearances, MVP awards, and Super Bowl victories per athlete (p < 0.05).

CONCLUSION

Over half of NFL QBs played multiple high school sports. Multisport involvement is associated with benefits in regular season including a higher proportion of games played, and more touchdowns/game, pass yards/game, and QB rating. Playing multiple sports was also associated with playing more playoff games and having more Pro Bowl appearances, MVP awards, and Super Bowl victories. This data supports the benefits of youth multisport training.

Early Sport Specialization and Relative Age Effect: Prevalence and Influence on Perceived Competence in Ice Hockey Players

The relative age effect (RAE) and early sport specialization (ESS) have been of growing interest in the sports world, especially in ice hockey, because of their potential adverse effects. However, little is known about their distribution within each level of play in Canadian minor ice hockey, or whether they influence young people’s perceived competence, a variable of interest in long-term sports development. A sample of elite adolescent players (N = 204) and a sample of recreational and competitive players (N = 404) were used to measure these constructs, and chi-square tabulations were conducted to compare their distribution. Our results reveal that RAE (χ2 = 20.03, p < 0.01, Cramer’s V = 0.13) and ESS (χ2 = 66.14, p < 0.001, Cramer’s V = 0.24) are present, but there are apparently no gender differences in their distributions. Neither the level of RAE nor ESS seems to affect the perceived competence of the players, regardless of gender. The results of this study highlight the presence of RAE and ESS in Canadian minor ice hockey, especially at the elite level, but indicate that they do not affect the self-perception of ice hockey players. Additional research on these concepts is needed to obtain a complete picture of their potential impact on sports development.

Specialization and Injury Risk in Different Youth Sports: A Bio-Emotional Social Approach

Aims

Sport specialization is an actual trend in youth athletes, but it can increase injury risk. The aim was to determine the eventual correlation between sports specialization and injury risk in various sports, using a biopsychosocial approach.

Methods

169 sport-specialized athletes completed [(38 female, 131 male); overall (11.2 ± 2.7 years), (56.28 ± 15.72 kg), (161.3 ± 15.52 cm)] a self-reported questionnaire regarding sociodemographic (age, gender, educational level), physical-attitudinal, injuries and psychological-attitudinal To analyze data univariate and correlate analyses were used.

Results

Of 169 athletes enrolled, 53% were single-sport specialized (reported participation in one sport and trained > 8 months/year). In team sports (100%, OR = 0.75; p = 0.022) a high risk of having to remain at rest for up to 1 month because of overuse was observed. Males who suffered direct trauma (70%; OR = 1.03; p = 0.006) in the team group (95%, OR = 0.09; p = 0.008) were more exposed to that type of injury, and also the type of specialization figured significantly (p = 0.047). In addition, interoceptive awareness correlates with injury (95%, 1.04, p = 0.01). This study shows that, even though young athletes seem to be at a high risk of becoming injured, early team sport specialization and a high performance level cannot be considered to be the only risk factors.

Ankle Sprain in Young Athletes: A 2-Year Retrospective Study at a Multisport Club

Objective  The present study aimed to analyze ankle sprains in young athletes of basketball, futsal, artistic gymnastics, trampoline, tennis, judo, and volleyball over 2 seasons. Methods  Data of 529 athletes in the 1 ^st year and of 495 athletes in the 2 ^nd year of analysis were investigated from the injury record database of a sports club. The following data were considered: the demographic characteristics (age, body mass, height, and sex), the mechanism (contact or noncontact), the severity, the moment at which the injury occurred, and the recurrence. Also, the incidence rate, the injury risk of the first ankle sprain, and the incidence rate ratio between sports were calculated. Results  The athletes sustained 124 ankle sprains in the 2 years of analysis. The majority occurred during training (76.6%) and lead to absence from sports practice (75.8%). The injury recurrence was low: 2 athletes (1.6%) had a recurrence in the same year and 5 (4.0%) in the following year. The incidence rate (0.79 to 12.81 per 1,000 hours) and the injury risk (1.14 to 19.44%) varied among sports. Volleyball, basketball, and futsal presented the highest injury rate incidence. Tennis, gymnastics, and trampoline showed the lowest injury rate incidence. Judo showed an incidence rate different from those of basketball and volleyball in the 1 ^st year and similar to those of other sports in the 2 ^nd year. Conclusion  Ankle sprain greatly impacted sports practice and presented characteristics that differ among the investigated sports. These findings may contribute to developing preventive injury programs.

Male Youth Ice Hockey Concussion Incidence in a USA Hockey Membership-Adjusted Population: A Peak in 2011 and the Impact of Major Rule Changes

OBJECTIVE

To investigate the incidence of youth ice hockey-related concussions preceding and following the implementation of new body-checking and head contact rules by USA hockey in 2011. We hypothesized a decrease in concussions after the rule change.

DESIGN

Retrospective analysis.

SETTING

United States emergency department (ED) data queried in the National Electronic InjurySurveillance System (NEISS).

PATIENTS

National Electronic Injury Surveillance System reported male youth (≤18 years) ice hockey concussion cases from January 1, 2002, to December 31, 2016. In total, 848 players were diagnosed with concussion, representing a national estimate of 17 374 cases.

INDEPENDENT VARIABLES

Time, specifically years.

MAIN OUTCOME MEASURES

Incidences and incidence rates (measured per 10 000 person-years) of male youth ice hockey concussions. Annual trends were analyzed using descriptive and linear or polynomial regression analysis.

RESULTS

The national estimate of youth ice hockey-related concussions seen in US emergency departments (EDs) increased significantly from 656 in 2007 to 2042 in 2011 (P < 0.01). During the same period, their respective incidence increased significantly from 21.8 to 66.8 per 10 000, before dropping through 2016 (P < 0.05). After 2011, concussions decreased from 1965 in 2012 to 1292 in 2016 (P = 0.055). The gap in concussion incidence between the 11 to 12 and 13 to 14 divisions widened after 2011 (before 2011: 41 vs 49 per 10 000 person-years [P = 0.80]; after 2011: 45 and 89, respectively [P < 0.01]).

CONCLUSIONS

US EDs experienced a significant increase in youth ice hockey concussion visits from 2007 to 2011. After the 2011 rule changes, concussion visits decreased significantly from 2012 to 2016.

Trends in Medial Ulnar Collateral Ligament Repair and Reconstruction From 2007 to 2016: A Population-Based Study of a Large Private Insurance Database

Background: Ulnar collateral ligament (UCL) reconstruction and UCL repair of the elbow are commonly performed procedures, resulting in high return-to-play rates. Whether the incidence rate of UCL reconstruction vs UCL repair has changed over time is not currently known. Purpose/Questions: We sought to assess temporal trends in the incidence rates of UCL repair and UCL reconstruction and to identify factors associated with UCL reconstruction. We hypothesized that UCL repair would demonstrate an increased incidence overall in recent years with an associated decline in UCL reconstruction rates. Methods: Using the PearlDiver Research Program to query the Humana administrative claims database, we identified patients who had undergone UCL repair and/or reconstruction from 2007 to 2016. Patients were stratified by age (15-19; 20-29; 30-49 years), sex, and year (2007-2011 vs 2012-2016). Poisson regression analysis (continuous variables) was used to calculate the incidence risk ratio (IRR); chi-square tests were performed for categorical variables, and odds ratios were calculated with 95% confidence intervals (CI). Results: The incidence rate of UCL repair was greater in 2012-2016 than in 2007-2011 (IRR: 1.86, 95% CI: 1.16-2.96). The incidence rate of UCL reconstruction vs UCL repair was greater for patients aged 15 to 19 years (IRR: 3.37, 95% CI: 1.97-5.77) but not patients aged 20 to 29 years (IRR: 0.89, 95% CI: 0.49-1.59) as compared with patients aged 30 to 49. Males aged 19 years were more likely than females to undergo UCL reconstruction (IRR: 10.09, 95% CI: 1.37-3.45). Conclusion: While UCL procedures are becoming more popular, our retrospective analysis showed that young males are preferentially treated with UCL reconstruction, warranting further investigation into these trends.

Therapeutic interventions in Osgood-Schlatter disease: A case report

RATIONALE

The purpose of this case study was to identify factors of bilateral etiopathogenesis of Osgood-Schlatter disease (OSD) and those supporting the effectiveness of the therapeutic process in a 12-year-old elite female Olympic karateka.

PATIENT CONCERNS

The present case study concerns OSD female karateka who started her sport-specific training at the age of 4 years.

DIAGNOSES

The results of subjective palpation by the orthopedic surgeon and objective medical examination using ultrasonography, wall slide test, magnetic resonance imaging, and body height and weight measurements were collected.

INTERVENTIONS

The therapeutic intervention for the athlete's knee joints lasted 20 months (5 stages). Physical therapy, kinesiotherapy, and pharmacological treatment were administered, and physical activity was gradually introduced.

OUTCOMES

The developmental trajectory was uniform for body height and labile for body weight. OSD was diagnosed after the second growth spurt, and significant progression was reported during the subsequent height and weight gains and increased volume and intensity of sports training. The rate and dynamics of changes in the distance from the patellar ligament to the tibial apophysis were irregular, with dominance in the right knee with the highest rate of change (-3.3 mm) and twice the regression of the rate of change (-2.5 mm). The analyzed distance never exceeded the baseline value (5.5 mm), which was the case in the left knee. Return to sports competition was possible from the second month of therapy, in which kinesiotherapy and static stretching were the most effective. A relatively correct distance of the patellar ligament from the tibial apophysis was recorded at the time of stabilization of the body height and weight gain. No pathological changes were observed following OSD, and full recovery was observed.

LESSONS

In the case discussed in this study, growth spurt, the specificity of the sport practiced, and early specialization including high-volume and high-intensity training should be considered as factors causing OSD and its progression. Kinesiotherapeutic management and static stretching are crucial for the treatment of OSD. Quick return to sports competition was possible due to early therapeutic intervention, which could also lead to the absence of pathological changes in the tibial tubercle and the absence of recurrence of OSD.

Validity and reliability study of the Turkish version of the 'A Sport Fitness Index'

BACKGROUND

The aim of this study was to adapt the 'Sport Fitness Index' into Turkish and to ensure its validity and reliability.

METHODS

After obtaining the necessary permissions, the Sports Fitness Index was independently translated from its English original to Turkish by four different physicians specialising in sports medicine. The content validity of index v.1 was calculated using the Davis technique in sample 1 of 20 people regularly participating in sports. In sample 2 consisting of 104 athletes who had a sports-related ligament/muscle injury or applied to the sports medicine clinic for general medical examination; the validity and reliability of index v.2 were examined. ROC analysis was applied to determine the cut-off point value of the score obtained from the Turkish version of the index.

RESULTS

The calculated I-CVI (lowest: 0.80, highest: 0.95) and S-CVI/Ave values (0.87) showed that the index provided content validity. Item 1 and item 10 were removed from the Turkish version of the index, as it caused a decrease in the Cronbach's alpha coefficient of the index v.2. Thus, the Cronbach's alpha coefficient of the index was calculated as 0.925. In the Turkish version of index v.2, the single-factor structure (explained variance rate 66.22%; eigenvalue 5.29) was preserved. The index provided confirmatory factor analysis model fit indices. The index provided a high level of negative correlation (r ˃ -.60; P = .0001) with the total score of the Physical Activity Inadequacy Scale Short Form-10 and the sub-scores of all summary components (r ˃ -.60; P = .0001). According to the ROC curve, the best cut-off point was 70 points with 96.6% sensitivity and 75% specificity in the Turkish version of the index.

CONCLUSION

The Sports Fitness Index-TR provided its Turkish validity and reliability with its 8-item and single-factor structure. The cut-off point is accepted as 70 points.

Sport specialization of female figure skaters: cumulative effects on low back injuries

Objective: 1) to determine the proportion of sport specialization among female figure skaters, 2) to compare proportion of low back injuries between specialized female figure skaters and non-specialized female figure skaters, and 3) to identify an independent risk factor(s) for low back injuries in female figure skaters.Methods: A cross-sectional questionnaire study was used. Young female figure skaters were asked questions related to sport specialization and any history of low back injuries. The primary outcome variables were status of sport specialization, weekly training hours, and low back injury. Descriptive statistics, t-test, chi-square analyses, and binary logistic regressions were used.Results: Responses from 132 female figure skaters (mean age: 16.3 ± 2.7 years, age range: 8-22 years) were analyzed. Sixty-two percent (82/132) of figure skaters were specialized. Specialized female figure skaters spent more time in training (11.3 ± 6.5 hours/week) than non-specialized skaters (7.6 ± 4.9 hours/week, p = 0.001). No statistical differences were found in proportion of low back injury history between specialized (25.6%) and non-specialized female figure skaters (24.0%, p = 0.836). Chronological age was also identified as an independent risk factor for low back injuries in female figure skaters (aOR: 1.24, 95%CI: 1.00, 1.54, p = 0.048).Conclusions: The majority of female figure skaters in this cohort were specialized. An association between chronological age and low back injuries, found in the current study, may be a result of cumulative effects of participating in figure skating over time.

The prevalence of high school multi-sport participation in elite national football league athletes

Objectives: Early youth specialization is increasingly being researched and identified as a risk factor for overuse injuries and burnout. This study aimed to characterize high school sport specialization in top National Football League (NFL) athletes and determine whether associations exist between single-sport specialization and future injury risk, performance, and longevity.Methods: For NFL first-round draft picks from 2008-2017, data on the number of games played in the NFL, overuse injuries causing athletes to miss one or more regular season games, Pro Bowl selections, and current status in the NFL were collected using publicly available information.Results: A total of 318 athletes were analyzed. Multi-sport athletes were highly prevalent (88%, n = 280), while only 12% (n = 38) of athletes were classified as single-sport. No difference between multi-sport and single-sport athletes was found regarding games missed to upper (p = 0.93) or lower extremity injuries (p = 0.49), total games played (p = 0.57), or NFL longevity (p = 0.97). There was no significant difference in the proportions of athletes reaching at least 1 Pro Bowl.Conclusion: The majority of NFL first-round draft picks were multi-sport athletes in high school. Single-sport football participation in high school does not appear to aid athletes in reaching or succeeding in the NFL.

Relationship Between Pitch Volume and Subjective Report of Injury in High School Female Fast-Pitch Softball Pitchers

BACKGROUND

The relationship between pitch volume and injury is well-represented within baseball literature. However, the impact of softball pitch volume on injury epidemiology is limited.

HYPOTHESIS

The purpose was to determine if increased pitch volumes in high school-aged softball pitchers are related to increased rates of subjectively reported pain/injury. We hypothesized that pitchers with increased volumes would have higher pain/injury rates.

STUDY DESIGN

Cross-sectional study.

LEVEL OF EVIDENCE

Level 4.

METHODS

A total of 28 female softball pitchers (aged 14-18 years) completed an online survey of questions pertaining to pitching history, pitch volume, and subjective report of pain or injury in the back, shoulder, and elbow. An independent-samples t test was used to (1) compare pitch volumes in those who reported pain in individual body regions (shoulder, elbow, back) compared with those who did not; (2) compare pitch volumes in those who reported pain in 0 or 1 of the regions of interest compared with 2 or 3 regions; and (3) compare the reported percentage of the past year that players reported playing through pain in players who averaged >85 compared with <85 pitches per game. Chi-square analysis was used to compare those who pitched either >85 or <85 pitches per game with regard to frequency of shoulder pain, elbow pain, back pain, seeking of medical attention, and actual injury diagnosis. Type I error was set at α = 0.05.

RESULTS

Weekly and yearly pitch counts were higher in those reporting pain or injury (YES) than those who did not (NO) in the shoulder (pitches per week: NO = 219 ± 35; YES = 429 ± 101; P = 0.027) (pitches per year: NO = 8876 ± 946; YES = 19,195 ± 4944; P = 0.022) and back (pitches per week: NO = 188 ± 16; YES = 426 ± 90; P = 0.014) (pitches per year: NO = 8334 ± 793; YES = 18,252 ± 4340; P = 0.027). Similar results were observed for those with pain or injury reported in 2 or 3 regions compared with 0 or 1 regions (pitches per week: NO = 220 ± 38; YES = 414 ± 95; P = 0.039) (pitches per year: NO = 8765 ± 1010; YES = 18,661 ± 4623; P = 0.028). Those reporting shoulder pain or injury also reported higher pitch counts per game (NO = 71.4 ± 5.2; YES = 83 ± 4; P = 0.049), and those reporting back pain also reported playing more games per week (NO = 2.7 ± 0.2; YES = 5.2 ± 1.1; P = 0.034). Those with pitch counts of >85/game were more than twice as likely to see a physician regarding pain/injury (P = 0.027) and reported playing through pain a higher percentage of the year (>85, 49.3% ± 10%; <85, 25.2% ± 6%; P < 0.05).

CONCLUSION

High pitching volumes commonly prevalent in high school-aged softball pitchers may be associated with increased pain/injury and appear related to cumulative volume.

CLINICAL RELEVANCE

This study provides recommendations for cumulative pitch volume guidelines in softball pitchers.

Attractor dynamics of elite performance: the high bar longswing

Combining biomechanics and motor control, the aim of this study was to investigate the limit cycle dynamics during the high bar longswing across the UK elite gymnastics pathway age groupings. Senior, junior and development gymnasts (N = 30) performed three sets of eight consecutive longswings on the high bar. The centre of mass motion was examined through Poincaré plots and recurrence quantification analysis exploring the limit cycle dynamics of the longswing. Close to one-dimensional limit cycles were displayed for the senior (correlation dimension (CD) = 1.17 ± .08), junior (CD = 1.26 ± .08) and development gymnasts (CD = 1.33 ± .14). Senior elite gymnasts displayed increased recurrence characteristics in addition to longer longswing duration (p < .01) and lower radial angular velocity of the mass centre (p < .01). All groups of gymnasts had highly recurrent and predictable limit cycle characteristics. The findings of this research support the postulation that the further practice, experience and individual development associated with the senior gymnasts contribute to the refinement of the longswing from a nonlinear dynamics perspective. These findings support the idea of functional task decomposition informing the understanding of skill and influencing coaches' decisions around skill development and physical preparation.

Comparison of incidence, prevalence, severity and profile of health problems between male and female elite youth judokas: A 30-week prospective cohort study of 154 athletes

OBJECTIVES

To describe and compare the incidence, prevalence, severity, and profile of injuries (acute and overuse) and illness between female and male youth elite judokas during 30 weeks of a sports season.

DESIGN

Prospective cohort study.

METHODS

A total of 154 elite youth judokas (83 males and 71 females) were assessed from January to August 2019 in a training period organized by the Brazilian Judo Confederation. We conducted a prospective 30-week follow-up study on acute and overuse injuries and illness among youth female and male judokas through the Oslo Sports Trauma Research Center questionnaire on health problems (OSTRC-H). Every week, the OSTRC-H was sent to all youth judokas electronically, starting in the first week of preseason. The incidence rate, prevalence, and severity of illnesses and acute and overuse injuries were compared between sexes using an independent t-test (variables with normal distribution) or Mann Whitney U test (variables with non-normal distribution) with α set a 0.05.

RESULTS

Female and male judokas showed 16.96 and 16.57 injuries per 1000 athletic exposures, respectively (p = 0.383). Female judokas showed a higher average weekly prevalence of health problems (38.8%) than male judokas (29.0%). In addition, females had a greater prevalence of substantial health problems (p < 0.001), injuries (p < 0.001), and overuse injuries (p < 0.001) than males.

CONCLUSION

There were no differences in the incidence rate of injuries between sexes. Youth female judokas showed a higher prevalence of all health problems than youth male judokas. For both sexes, the knee and shoulder were the most affected joints for acute and overuse injuries, respectively.

Age Is More Predictive of Safe Movement Patterns Than Are Physical Activity or Sports Specialization: A Prospective Motion Analysis Study of Young Athletes

BACKGROUND

Movement quality and neuromuscular balance are noted predictors of acute injury. Early sports specialization and extremely high activity levels have been linked to elevated risk of injury.

PURPOSE

To investigate for any relationships among quality of physical movement, quantity of physical activity, and degree of sports specialization in a healthy cohort of active children and adolescents.

STUDY DESIGN

Cross-sectional study with prospectively collected data.

METHODS

Healthy children between the ages of 10 and 18 years were recruited and completed the Hospital for Special Surgery Pediatric Functional Activity Brief Scale to assess quantity of physical activity and the Jayanthi scale to assess degree of sports specialization (high, score of 2 or 3; low, score of 0 or 1). Movement quality was assessed using motion analysis sensors during 5 repetitions of 4 different jumping and squatting motions, with a maximum score of 100 per participant. Independent-samples t tests were used to compare participants with high versus low specialization on physical activity and movement quality. A Spearman correlation was used to determine the relationship between quantity of physical activity and movement quality, and linear regression was used to assess for the effect of participant age on relevant covariables.

RESULTS

Final analyses included 147 participants (72% male) with a mean ± SD age of 13.4 ± 2.2 years. Participants who were highly specialized displayed better movement quality than did participants with low sports specialization (27.6 ± 14.0 vs 19.8 ± 10.1; P < .01). Participants who were highly specialized had significantly higher activity levels (24.6 ± 5.9 vs 18.1 ± 6.9; P < .001). Movement quality was moderately correlated with physical activity level (r = 0.335; P < .001). Physical activity; hours of organized sports activity; hours of free, unorganized physical activity; and specialization level were not significant predictors of movement quality when controlling for age. Age alone predicted 24.2% of the variance in the overall movement quality score (R² = 0.242; B = 3.0; P < .001).

CONCLUSION

This study found that sports specialization and physical activity levels were not associated with movement quality when controlling for age, which was the most important variable predicting athletic movement quality. Although all participants displayed movement patterns that were associated with high risk for injury, overall movement quality improved with advancing chronological age.

CLINICAL RELEVANCE

All young athletes should ensure that neuromuscular training accompanies sport-specific training to reduce risk of injury.

High Specialization among Female Youth Soccer Players Is Associated with an Increased Likelihood of Serious Injury

PURPOSE

This study aimed to assess the associations between serious injury (≥3-month time loss) and level of specialization among high-level female soccer players and to compare the specialization and college commitment ages of female youth soccer players to Division I college and professional soccer athletes.

METHODS

Youth, college, and professional female soccer players in the United States playing in the top league at each level were recruited to complete an anonymous online survey. The survey collected information about player demographics, soccer specialization and training patterns, history of serious injuries from soccer, and perceptions surrounding soccer specialization. Comparisons between groups were performed using two-sample t-tests, χ2 analyses, and multiple logistic regression models controlling for differences in age. A P value of less than 0.05 was set as significant.

RESULTS

A total of 1,018 (767 youth, 251 college/professional) athletes completed the survey. Serious injuries affected 23.6% of youth and 51.4% of college/professional athletes. Anterior cruciate ligament tears were more prevalent in college/professional players compared with youth athletes (18.3% vs 4.0%; P < 0.001). Highly specialized youth athletes (66.5%) were more likely to have sustained a serious injury from soccer compared with athletes with low specialization (odds ratio, 2.28 (1.38-3.92); P = 0.008) but not moderate specialization (odds ratio, 1.37 (0.83-2.27); P = 0.43). A higher proportion of youth athletes specialized at a young age (≤10 yr) compared with college/professional players (44.2% vs 25.9%; P < 0.001).

CONCLUSIONS

High specialization in female youth soccer players is associated with an increased likelihood of sustaining a serious injury. Current youth soccer players are specializing earlier and committing to play college soccer at a younger age compared with when current college and professional players did.

Risk Factors, Diagnosis and Management of Bone Stress Injuries in Adolescent Athletes: A Narrative Review

Physical activity is known to be beneficial for bone; however, some athletes who train intensely are at risk of bone stress injury (BSI). Incidence in adolescent athlete populations is between 3.9 and 19% with recurrence rates as high as 21%. Participation in physical training can be highly skeletally demanding, particularly during periods of rapid growth in adolescence, and when competition and training demands are heaviest. Sports involving running and jumping are associated with a higher incidence of BSI and some athletes appear to be more susceptible than others. Maintaining a very lean physique in aesthetic sports (gymnastics, figure skating and ballet) or a prolonged negative energy balance in extreme endurance events (long distance running and triathlon) may compound the risk of BSI with repetitive mechanical loading of bone, due to the additional negative effects of hormonal disturbances. The following review presents a summary of the epidemiology of BSI in the adolescent athlete, risk factors for BSI (physical and behavioural characteristics, energy balance and hormone disruption, growth velocity, sport-specific risk, training load, etc.), prevention and management strategies.

Pediatric Orthopedics: Is One Fellowship Enough?

Dual-fellowship-trained surgeons specializing in both pediatric and sport medicine are treating an increasing number of pediatric orthopedic injuries, making pediatric orthopedic sports medicine a potential new emerging subspecialty. With fellowship training now being the norm rather than the exception across orthopedics, it is possible that dual-fellowship training may become a prerequisite for treatment of pediatric sports medicine patients. This may impact the practices of surgeons trained in either pediatric or sports medicine alone. As the trend toward dual-fellowship training is likely to continue, future studies are needed to characterize the impact it has on patient care and training patterns.

Early Sport Specialization Among Former National Collegiate Athletic Association Athletes: Trends, Scholarship Attainment, Injury, and Attrition

BACKGROUND

Many youth athletes focus on 1 sport to gain a competitive advantage, but early sport specialization may increase risk of overuse injuries and burnout. College athletes have successfully achieved advanced status; therefore, the study of their specialization patterns is a method to assess how specialization affects an athletic career.

PURPOSE

To determine trends in sport specialization by sex, sport, and decade of participation in National Collegiate Athletic Association (NCAA) athletes and assess the effect of specialization on scholarship attainment, injury, and attrition.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

An electronic survey was distributed to NCAA athletes who participated from 1960 to 2018. Survey topics included sex, sport, decade of participation, scholarship status, ≥30-day time-loss injuries sustained in college, orthopaedic surgery in college, career length, and age of single-sport specialization. Early specialization was defined as specialization in a single sport before age 15 years. Rates of early specialization were calculated for each sport, sex, individual and team sports, and decade of participation. Rates of scholarship attainment, injury, and attrition were compared between groups. Univariate associations were queried with logistic regression analysis to determine predictors of specialization, scholarship attainment, injury, and early attrition.

RESULTS

Of 1550 athletes who participated (17% response rate), 544 (35.1%) were women. Overall, 18.1% of athletes specialized before age 15 years (n = 281). Athletes in gymnastics, tennis, swimming and diving, and soccer were significantly more likely to specialize early, whereas football and baseball athletes were more likely to specialize late (P < .05 for all groups). Early specialization was more common among women (23.4% vs 15.2%; odds ratio, 1.72; P < .01). There was a trend toward earlier specialization for recent college graduates, with graduates from the last decade more likely to be classified as early specialization than those from previous decades (P = .036). Scholarship attainment was overall equivalent between groups. Time-loss injuries, lower extremity injuries, and orthopaedic surgery in college were not statistically different between groups. Career lengths were similar, but burnout was more common among early specialization athletes (10.5% vs 7.0%; odds ratio, 3.76; P < .01).

CONCLUSION

Less than one-fifth of NCAA athletes surveyed specialized before age 15 years, and neither scholarship attainment nor time-loss injury rate was affected by early specialization. Early specialization is on the rise but is associated with increased burnout.

Contrasts in fitness, motor competence and physical activity among children involved in single or multiple sports

Study aim: While there is wide debate around specialization in one sport, there is a lack of information about fitness levels and motor competence of children participating in single or multiple sports.

Material and methods: The study involved 358 fifth-grade children who participated in a set of health-related fitness and motor competence tests over two consecutive years. A subsample of children (n = 109) wore an accelerometer for seven consecutive days. The independent samples t-test and ANCOVA were used to compare differences between single and multi-sport participants in study variables and changes between baseline and follow-up.

Results: Multi-sport participants performed better in shuttle run (baseline/follow-up; p = 0.001/p = 0.006), push-up (p = 0.006/p = 0.036), and five leap tests (p = 0.001/p = 0.009) in baseline than single sport participants among boys. Likewise, multi-sport participants showed significantly more improvement in the throwing and catching combination test between study years among boys F1,159 = 3.570, p = 0.030. Among girls, no differences were found in any study variable between single and multi-sport participants.

Conclusions: From the perspective of fitness and motor competence tests, there are no arguments for participating in just one sport at an early age. Instead, multi-sport participants performed better than single sport participants in the majority of test variables.

Competition-Based Success Factors During the Talent Pathway of Elite Male Swimmers

Marginal differences in race results between top swimmers have evoked the interest in competition-based success factors of long-term athlete development. To identify novel factors for the multi-dimensional model of talent development, the aim of the study was to investigate annual variation in competition performance (ACV), number of races per year, and age. Therefore, 45,398 race results of all male participants (n = 353) competing in individual events, i.e., butterfly, backstroke, breaststroke, freestyle, and individual medley, at the 2018 European Long-Course Swimming Championships (2018EC) were analyzed retrospectively for all 10 years prior to the championships with Pearson's correlation coefficient and multiple linear regression analysis. Higher ranked swimmers at the 2018EC showed significant medium correlations with a greater number of races per year and small but significant correlations with higher ACV in 10 and nine consecutive years, respectively, prior to the championships. Additionally, better swimmers were older than their lower ranked peers (r = −0.21, p < 0.001). Regression model explained a significant proportion of 2018EC ranking for 50 m (47%), 100 m (45%), 200 m (31%), and 400 m races (29%) but not for 800 and 1,500 m races with number of races having the largest effect followed by age and ACV. In conclusion, higher performance variation with results off the personal best in some races did not impair success at the season's main event and young competitors at international championships may benefit from success chances that increase with age. The higher number of races swum per year throughout the career of higher ranked swimmers may have provided learning opportunities and specific adaptations. Future studies should quantify these success factors in a multi-dimensional talent development model.

Trends of Ulnar Collateral Ligament Reconstruction in the United States from 2003 to 2014: Analysis of 3,133 Patients

Purpose

The purpose of this study is to investigate the trends concerning ulnar collateral ligament (UCL) reconstruction (UCLR) for athletic injuries within the United States over the years 2003 to 2014.

Methods

A retrospective review of the Truven Health Marketscan® Commercial Database was conducted for patients undergoing UCLR. Data was reviewed for patients treated between 2003 and 2014, and the cohort of patients undergoing UCLR was queried using Common Procedural Terminology code 24346. Patients ages 11 to 40 years were included and divided into 6 different age groups, with the rate of UCLR calculated for each group.

Results

The overall rate of UCLR increased from 4.4 per million in 2003 to 11.9 per million in 2014 (p < .01). Throughout the same time period, the rate per million increased from 3.3 to 22.1 in 11- to 15-year-olds (p < .01), from 105.4 to 293.2 in 16- to 20-year-olds (p < .01), from 23.1 to 67.0 in 21- to 25-year-olds (p < .01), and from 2.1 to 5.7 in 31- to 35-year-olds (p < .01). There was no significant increase in the rate of UCLR in the age groups of 26 to 30 and 36 to 40 years.

Conclusion

UCLR was mostly performed in patients aged 11 to 25 years (96.6%), and specifically most common in those patients aged 16 to 20 years (67.4%). The rate of UCLR procedures increased over time for younger age groups significantly more than for their older counterparts.

Clinical Relevance

UCLR rates are increasing in young patients despite efforts addressing injury risk reduction strategies and education for coaches, players, and parents regarding risk factors for UCL injury.

Variation in competition performance, number of races, and age: Long-term athlete development in elite female swimmers

While talent development and the contributing factors to success are hardly discussed among the experts in the field, the aim of the study was to investigate annual variation in competition performance (AVCP), number of races per year, and age, as potential success factors for international swimming competitions. Data from 40’277 long-course races, performed by all individual female starters (n = 253) at the 2018 European Swimming Championships (2018EC) for all 10 years prior to these championships, were analyzed. Relationships between 2018EC ranking and potential success factors, i.e., AVCP, number of races per year, and age, were determined using Pearson’s correlation coefficient and multiple linear regression analysis. While AVCP was not related to ranking, higher ranked swimmers at the 2018EC swam more races during each of the ten years prior to the championships (P < 0.001). Additionally, older athletes were more successful (r = -0.42, P < 0.001). The regression model explained highly significant proportions (P < 0.001) and 43%, 34%, 35%, 49% of total variance in the 2018EC ranking for 50m, 100m, 200m, and 400m races, respectively. As number of races per year (β = -0.29 –-0.40) had a significant effect on ranking of 50-400m races, and age (β = -0.40 –-0.61) showed a significant effect on ranking over all race distances, number of races per year and age may serve as success factors for international swimming competitions. The larger number of races swum by higher ranked female swimmers may have aided long-term athlete development regarding technical, physiological, and mental skill acquisitions. As older athletes were more successful, female swimmers under the age of peak performance, who did not reach semi-finals or finals, may increase their chances of success in following championships with increased experience.

What Defines Early Specialization: A Systematic Review of Literature

Introduction: While practitioners and organizations advise against early specialization, the lack of a consistent and clear definition of early specialization reduces the impact of recommendations and policies in youth sport. An important first step in understanding the consequences of early specialization is establishing what early specialization is. Objectives: This PRISMA-guided systematic review aimed to determine the types, characteristics, and general content of early specialization papers within the literature, and examine how early specialization has been defined and measured in order to advance knowledge toward a clear and consistent definition of early specialization. Data sources: Four different electronic databases were searched (SPORTDiscus, Web of Science, Sports Medicine and Education Index, and Scopus). Both non data-driven and data-driven studies were included to ensure a comprehensive understanding of the literature. Eligibility Criteria: In order to be included in the review, the paper must: (a) Focus on specialization and explicitly use the term "specialization" (b) Focus on sport and athletes (c) Be papers from a peer-reviewed (d) Be in English. And finally, (e) be available in full text. Results: One thousand three hundred and seventy one articles were screened resulting in 129 articles included in the review after applying inclusion/exclusion criteria. Results indicated a clear discrepancy between key components of early specialization and the approaches used to classify early specializers. Conclusion: Future research should work toward developing a valid and reliable approach to classifying early specializers and establishing a consistent definition across studies.

Current Trends and Impact of Early Sports Specialization in the Throwing Athlete

Early sports specialization (ESS) is a relatively new trend that has led to many youth athletes to focus on only 1 sport at an increasingly young age. Although parents and coaches perceive that this will improve their athlete's chances of success at the collegiate and professional levels, studies have shown the opposite. ESS leads to increased injury risk, higher rates of burnout, and lower lifelong sports participation without increasing elite achievement. Throwing athletes are particularly vulnerable to these overuse injuries of the shoulder and elbow, which have been shown to correlate directly to the number of throws and innings played.