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

A National Survey on the Relationship of Youth Sport Specialization Behaviors to Self-Reported Anxiety and Depression in Youth Softball Players

BACKGROUND

There are little to no data on whether any associations exist between sport specialization and mental health in youth softball athletes.

HYPOTHESIS

Highly specialized youth softball athletes will have worse self-reported depression and anxiety symptom scores compared with low and moderate specialized athletes.

STUDY DESIGN

Cross-sectional survey.

LEVEL OF EVIDENCE

Level 4.

METHODS

An online cross-sectional survey was distributed in the fall of 2021 to a national sample of female youth softball athletes between the ages of 12 and 18 years. Sport specialization status was determined using a 3-point specialization scale that classifies either low, moderate, or high. The patient health questionnaire-9 (PHQ-9) and the 7-item general anxiety disorder scale (GAD-7) were used to assess self-reported symptoms of depression and anxiety. Comparison also included sports participation and specialization behaviors between specialization groups.

RESULTS

A total of 1283 subjects (mean age, 15.1 ± 1.7 years) fully completed the survey. After adjusting for covariates, lower scores were reported on both the PHQ-9 and GAD-7 by highly specialized athletes compared with moderate or low specialization athletes (PHQ-9, high = 8.6 ± 0.4; moderate = 11.2 ± 0.3; low = 10.9 ± 0.5; P < 0.01; GAD-7, high = 6.5 ± 0.4; moderate = 8.6 ± 0.3; low = 8.4 ± 0.4, P < 0.01). Conversely, higher scores were reported on both scales for athletes who received private softball coaching compared with those who did not (PHQ-9, 11.5 ± 0.3 vs 9.0 ± 0.3; P < 0.01; GAD-7, 8.8 ± 0.3 vs 6.9 ± 0.3, P < 0.01). Finally, athletes who reported an arm overuse injury in the previous year reported higher PHQ-9 scores (10.8 ± 0.3 vs 9.8 ± 0.3; P < 0.01).

CONCLUSION

While sport specialization, as measured by the validated 3-point scale, was not associated with increased anxiety and depression symptom scores, other aspects of specialization behavior such as private coaching or overuse injury history were associated with worse scores on these scales, indicating potential concern for anxiety and depression. However, although the differences we observed were statistically significant, they did not exceed the minimal clinically important difference values that have been established for the PHQ-9 (5 points) or GAD-7 (4 points).

CLINICAL RELEVANCE

This project is a first step toward understanding the sport specialization behaviors and their influence on the mental health of youth softball athletes. Focusing on investigating specialization behaviors further may reveal to be a better indicator of risk of developing anxiety and depression symptoms compared with utilizing the 3-point specialization scale.

Sport Specialization and Sport Motivation in Middle School-Aged Athletes

CONTEXT

Sport specialization has been assumed to have psychosocial ramifications for athletes, especially autonomous motivation, which has been associated with continued sport participation. Sport dropout is common in youth athletes, yet it is unknown how sport specialization may affect this population psychosocially.

OBJECTIVE

To determine the association of sport specialization with autonomous and controlled motivation and amotivation in middle school-aged athletes.

DESIGN

Cross-sectional study.

SETTING

An anonymous online questionnaire was distributed to athletes via schools, club sports, and social media.

PATIENTS OR OTHER PARTICIPANTS

A total of 178 athletes (male = 59%; private school = 51%; grade: sixth = 20%, seventh = 32%, eighth = 48%) completed the questionnaire.

MAIN OUTCOME MEASURE(S)

The questionnaire assessed demographics, sport participation, and motivation using the Youth Behavioral Regulation in Sport Questionnaire. Sport specialization was defined using a modified 3-point scale (low, moderate, or high) and multisport versus single-sport athletes. Nonparametric tests were used to analyze the differences among the types of motivation and specialization levels and between multisport and single-sport athletes.

RESULTS

Sport specialization categories were not significantly associated with autonomous motivation, controlled motivation, or amotivation. No significant associations were present between multisport or single-sport athletes and any type of motivation. However, multisport athletes had higher scores for intrinsic motivation, a subscale of autonomous motivation, compared with single-sport athletes (single sport: median = 5.00, 25th-75th quartile = 4.50-5.00; multisport: median = 5.00, 25th-75th quartile = 5.00-5.00; P = .04).

CONCLUSIONS

Sport motivation did not differ between sport specialization groups in middle school athletes. Dropout from sport is common in this age group but is multifactorial in nature. A lack of sport motivation could be a factor for some athletes, but all specialization groups appeared to have similar outcomes. Our exploratory analysis suggests that clinicians may consider having an open dialogue with single-sport athletes, their parents or guardians, and coaches to ensure that athletes are enjoying their sport.

Injury Patterns in Highly Specialized Youth Athletes: A Comparison of 2 Pathways to Specialization

CONTEXT

Sport specialization, commonly defined as intensive year-round training in a single sport to the exclusion of other sports, has been associated with an increased risk for overuse injury. Two pathways to becoming highly specialized are recognized: (1) having only ever played 1 sport (exclusive highly specialized) and (2) quitting other sports to focus on a single sport (evolved highly specialized). Understanding the differences in injury patterns between these groups of highly specialized athletes will inform the development of injury-prevention strategies.

OBJECTIVE

To compare the distribution of injury types (acute, overuse, serious overuse) among evolved highly specialized athletes, exclusive highly specialized athletes, and low-moderately specialized athletes.

DESIGN

Cross-sectional study.

SETTING

Tertiary care pediatric sports medicine clinic between January 2015 and April 2019.

PATIENTS OR OTHER PARTICIPANTS

A total of 1171 patients (age = 12.01-17.83 years, 59.8% female) who played ≥1 organized sports, presented with a sport-related injury, and completed a sports participation survey.

MAIN OUTCOME MEASURE(S)

Distribution of injury types (acute, overuse, serious overuse).

RESULTS

The percentage of injuries due to overuse was similar between the exclusive and evolved highly specialized athletes (59.2% versus 53.9%; P = .28). Compared with low-moderately specialized athletes, exclusive and evolved highly specialized athletes had a higher percentage of overuse injuries (45.3% versus 59.2% and 53.9%, respectively; P = .001). Multivariate analysis of the highly specialized groups revealed sport type to be a significant predictor of a higher percentage of injuries due to overuse, with individual-sport athletes having increased odds of sustaining an overuse injury compared with team-sport athletes (odds ratio = 1.95; 95% CI = 1.17, 3.24).

CONCLUSIONS

The distribution of injury types was similar between evolved and exclusive highly specialized youth athletes, with both groups having a higher percentage of injuries due to overuse compared with low-moderately specialized athletes. Among highly specialized athletes, playing an individual sport was associated with a higher proportion of overuse injuries compared with playing a team sport.

Risk Factors for Running-Related Injury in High School and Collegiate Cross-country Runners: A Systematic Review

OBJECTIVE: To summarize and describe risk factors for running-related injuries (RRIs) among high school and collegiate cross-country runners. DESIGN: Descriptive systematic review. LITERATURE SEARCH: Four databases (Scopus, SPORTDiscus, CINAHL, Cochrane) were searched from inception to August 2023. STUDY SELECTION CRITERIA: Studies assessing RRI risk factors in high school or collegiate runners using a prospective design with at least 1 season of follow-up were included. DATA SYNTHESIS: Results across each study for a given risk factor were summarized and described. The NOS and GRADE frameworks were used to evaluate quality of each study and certainty of evidence for each risk factor. RESULTS: Twenty-four studies were included. Overall, study quality and certainty of evidence were low to moderate. Females or runners with prior RRI or increased RED-S (relative energy deficiency in sport) risk factors were most at risk for RRI, as were runners with a quadriceps angle of >20° and lower step rates. Runners with weaker thigh muscle groups had increased risk of anterior knee pain. Certainty of evidence regarding training, sleep, and specialization was low, but suggests that changes in training volume, poorer sleep, and increased specialization may increase RRI risk. CONCLUSION: The strongest predictors of RRI in high school and collegiate cross-country runners were sex and RRI history, which are nonmodifiable. There was moderate certainty that increased RED-S risk factors increased RRI risk, particularly bone stress injuries. There was limited evidence that changes in training and sleep quality influenced RRI risk, but these are modifiable factors that should be studied further in this population. J Orthop Sports Phys Ther 2024;54(2):1-13. Epub 16 November 2023. doi:10.2519/jospt.2023.11550.

Higher Family Affluence is Associated With Multi-Sport Participation Among Irish Youth

The impact of early single sport participation among young people has received much attention, with both sport leaders and pediatricians advocating multi-sport participation at least until early adolescence. In this study we explored the association between family socioeconomic status and level of Irish youth specialization in sport. We relied on data from the Children's Sport Participation and Physical Activity (CSPPA) study, involving a representative sample of 3499 Irish children and adolescents aged 10-15 years. We analyzed data from questions related to the number of sports played, the number of days per week the youth were engaged in sport, and family affluence (as a proxy measure for socioeconomic status). Youth sport specialization before 12 years of age (males 5.7%; females 4.2%) and even between 13-15 years of age (males, 7.8%; females, 5.8%) was uncommon. However, lower levels of specialization were associated with higher socioeconomic status in that more children with high family affluence participated in multiple sports. Careful consideration should be given to whether low socioeconomic status may act as a barrier to participation in multiple sports.

Training volume recommendations and psychosocial outcomes in adolescent athletes

OBJECTIVES

Researchers have recommended that youth athletes limit their practice volume to the number of hours/week that they are old in years. We examined sport perceptions, burnout, anxiety, and depressive symptoms among youth athletes who did and did not report playing more hours/week of organized sports than their age.

METHODS

Uninjured athletes aged 13-18 years old completed questionnaires documenting demographics, sport participation volume, health and injury history, depressive symptoms, anxiety, burnout, and sport perceptions during a pre-participation physical examination. We grouped participants as those who reported more hours/week in organized sports than their age (exceeds age/volume recommendation) vs. those who reported equal/less hours/week in organized sports than their age (meets age/volume recommendation).

RESULTS

Of 161 participants, 21% (n = 33) were in the 'exceeds age/volume recommendation' group (age = 15.2 ± 1.3 years; 55% female; 18.7 ± 4.0 hours/week) and 79% (n = 128) were in the 'meets age/volume recommendation' group (age = 15.6 ± 1.2 years; 50% female; 10.2 ± 3.4 hours/week). A higher proportion of the 'exceeds age/volume recommendation' group agreed with the statement 'youth in my sport play too many games before college' than the 'meets age/volume recommendation' group (33% vs. 16%; p = 0.03). After adjusting for the effect of age, sport specialization level, and weight, exceeding age/volume recommendations was associated with the perception that youth in sports play too many games before college (aOR = 3.24; 95% CI = 1.26, 8.29; p = 0.01), while burnout (aOR = 0.99; 95% CI = 0.94, 1.06; p = 0.93), anxiety (aOR = 0.97; 95% CI = 0.84, 1.11; p = 0.65), and depressive symptoms (aOR = 0.90; 95% CI = 0.74, 1.10; p = 0.30) were not significantly related.

CONCLUSION

Athletes who spend more hours in sport than their age appear to perceive their competition load during youth sports to be excessive. Coaches and providers should monitor athlete's training hours and perceptions of competition load to offer support and potentially prevent burnout development.

Inequalities in the Evaluation of Male Versus Female Athletes in Sports Medicine Research: A Systematic Review

BACKGROUND

Female sports participation continues to rise; however, inequalities between male and female athletes still exist in many areas and may extend into medical research.

PURPOSE

The purpose of this study was to (1) compare the number of published studies evaluating male versus female athletes in various sports and (2) identify which co-ed sports currently underrepresent female athletes in the sports medicine literature.

STUDY DESIGN

Systematic review; Level of evidence, 4.

METHODS

All nonreview research studies published from 2017 to 2021 in 6 top sports medicine journals were considered for inclusion. Sports medicine studies were included that isolated athletes, reported study outcomes specific to male and/or female patients, provided study outcomes for specific sports, and evaluated ≤3 different sports. The total number of studies reporting on male and/or female athletes were compared for all sports, and odds ratios (ORs) were calculated. Comparisons of study design, level of sports participation, outcomes assessed, and study quality were also made according to participant sex.

RESULTS

Overall, 669 studies were included the systematic review. Most studies isolated male athletes (70.7%), while 8.8% isolated female athletes and 20.5% included male and female athletes. Female athletes were more frequently studied in softball and volleyball, while male athletes were more commonly researched in baseball, soccer, American football, basketball, rugby, hockey, and Australian football. Notably, male athletes were largely favored in baseball/softball (91% vs 5%; OR = 18.2), rugby (72% vs 5%; OR = 14.4), soccer (65% vs 15%; OR = 4.3), and basketball (58% vs 18%; OR = 3.2).

CONCLUSION

Sports medicine research has favored the evaluation of male athletes in most sports, including the majority of co-ed sports. Potential reasons for this inequality of research evaluation include availability of public data and database data, financial and promotional incentives, a high percentage of male sports medicine clinicians and researchers, and sex biases in sport. While the causes of these differences are multifaceted, researchers should consider both sexes for study inclusion whenever possible, and journals should support a more balanced representation of research publications regarding male and female athletes.

Early Sport Specialization and Long-term Throwing Arm Health in College Baseball Players

BACKGROUND

Early sport specialization is associated with increased risk of overuse injuries in several sports, including baseball. However, limited evidence exists evaluating how early sport specialization affects patient-reported outcome measures as they age. The purpose of this study was to determine differences in Kerlan-Jobe Orthopedic Clinic (KJOC) Shoulder and Elbow Scores among collegiate baseball players based on the grade when a participant first reported high specialization behaviors.

HYPOTHESIS

Baseball players who were highly specialized at a younger age will have worse throwing arm health while participating in college.

STUDY DESIGN

Cross-sectional study.

LEVEL OF EVIDENCE

Level 3.

METHODS

A total of 752 college baseball players was contacted through their institution's athletic trainer. We measured baseball specialization and KJOC scores using the validated Baseball and Sport Experience survey. Data were summarized using means and SDs, medians and interquartile ranges (IQRs), and frequencies and percentages. A Kruskal-Wallis test was used to determine differences in mean KJOC scale scores based on the earliest time the participant reported high-level specialization.

RESULTS

A total of 294 baseball players completed the survey (response rate: 39.1%). Of the 294 participants, 280 completed the KJOC scale questions to generate a total KJOC score (median: 90.5; IQR: 76.6-97.2). No significant differences in KJOC total scores (P = 0.78) existed based on the grade period in which the athlete was first highly specialized.

CONCLUSION

Early baseball specialization as a youth baseball player may not impact throwing arm health in college baseball athletes.

CLINICAL RELEVANCE

Early specialization has been linked to increased risk for overuse injuries in certain sports, but may not lead to poorer throwing arm health in college baseball players. Sports medicine clinicians and researchers may use this information to educate various stakeholders about the benefits and risks associated with early sport specialization.

High Sport Specialization Is Associated With More Musculoskeletal Injuries in Canadian High School Students

OBJECTIVE

To describe levels of sport specialization in Canadian high school students and investigate whether sport specialization and/or sport participation volume is associated with the history of musculoskeletal injury and/or concussion.

DESIGN

Cross-sectional study.

SETTING

High schools, Alberta, Canada.

PARTICIPANTS

High school students (14-19 years) participating in various sports.

INDEPENDENT VARIABLES

Level of sport specialization (high, moderate, low) and sport participation volume (hours per week and months per year).

MAIN OUTCOME MEASURES

Twelve-month injury history (musculoskeletal and concussion).

RESULTS

Of the 1504 students who completed the survey, 31% were categorized as highly specialized (7.5% before the age of 12 years). Using multivariable, negative, binomial regression (adjusted for sex, age, total yearly training hours, and clustering by school), highly specialized students had a significantly higher musculoskeletal injury rate [incidence rate ratio (IRR) = 1.36, 95% confidence interval (CI), 1.07-1.73] but not lower extremity injury or concussion rate, compared with low specialization students. Participating in one sport for more than 8 months of the year significantly increased the musculoskeletal injury rate (IRR = 1.27, 95% CI, 1.02-1.58). Increased training hours significantly increased the musculoskeletal injury rate (IRR = 1.18, 95% CI, 1.13-1.25), lower extremity injury rate (IRR = 1.16, 95% CI, 1.09-1.24), and concussion rate (IRR = 1.31, 95% CI, 1.24-1.39).

CONCLUSIONS

Approximately one-third of Canadian high school students playing sports were categorized as highly specialized. The musculoskeletal injury rate was higher for high sport specialization students compared with low sport specialization students. Musculoskeletal injuries and concussion were also more common in students who train more and spend greater than 8 months per year in one sport.

Impact of the COVID-19 Pandemic Hiatus From Sports Activities on Injuries Observed Among Division I NCAA Athletes

Background

The coronavirus disease 2019 (COVID-19) pandemic significantly disrupted athletic activities, including those in the Pacific 12 (Pac-12) Conference of the National Collegiate Athletic Association. It is currently unknown how the disruption in training and competition impacted athletes' risk of injury upon resumption of activities.

Purpose

To describe and compare the rate, timing, mechanism, and severity of injuries among collegiate athletes across multiple sports in the Pac-12 Conference before and after the COVID-19 pandemic-associated hiatus of intercollegiate athletic activities.

Study Design

Descriptive epidemiology study.

Methods

Descriptive and injury data among intercollegiate athletes from both the season before the hiatus and the season after the hiatus were acquired from the Pac-12 Health Analytics Program database. Injury elements (timing of injury onset, injury severity, mechanism, recurrence, outcome, need for procedural intervention, and event segment during which the injury took place) were compared by time using the chi-square test and a multivariate logistic regression model. Subgroup analyses were performed on knee and shoulder injuries among athletes participating in sports with traditionally high rates of knee and shoulder injuries.

Results

A total of 12,319 sports-related injuries across 23 sports were identified, with 7869 pre-hiatus injuries and 4450 post-hiatus injuries. There was no difference in the overall incidence of injury between the pre-hiatus and post-hiatus seasons. However, the proportion of noncontact injuries was higher in the post-hiatus season for football, baseball, and softball players, and the proportion of nonacute injuries in the post-hiatus season was higher among football, basketball, and rowing athletes. Finally, the overall proportion of injuries sustained by football players in the final 25% of competition or practice was higher in the post-hiatus season.

Conclusion

Athletes competing in the post-hiatus season were observed to have higher rates of noncontact injuries and injuries sustained in the final 25% of competition. This study demonstrates that the COVID-19 pandemic has had varied effects on athletes from different sports, suggesting that many factors must be considered when designing return-to-sports programs for athletes after an extended absence from organized training.

Early Sport Specialization Trends and Injuries in Former High School Athletes Specialized in Sports

Purpose

Determining the effects of early specialization in a specific sport is difficult. Therefore, it is necessary to investigate its effects based on the type of sports. The purpose of this study was to investigate the proportion of participants who had been participating in a single sport, in individual or team sports from an early age and to compared the prevalence of acute and overuse injuries among these participants.

Methods

A total of 1377 adult participants (team sports = 700, individual sports = 637) retrospectively completed a questionnaire assessing sports participation from elementary school to high school and injury history (acute and overuse) at high school age. The proportions of the specialized / nonspecialized groups per sport type were compared, and differences in acute or overuse injury prevalence were examined.

Results

The proportion of the specialized group participants who continued to play the same single sport from elementary school age to high school age was greater in team sports (33.6%) than that in individual sports (19.2%) (p < 0.01). The specialized group participating in team sports had a greater prevalence of overuse injury at high school age than the nonspecialized group (p < 0.05) who previously participated in several sports. However, the prevalence of overuse injury at high school did not significantly differ between the specialized and nonspecialized groups participating in individual sports.

Conclusion

More children who continued to play only one sport from elementary school age to high school age played in team sports in Japan. They also had a higher prevalence of overuse injuries when they were at high school age. It is necessary to consider the environment to play multi sports before high school age, especially in team sports.

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.

The Association of Sport Specialization With Youth Ice Hockey Position and Youth Ice Hockey Parents’ Perceptions of Sport Specialization

Attitudes and beliefs of parents about sport specialization may indicate why youth athletes decide to specialize. The purpose of this study was to determine the association between sport specialization level, ice hockey position, and the parent/guardians’ attitudes and beliefs on sport specialization. Our results demonstrate that goalies were the most likely to specialize, and parents of specialized ice hockey players tend to believe that sport specialization helps their child achieve future sporting aspirations. Increased sport specialization may put ice hockey goalies at an increased risk for overuse injuries, and parents’ beliefs about sport specialization may impact their child’s sporting behaviors.

Attitudes and beliefs of little league baseball parents regarding sport specialization and college scholarship availability

OBJECTIVES

Previous studies of parents of adolescent athletes identified a belief among parents of the importance of early specialization for skill development. However, it is unclear if these attitudes and beliefs are also held among parents of baseball athletes, which is the second-most popular boy's sport in the United States. The purpose of this study was to describe the knowledge, attitudes, and beliefs of parents of Little League baseball players regarding sport specialization and college scholarships.

METHODS

Two-hundred and forty-four parents of Little League baseball players (female parents: 60.7%, parent age: 41.1 ± 6.2 years old, male children: 98.0%, child age: 9.5 ± 1.6 years old) completed an anonymous online questionnaire regarding parent attitudes and beliefs on sport specialization and college scholarships.

RESULTS

Most parents (72.4%) felt that specialization would increase their child's baseball ability either 'quite a bit' or 'a great deal.' Fewer than half of all parents (42.0%) reported that specialization was either 'quite a bit' or 'a great deal' of a problem. Parents underestimated the availability of Division I college baseball scholarship availability (median [IQR]: 5 [4-10]), compared to the actual value of 11.7 scholarships per Division I roster. Only 10.2% of parents (N = 25) reported that they believed it was 'somewhat' or 'very' likely that their child would receive a college baseball scholarship.

CONCLUSION

Further efforts are needed to understand parent attitudes and beliefs regarding sport specialization and college scholarships in various sports to better understand current trends in youth sport participation.

Sport Specialization Classification and Injury Risk in Female Athletes

BACKGROUND

Description of possible detrimental effects of sport specialization specific to adolescent female athletes is limited in current literature with no consensus on sport specialization classification.

HYPOTHESIS

Specialized female athletes will have higher rates of injury, body image issues, and menstrual dysfunction, regardless of the specialization classification utilized.

STUDY DESIGN

Cross-sectional.

LEVEL OF EVIDENCE

Level 3.

METHODS

Retrospective data was obtained from questionnaires from female athletes in local high schools (n = 229; 13-18 years of age). The 3-point specialization scale was used to analyze differences in injury rates, body image issues, and menstrual dysfunction within low, moderate, and highly specialized athletes. When comparing accuracy of specialization scales in identifying high risk athletes, three peer-reviewed specialization classification scales were utilized-a 3-point scale, a 6-point scale, and a binary self-selection scale. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for studied variables (a priori p ≤ 0.05).

RESULTS

Of 229 athletes surveyed, 219 (95.6%) completed the 3-point specialization classification questions and were included in the study. 91 athletes (41.6%) were categorized as low specialization (LS), 59 (26.9%) were moderately specialized (ModS), and 69 (31.5%) were highly specialized (HS). ModS athletes were more likely to have a history of stress fractures (SFx) compared to LS athletes (p = 0.02; OR 3.62; 95% CI 1.27-10.26). Compared to LS athletes, HS athletes were more likely to have injury history (p = 0.01; OR 2.93; 95% CI 1.38-6.24) and a history of concussion (p < 0.01; OR 5.00; 95% CI 1.86-13.42).

CONCLUSION

Among female high school athletes, higher levels of specialization are associated with greater risk of injuries overall, and greater risk of concussions and SFx. This study did not demonstrate significant associations between specialization and body image issues or menstrual dysfunction.

CLINICAL RELEVANCE

This study further strengthens the association between injury and sport specialization and suggests that combining specialization scales better improves risk stratification which overall aids in preventing athlete injury.

Multidisciplinary Neuromuscular and Endurance Interventions on Youth Basketball Players: A Systematic Review with Meta-Analysis and Meta-Regression

The main aims of this systematic review with meta-analysis and meta-regression were to describe the effect of multidisciplinary neuromuscular and endurance interventions, including plyometric training, mixed strength and conditioning, HIIT basketball programs and repeated sprint training on youth basketball players considering age, competitive level, gender and the type of the intervention performed to explore a predictive model through a meta-regression analysis. A structured search was conducted following PRISMA guidelines and PICOS model in Medline (PubMed), Web of Science (WOS) and Cochrane databases. Groups of experiments were created according to neuromuscular power (vertical; NPV and horizontal; NPH) and endurance (E). Meta-analysis and sub-groups analysis were performed using a random effect model and pooled standardized mean differences (SMD). A random effects meta-regression was performed regressing SMD for the different sub-groups against percentage change for NPV and NPH. There was a significant positive overall effect of the multidisciplinary interventions on NPV, NPH and E. Sub-groups analysis indicate differences in the effects of the interventions on NPV and NPH considering age, gender, competitive level and the type of the intervention used. Considering the current data available, the meta-regression analysis suggests a good predictability of U-16 and plyometric training on jump performance. Besides, male and elite level youth basketball players had a good predictability on multidirectional speed and agility performance.

EVIDENCE-BASED SPORTS MEDICINE TO PREVENT KNEE JOINT INJURY IN TRIPLE JUMP

ABSTRACT Introduction: Triple jump has high technical requirements. However, in recent years, the frequent knee injuries during the training of triple jump athletes have seriously impacted their training and competition levels. Objective: This article proposes a method for modeling knee joint injury caused by triple jump athletes overtraining based on an improved principal component analysis algorithm. It also studied the relationship between movement amplitude and sports injury. Methods: We obtained the optimal hyperplane showing data on the relationship between sports injury and joint motion range through the triple jump in the decision table. Then, the relationship model between the two was established. The article estimated the principal components of triple jump athletes’ knee joint injuries and established an accurate model relating the overtraining of these athletes and their knee joint injuries. Results: The accuracy of improved algorithm modeling is closer to that of physical examination outpatient records than to that of traditional algorithm modeling. Conclusion: The relationship model between triple jump injury and joint motion range was established using the improved algorithm. This model can greatly improve the accuracy of the relationship between the two and can effectively prevent triple jump injuries. Level of evidence II; Therapeutic studies - investigation of treatment results.

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.

Epidemiology of overuse injuries in U.S. secondary school athletics from 2014-2015 to 2018-2019 using the National Athletic Treatment, Injury and Outcomes Network Surveillance Program

CONTEXT

With 8 million annual participants in the United States, the epidemiology of sports-related injuries in high school athletics has garnered significant interest. The most recent studies examining overuse injury rates in high school sports reported data from 2012-2013 and therefore may not reflect current overuse injury rates in high school sports.

OBJECTIVE

To 1) to determine overuse time-loss (TL) and non-time-loss (NTL) injury rates among high school student athletes using NATION-SP data collected from 2014-2015 to 2018-2019 and 2) compare overuse injury rates based on student-athlete gender defined by sport, sport, and injury location.

DESIGN

Descriptive epidemiology study.

SETTING

Online injury surveillance from 211 high schools (345 individual years of high school data).

PATIENTS OR OTHER PARTICIPANTS

Athletes participating in secondary school-sponsored boys' and girls' sports.

MAIN OUTCOME MEASURES

Boys' and girls' overuse injury data from the National Athletic Treatment, Injury and Outcomes Network Surveillance Program (NATION-SP) from the 2014-2015 to 2018-2019 school years were analyzed. Overuse injuries were identified using a combination of reported injury mechanism and diagnosis. TL injuries resulted in restriction from participation beyond the day of injury; a NTL injury did not result in restriction from participation beyond the day of injury or lost no time due to the injury. Injury counts, rates, and rate ratios (IRRs) were reported with 95% confidence intervals (CIs).

RESULTS

The overall overuse injury rate was 5.3/10,000 AEs (95%CI=5.1, 5.7), the NTL overuse injury rate was 3.4/10,000 AEs (95%CI=3.1, 3.6), and the TL overuse injury rate was 2.0/10,000 AEs (95%CI=1.8, 2.2). The overuse injury rate was greater in girls' sports compared to boys' sports (IRR=1.9; 95%CI=1.7, 2.1). The highest rates of overuse injury were reported in girls' cross-country (19.2/10,000 AEs; 95%CI=15.0, 24.2), girls' track and field (16.0/10,000 AEs; 95%CI=13.5, 18.8), and girls' field hockey (15.1/10,000 AEs; 95%CI=10.2, 21.6). Overuse injury rates were highest for the lower extremity compared to the upper extremity (IRR=5.7; 95%CI=4.9, 6.7) and for the lower extremity compared to the trunk and spine (IRR=8.9; 95%CI=7.3, 10.8).

CONCLUSIONS

Awareness of overuse injury risk as well as prevention and intervention recommendations are necessary and should be specifically targeted towards cross-country, field hockey, and track and field athletes.

High School Sport Specialization and Injury in Collegiate Club-Sport Athletes

CONTEXT

Sport specialization during adolescence may affect future injury risk. This association has been demonstrated in some professional sport athletes.

OBJECTIVE

To determine the association between adolescent sport specialization levels in high school and injuries sustained during collegiate club sports.

DESIGN

Cross-sectional study.

SETTING

Paper and online surveys.

PATIENTS OR OTHER PARTICIPANTS

Collegiate club-sport athletes.

MAIN OUTCOME MEASURES(S)

An anonymous survey was administered from September 2019 to May 2020. The survey included sport specialization classification via a commonly used 3-point scale (low, moderate, high) for each high school year (9th-12th), high school sports participation, and collegiate club-sport injury history. The number of years (0-4) an individual was highly specialized in high school was calculated. Individuals who participated in the same sport in high school and college were compared with individuals who played a different sport in college than in high school. An injury related to sport club activities was classified as arising from a contact, noncontact, or overuse mechanism required and the individual to seek medical treatment or diagnosis. Injuries were classified into overuse and acute mechanisms for the upper extremity, lower extremity (LE), and head/neck.

RESULTS

Single-sport participation and the number of years highly specialized in high school sport were not associated with college club-sport injuries (P > .1). Individuals who played a different collegiate club sport than their high school sport were more likely to report an LE or head/neck acute injury compared with athletes who played the same collegiate and high school sport (LE = 20% versus 8%, χ2 = 7.4, P = .006; head/neck = 16% versus 3%, χ2 = 19.4, P < .001).

CONCLUSIONS

Adolescent sport specialization was not associated with reported injuries in collegiate club-sport athletes. Collegiate club-sport athletic trainers should be aware that incoming students exploring a new sport may be at risk for LE and head/neck acute injuries.

Sport Specialization, Physical Performance and Injury History in Canadian Junior High School Students

BACKGROUND

Youth sports participation is encouraged for proposed physical and psychological benefits. However early sport specialization and the potentially negative consequences may be a cause for concern.

PURPOSE

To describe sport specialization in Canadian youth and investigate associations with previous injury and physical performance.

STUDY DESIGN

Cross-sectional study.

METHODS

Junior high school students (grades 7-9, ages 11-16) were invited to participate. All participants completed a questionnaire capturing specialization level (low, moderate, high; based on year-round training, exclusion of other sports, and single-sport training) and injury history in the previous 12-months. Additionally, all participants completed physical performance measures including vertical jump (cm), predicted VO2max (mL/kg/min), single-leg balance (secs) and Y-Balance composite score (%). Logistic regression examined the association between school grade, school size, sex and sport specialization (Objective 1) and the association between sport specialization and injury history (Objective 2). Multivariable linear regression analyses (4) assessed associations between sport specialization category and physical performance measures (Objective 3).

RESULTS

Two hundred and thirty-eight students participated in the study. Eighteen percent of participants reported high specialization, with no significant associations between sex, grade or school size and specialization category. There was no significant difference in the odds of sustaining previous injury between participants reporting moderate (odds ratio [OR]=1.94, 95% CI 0.86-4.35) or high (OR=2.21, 95% CI 0.43-11.37) compared to low specialization. There were no significant differences in vertical jump height (mean diff [MD] = -0.4 to 2.1cm), predicted VO2max (MD = 2.2 to 3.1mL/kg/min), single leg balance (MD = 0.5 to 1.9sec) or Y-balance (MD = 0.6 to 7.0%) between sport specialization categories.

CONCLUSIONS

Sport specialization exists in Canadian junior high schools but may be less common than previously reported and it was not associated with sex, grade, or school size. Level of specialization was not associated with history of injury nor a range of physical performance measures.

LEVEL OF EVIDENCE

Level 3.

Changes in U.S. girls' participation in high school sports: implications for injury awareness

CONTEXT

The number of female athletes has grown exponentially since Title IX. However, little data exists on the proportion of women and girls who play each sport.

OBJECTIVE

To quantify changes in female sports participation in high school sports from 1973 to 2018.

DESIGN

Retrospective analysis of data from the National Federation of State High School Associations Participation Survey.

SETTING

US high schools.

PARTICIPANTS

US high school athletes from 1973 to 2018.

MAIN OUTCOME MEASURES

Percentage of female participation for each high school sport in 5-year intervals; and changes in rates of participation by player gender and sport at designated intervals.

RESULTS

From 1973 to 2018, the percentage of high school sports played by girls increased from 24.2% to 42.9% ([95%CI, 18.6,18.8], p < 0.0001). In the 14 sports included in our study, all had an increase in the percentage of female participation between 1973 and 2018. >80% of the increases occurred between 1973 and 1998 for all sports except lacrosse, ice hockey, football, and wrestling. Between 1998 and 2018, the percentage of girls playing each sport increased by less than 5% in all sports, except for ice hockey (11.5%, 95% CI 11.0, 12.0, p < 0.001) and wrestling (7.1%, 95% CI 6.9, 7.1, p < 0.001).

CONCLUSIONS

Girls' participation in high school sports continues to grow not only in numbers but in the types of sports played. Between 1998 and 2018, the greatest increases were noted in ice hockey and wrestling, which had fewer than 1% female participation before 1998. Physicians providing care for female athletes should be aware of these changes and understand the potential injuries associated with these sports.

Training in spikes and number of training hours correlate to injury incidence in youth athletics (track and field): A prospective 52-week study

OBJECTIVES

The aim was to describe the annual incidence and types of musculoskeletal injuries, and to examine factors associated with injury risk.

DESIGN

A 52-week prospective study in Swedish youth athletics aged 12-15 years.

METHODS

Data on exposure to training and injury were collected from parents/caregivers and youth athletes using a web-survey system.

RESULTS

A total of 101 (86%) youth athletes participated. Fifty-four (53%) of the athletes reported one new injury. Girls were at higher risk of sustaining an injury than boys (p = 0.048). Ninety-one percent of the new injuries were non-traumatic and 85% occurred in the lower extremities. Injuries to the front thigh represented 20% of the injuries. Cox proportional hazard regression analyses showed a six-fold increased risk for a first injury for athletes reporting use of spikes and training <6 h every two weeks (hazard ratio, 6.1; 95% confidence interval, 1.2-31.3) compared to athletes training <6 h using no spikes. Athletes training 6 h or more reporting use or no use of spikes had an eight-fold increase injury risk (p < 0.01).

CONCLUSIONS

Almost half of the youth athletes experienced a new injury and girls had a higher risk compared to boys. Nine out of ten injuries were related to overuse. An interesting observation was the high incidence of injuries to the quadriceps muscle complex. The study identified a correlation with training hours and an interaction with track spikes and risk of injury that needs further attention.

Acceleration profile of high-impact movements during young football games: a cross-sectional study involving healthy children

Repetitive high-impact movements cause growth-related injuries in children. This study aimed to identify which movements during junior football games require >6 G and >8 G acceleration and the frequency at which they occur. Additionally, we compared the components of acceleration among movements with >8 G resultant acceleration. Eleven young male footballers (10.7 ± 0.4 years) played 8-a-side games while wearing a tri-axial accelerometer on their upper back. The number and frequency of the movements that generated >6 G and >8 G were calculated, and each directive acceleration of the top five items was compared using two-way ANOVA to examine the effect of movements. The frequency of movements that generated >6 G and >8 G acceleration during junior football games was 8.70 case/min and 2.62 case/min, respectively. The top five >8 G movements were braking and pre-braking in shuffle, slowdown, stop, and run/jog items. The vertical acceleration was significantly greater during braking in shuffle than during slowdown, stop, and run/jog and also greater during stop and pre-braking in shuffle than during run/jog movement. This pilot study suggests that decelerated movements mainly provoked high-impact situations and may be key actions for preventing overuse injury in young footballers.

How injury registration and preseason assessment are being delivered: An international survey of sports physical therapists

OBJECTIVE

To identify the role of sports physical therapists (PT) in the organization of injury registration and preseason assessment, applied in athletic organizations and sports teams of different gender and level world-wide.

DESIGN

cross-sectional study.

SETTING

LimeSurvey platform.

PARTICIPANTS

Sports PTs working with athletes invited through International Federation of Sports Physical Therapy.

MAIN OUTCOME MEASURES

injury registration and athlete's screening.

RESULTS

414 sports PTs participated in this international survey (mean age of 37.66 (SD = 9.38) years). 340 participants indicated that the PT as the responsible for injury registration. Barriers to properly register injury throughout the season were indicated by 157 sports PT and 86 (54.77%) indicated a lack of time on their routine as the main factor. 93 participants (30.09%) indicated that they customize the prevention program based on the preseason assessment. Sports PTs who reported not performing a preseason assessment (92 participants - 22.22%) mainly indicated this to be consequence of lack of structure in the organization (44 participants - 47.82%).

CONCLUSION

The majority of the sports PTs participate on injury registration and perform preseason assessment in athletes. However, lack of time in their routine and structure in the organization were recognized as the most important barriers to organize these properly.

Sport Specialization Behaviors Are Associated With History of Reported Injury in Youth Basketball

BACKGROUND

There is significant emerging evidence that early sport specialization is a potential risk factor for injury in youth sports. Despite basketball being the most popular youth team sport in the United States, sport specialization research, specifically in youth basketball players, has been limited. The purpose of this paper was to examine the association of sport specialization behaviors with injury history by surveying a nationally representative sample of parents of youth basketball athletes. We hypothesized that athletes who specialized in basketball, participated on multiple teams at the same time, and traveled regularly for basketball competitions would be more likely to report a basketball-related injury in the previous year.

METHODS

A nationally representative sample of 805 parents of 805 youth basketball players (female N=241, 29.9%; age: 12.9±2.5 y old) completed an online questionnaire that had 3 sections: (1) parent/child demographics, (2) child basketball participation information for the previous year, and (3) child basketball injury history in the previous year. Multivariate logistic regression examined the associations between variables of interest and injury history, adjusting for covariates. Odds ratios (ORs) with 95% confidence intervals (95% CI) were calculated for the variables of interest from the logistic regression model.

RESULTS

Highly specialized athletes were more likely than low specialization athletes to report history of basketball injury in the previous year [OR (95% CI): 2.47 (1.25-4.88), P=0.009]. The odds of reporting an injury in the previous year were twice as great among athletes who played on a basketball team at the same time as another sport team compared with those who played basketball only [OR (95% CI): 1.98 (1.30-3.01), P=0.001]. The odds of reporting an injury in the previous year were 3 times greater among athletes who received private coaching compared with those who did not receive private coaching [OR (95% CI): 2.91 (1.97-4.31), P<0.001].

CONCLUSION

Specialization in basketball, along with several other behaviors that have become typical of modern youth sport participation, were associated with reported injury history. Further prospective research is necessary to determine whether sport specialization behaviors increase the risk of injury in youth basketball.

LEVEL OF EVIDENCE

Level III-cross-sectional study.

Volleyball-related injuries in adolescent female players: an initial report

OBJECTIVE

To determine the prevalence and risk factors associated with musculoskeletal injuries sustained in female adolescent volleyball players.

METHODS

Volleyball players (n = 276; 13-18 years), with any level of volleyball experience, were recruited. Participants completed a study-specific survey about their overall sport(s) involvement, training modalities, volleyball experience (beginner, intermediate, advanced), annual volume of volleyball play, injuries accrued during volleyball, and care received for injury.

RESULTS

Annual volume of volleyball play was higher in advanced than beginner/intermediate players (490.0 hr/yr versus 302.3 hr/yr; p < 0.0001). Nearly 67% (188/276) of participants incurred one or more volleyball-related injuries over the last year. The ankle (40.6%), fingers (36.6%), knee (21.2%), and shoulder (15.5%) were the most frequently reported injury. Injury prevalence was higher in advanced than beginner/intermediate players (73.5% versus 62.0%; p = 0.04). Beginner/intermediate players have significantly higher odds ratio (OR) of sustaining an elbow injury than advanced players (OR 5.88; p = 0.025). 21.5% of injured players missed more than one month of play.

CONCLUSION

More competitive and experienced adolescent female players may incur injuries due to progressively higher volumes of play as experience and competition level increase. Players who have committed to only playing volleyball participated in greater volumes of volleyball play, which increases the odds of sustaining an injury.

CLINICAL RELEVANCE

Understanding injury risk factors may improve clinical management and injury prevention.

An epidemiologic comparison of acute and overuse injuries in high school sports

Background

Acute and overuse injuries affect millions of high school athletes annually and a better understanding of differences between these injuries is needed to help guide prevention, treatment, and rehabilitation strategies. This study compares acute and overuse injuries using a nationally representative sample of high school athletes.

Methods

Injuries among United States high school athletes participating in 5 boys’ sports (football, soccer, basketball, wrestling, baseball) and 4 girls’ sports (soccer, volleyball, basketball, softball) reported in the High School RIO™ surveillance system during the 2006-07 through 2018-19 school years were classified as acute or overuse. National estimates and injury rates were calculated.

Results

Of 17 434 646 estimated injuries, 92.0 % were acute and 8.0 % were overuse. The acute injury rate was higher than the overuse injury rate among both male (Rate Ratio [RR] 16.38, 95 % CI: 15.70–17.10) and female (RR 8.14, 95 % CI: 7.71–8.60) athletes. The overuse injury rate per 10,000 athlete exposures among female athletes (1.8) was slightly higher than among males (1.4). The rate of acute injury compared with the rate of overuse injury was higher during competition (RR 32.00, 95 % CI: 29.93–34.22) than practice (RR 7.19, 95 % CI: 6.91–7.47). Boys’ football contributed the most acute (42.1 %) and overuse (23.7 %) injuries among the 9 sports. Among female sports, girls’ soccer contributed the most acute (15.6 % of all acute injuries) and overuse (19.4 % of all overuse injuries) injuries. The lower extremity was most commonly injured in acute (48.9 %) and overuse (65.9 %) injuries. Ligament sprain (31.7 %) and concussion (21.0 %) were the most common acute injury diagnoses, while muscle strain (23.3 %) and tendonitis (23.2 %) were the most common overuse injury diagnoses. Compared with acute injuries, overuse injuries were more likely to result in time loss from sports participation of < 1 week among both boys and girls and across most sports. Acute injuries were more likely than overuse injuries to cause a time loss of 1–3 weeks or medical disqualification from sports participation.

Conclusions

Acute and overuse injuries display many differences that provide opportunities for data-informed athlete preparation, treatment, and rehabilitation, which may reduce injuries and improve injury outcomes in high school athletics.

Early sports specialisation and the incidence of lower extremity injuries in youth athletes: current concepts

Year-round intensive, single-sport training beginning at an young age is an increasingly common trend in the youth athlete population. Early sport specialisation may be ineffective for long-term athletic success and contribute to an increased risk of physical injury and burn-out. The medical community has noted that repetitive movement patterns may occur in non-diversified activity and this may contribute to overuse injury in young athletes. Studies have begun to identify an association between early sport specialisation and lower extremity injuries in the youth athlete population that is independent of training volume. Recent literature has suggested that sport diversification, not specialisation, is a better path for athletic success and minimised lower extremity injury risk.

The association of sport participation behaviors with throwing-arm health in Little League Baseball pitchers

Background and Hypothesis

There is increasing concern about the role sport specialization might play in the increasing injury rates observed among youth baseball pitchers. However, existing research on specialization in baseball has focused on high school and professional baseball populations. We hypothesized that pitchers who were highly specialized, reported pitching more than eight months in the past year, received private coaching, or pitched with pain or fatigue in the previous year would report worse throwing-arm health.

Methods

One-hundred eighty-four Little League pitchers (boys N = 181, age 9.8 ± 1.6 years old) between 7 and 12 years of age completed an anonymous, online questionnaire with their parents' assistance. The questionnaire consisted of participant demographics, sport specialization status, months of pitching per year, whether they traveled regularly to participate in showcases, if they received private coaching, whether they pitched with elbow or shoulder pain, whether they pitched with fatigue, and the Youth Throwing Score (YTS), a valid and reliable patient-reported outcome measure for youth baseball players. The associations between variables of interest and YTS were examined using multivariable linear regression, adjusting for covariates.

Results

Sport specialization, pitching year-round, and receiving private coaching were not associated with the YTS (P > .05). Pitching with pain in the previous year was associated with a worse YTS score than pitching without pain (least square mean [standard error]: 49.6 [1.8] vs. 57.8 [1.1], P < .001). Similarly, pitching with fatigue in the previous year was associated with worse YTS scores (least square mean [standard error]: 52.1 [1.4] vs. 55.3 [1.3], P = .01). Pitchers who reported traveling regularly for showcases scored worse on the YTS compared with those who did not travel regularly for showcase events (least square mean [standard error]: 51.0 [2.0] vs. 56.4 [0.9], P = .01).

Conclusions

Pitching with pain or fatigue was associated with worse throwing-arm health in Little League baseball pitchers. While traveling at least once a month to participate in showcases was also associated with worse throwing-arm health, specialization and private coaching were not related to worse throwing health. Clinicians working with pediatric patient populations should be aware that while the factors examined in this article were reported relatively infrequently, screening for Little League pitchers who participate in showcases or pitch with pain or fatigue may be an effective strategy for identifying these individuals who are at higher 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.

Financial and medical burdens of youth sports specialization - survey of pediatric sports patients

BACKGROUND

The trend towards youth sports specialization has led to increased costs from higher injury rate and from private club fees. The objectives were to characterize the financial and medical burdens of sports specialization with single sport participation or club sports involvement.

METHODS

An 18-item survey on sports participation and musculoskeletal injury was administered to parents of patients visiting the clinic of a pediatric sports medicine orthopaedic surgeon over a three-month period. Comparisons were made between groups to identify differences in medical and financial burdens. Logistic regressions were performed to evaluate odds ratios for binary outcomes.

RESULTS

Club athletes were significantly younger than non-club athletes (12.9 ± 3.1 years versus 14.9 ± 2.8 years, p = .0002) with club athletes starting sports at average of 7.2 ± 3.1 years. Club sports participation (adjusted OR 5.88, 95% CI: 1.10, 31.4) and female sex (adjusted OR 3.47, 95% CI: 1.12, 10.74) were significant predictors of spending > $1000 USD on sports annually. Multisport participation (OR 5.72, 95% CI: 1.21, 26.96) and spending > $1000 on sports annually (OR 17.21, 95% CI: 1.49, 199.25) were significant predictors of presenting to clinic for a sports-related injury. Single sport athletes had a higher number of medical appointments for sports injuries (18.6 ± 23.0 versus 9.3 ± 10.0 for multisport, p = .0042).

CONCLUSIONS

Youth sports specialization is of substantial financial and medical burden to families. This data can help identify areas of intervention to mitigate injury risk and reduce financial barriers to youth sports participation.

Prevalence and Consequences of Sport Specialization Among Little League Baseball Players

BACKGROUND

Baseball is one of the most popular boy's youth sports, and there has been a rise in the rates of certain overuse injuries among players. Specialization has been identified as a risk factor for overuse injury in high school athlete populations, but there is little understanding of the prevalence or consequences of sport specialization in Little League baseball players.

HYPOTHESIS

Sport specialization will be highly prevalent among Little League baseball players and specialization will be associated with worse throwing arm health.

STUDY DESIGN

Cross-sectional study.

LEVEL OF EVIDENCE

Level 3.

METHODS

A total of 246 Little League baseball players (male; N = 241; age, 9.5 ± 1.6 years) between 7 and 12 years old completed an anonymous, online questionnaire with their parent's assistance. The questionnaire consisted of participant demographics and baseball participation information, including sport specialization status and the Youth Throwing Score (YTS), a valid and reliable patient-reported outcome measure for youth baseball players.

RESULTS

Only 29 (11.8%) players met the criteria for high specialization. Approximately one-third of all players (n = 77; 31.3%) reported participating in baseball year-round or receiving private coaching outside of their league (n = 81; 32.9%). Highly specialized athletes demonstrated worse scores on the YTS on average compared with low-specialization athletes (mean [SE]: 56.9 [1.6] vs 61.1 [1.2]; P = 0.01). Similarly, pitching in the previous year (P < 0.01) or traveling overnight regularly for showcases (P = 0.01) were associated with a worse score on the YTS.

CONCLUSION

While the prevalence of high sport specialization was low among Little League baseball players, other behaviors associated with specialization such as year-round play and the receiving of private coaching were more common. Highly specialized Little League players demonstrated worse throwing arm health compared with low-specialization players.

CLINICAL RELEVANCE

Little League players and their parents may represent a potential target audience for dissemination campaigns regarding sport specialization.

Physical function characteristics in Japanese high school volleyball players with low back pain: A case-controlled study

Low back pain (LBP) is a typical symptom in volleyball players, yet associated physical function factors have not been identified. This study purpose is to determine the relationship between LBP and physical function factors in order to identify potential factors for the management of LBP.Participants were 123 male and female volleyball players of 15- to 17-year-olds who, completed a questionnaire regarding demographic details, presence of LBP, and years of volleyball experience. Participants were divided into 2 groups based on the presence of current LBP and evaluated on physical function tests. The results of the questionnaire response and physical function test were compared between the 2 groups. Data were analyzed using a multivariate logistic regression analysis with presence and absence of current LBP as the explanatory variable.11.4% of all participants reported current LBP. Physical function factors associated with current LBP were a positive modified Thomas test, years of volleyball experience and reduced range of motion of shoulder horizontal abduction on the dominant hand side.The associations between physical function factors and LBP found in this survey suggest that attention should be given to more experienced players with decreased flexibility of hip and shoulder flexors on the dominant side in order to manage LBP in high school volleyball players.

Sport specialization and sport participation opportunities and their association with injury history in female high school volleyball athletes

OBJECTIVE

Determine the association of sport specialization in female volleyball athletes with previous injury history and determine the association of sport specialization with volleyball participation opportunities.

DESIGN

Cross-sectional.

SETTING

Recruitment occurred from 83 Wisconsin high schools during the 2018 volleyball season.

PARTICIPANTS

Female volleyball athletes (N = 1,588, grades 9-12, age = 15.6 ± 1.1 years).

MAIN OUTCOMES

Participants completed a pre-season questionnaire soliciting information regarding 1) demographics, 2) sport specialization, 3) sport participation, and 4) sport-related injuries in the previous 12 months. Univariable logistic regression models were used to identify associations with previous injury. Chi-square analyses were used to investigate associations between sport specialization classification and other sport participation opportunities.

RESULTS

Both moderately and highly specialized athletes were more likely to report a previous injury compared to low specialized athletes (moderate OR: 1.84 [1.29-2.62]; p < 0.001 and high OR: 2.30 [1.64-3.24]; p < 0.001). Highly specialized athletes were more likely to report participating in club volleyball, summer tournaments, and training camps in the past 12 months. Participants who reported participating in club volleyball, summer competitions, and training camps last year were more likely to report an injury.

CONCLUSIONS

Specialization was associated with injury history and year-round volleyball opportunities among female adolescent volleyball athletes.

Deliberate Practice, Functional Performance and Psychological Characteristics in Young Basketball Players: A Bayesian Multilevel Analysis

BACKGROUND

Early sport specialization has increased its popularity mostly based on the deliberate practice theory premises. In this study, we examined the influence of the age of onset of deliberate basketball practice on body size, functional performance (countermovement jump, line drill and yo-yo intermittent recovery level 1), motivation for achievement and competitiveness, motivation for deliberate practice and sources of enjoyment among young Brazilian basketball players. In addition, we adjusted for the influence of gender, age group, maturity status and state basketball federation on the outcomes.

METHODS

The sample included 120 female and 201 male adolescent basketball players aged 14.0 (1.7) years, on average. We grouped players by the age of onset of deliberate basketball practice as related to biologic maturation milestones (pre-puberty deliberate practice onset, mid-puberty deliberate practice onset and late-puberty deliberate practice onset).

RESULTS

There was no substantial variation among contrasting players by the onset of deliberate practice in all of the outcomes. Adjusting for gender, male players with late-puberty deliberate practice onset had better functional performance than players with pre- and mid-puberty onset of practice. Females players with late-puberty deliberate practice onset had slightly worst functional performance than players with pre- and mid-puberty onset of practice.

CONCLUSIONS

Early deliberate basketball practice does not appear to provide an advantage for the development of physiological functions. Likewise, enjoyment, motivation for deliberate practice and motivation for achievement and competition do not appear to be negatively influenced by early deliberate basketball practice. The debate about the relationship between time spent in deliberate practice and performance development in young athletes will need to emphasize the coaching pedagogical quality and the training environment and account for informal practice and deliberate play.

Ultrasound of sports injuries of the musculoskeletal system: gender differences

In recent years, women and girls are increasing their sport participation, and female sports are becoming more challenging. While more women and girls are participating in sports, there is still a lack of information about gender-specific lesions. We will therefore evaluate gender differences in sports injuries, analyzing the five sports and sporting activities that are most widespread in the western world: running, soccer, basketball, water sports, and winter sports. The ability to make correct ultrasonographic diagnoses in sports injuries is improving as the technology is advancing. Ultrasonography demonstrates tissue structure with two-dimensional grayscale images, while blood flow can be visualized with color and power Doppler. Furthermore, ultrasonography is the preferred imaging modality for studying soft-tissue lesions dynamically. High-quality diagnostic ultrasound cannot be performed without the knowledge of the underlying clinical background, and an understanding of gender-specific injuries and mechanisms of injuries is therefore important for assessing proper diagnostic and treatment guidelines tailored to phenotypic differences in professional and amateur athletes between male and female.

Sports Specialization and Intensive Training in Young Athletes

Sports specialization is becoming the norm in youth sports for a variety of reasons. When sports specialization occurs too early, detrimental effects may occur, both physically and psychologically. If the timing is correct and sports specialization is performed under the correct conditions, the athlete may be successful in reaching specific goals. Young athletes who train intensively, whether specialized or not, can also be at risk of adverse effects on the mind and body. The purpose of this clinical report is to assist pediatricians in counseling their young athlete patients and their parents regarding sports specialization and intensive training. This report supports the American Academy of Pediatrics clinical report "Overuse Injuries, Overtraining, and Burnout in Child and Adolescent Athletes."