The Effect of Single Sport Specialization in Youth Sports: Does It Increase the Risk of

Injury? A Prospective Study

Danielle Weekes MD, Richard Campbell, BS, Fotios Tjoumakaris MD, Matthew D. Pepe MD, Bradford S. Tucker MD

Rothman Orthopaedic Institute

Disclosure Information

Consultant • Mitek

• DePuy

• Knee Creations

Stocks • Johnson & Johnson

• Franklin/Keystone Biosciences

• Trice Medical

Introduction

Youth participation in organized athletic activities has considerably increased over the last 2 decades.

1997: 44 million → 2008: 60 million1

81% of Children in the United States1,2

Adolescents are choosing to specialize in a single sport and exclude other sports, often at an earlier age.3,4

Potential Motives for Early Specialization

Competitive advantage

Collegiate scholarships

Professional career opportunity

Olympic participation

Introduction

• High school athletes who trained for more than 8 months per year are 3 times as likely to

report an history of an overuse knee injury.5

• Pediatricians have raised concerns about high intensity training programs

• The American Academy of Pediatrics has published guidelines addressing the intensity of

training of specialized pediatric athletes.3

• Physician Concerns:

• Intense physical demands on immature musculoskeletal system.

• Potential increased risk of overuse injuries

• Effect on non-musculoskeletal organ systems

Aims

1. Determine the prevalence of sport specialization among high school athletes.

2. Investigate the relationship between sport specialization and athletic injuries in both a retrospective and prospective fashion.

Methods: Study Design

• Potential participants were recruited from 3 high schools within our geographic practice distribution.

• 883 Freshman and sophomore high school athletes who did not previously participate in the school athletic program were enrolled with the plan to be followed until graduation.

• Data Collection:

• Pre-seasonal survey • Demographics, current sport commitment, intensity of training, and prior injuries • Conducted in the fall, winter and spring

• Assessment of sport specialization by questionnaire • Certified Athletic Trainer records at the end of each season. • Athletes’ physician medical records when applicable.

Results

Parameter Specialized Non-Specialized

Total 365 (41.3%) 518 (58.7%)

Male 204 (40.9%) 295 (59.1%)

Female 161 (41.9%) 223 (58.1%)

Age of initial competitive sport participation∗ 7.3 years ± 2.7 8.3 years ± 3.2

Hours/week participating in organized sport activities∗

6 hours/week 5 hours/week

∗: significant difference, p <0.05

• Injuries Reported • 60.2% Specialized vs. 52.3% Non-

specialized (p = 0.02, OR: 1.38)

• Season ending injuries reported • 38.1% Specialized vs. 29.3% non-

specialized (p < 0.01, OR: 1.48)

• 38.3% of specialized athletes believed specializing in one sport contributed to their previous injuries.

Results: Prevalence of Retrospective Injuries

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Specialized Athlete Non-Specialized Athlete

Pe

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f A

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in C

oh

ort

Prevalence of Retrospective Injuries

• 25 injuries occurred in 21

specialized athletes (6.8% injuries

per athlete).

• 30 injuries occurred in 25 non-

specialized athletes (5.8% injuries

per athlete).

• There was no significant difference

in the prevalence of injury in each

group (p = 0.52).

Results: Prevalence of Prospective Injuries

0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

10%

Specialized Athlete Non-Specialized Athlete

Pe

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nta

ge o

f A

thle

tes

in C

oh

ort

Prevalence of Prospective Injuries

Conclusions

Over 40% of high-school athletes specialized in a sport before or during their freshman and sophomore year.

Specialized athletes begin participating in competitive sports earlier in life, and dedicated more of their time to organized athletic activities.

Retrospectively: Specialized athletes are more likely to have a history of sports related injuries and were more likely to have participation limiting injuries.

Prospectively: Higher rate of injury among specialized athletes, although this relationship was not significant.

References

1. National Council of Youth Sports. Report on Trends and Participation In Organized Youth Sports National Council of Youth Sports.; 2018. https://ncys.org/pdfs/2008/2008-ncys-market-research-report.pdf. Accessed December 7, 2018.

2. Annie E. Casey Foundation. The Changing Child Population of the United States An Analysis of the U.S. Population Under 18 Using Data From the 2010 Census.; 2011. https://www.aecf.org/m/resourcedoc/AECF-ChangingChildPopulation-2011-Full.pdf. Accessed December 8, 2018.

3. Intensive Training and Sports Specialization in Young Athletes. Pediatrics. 2000;106(1):154 LP-157.

4. Jayanthi NA, Holt Jr DB, LaBella CR, Dugas LR. Socioeconomic Factors for Sports Specialization and Injury in Youth Athletes. Sports Health. 2018;10(4).

5. Bell DR, Post EG, Trigsted SM, Hetzel S, Mcguine TA, Brooks MA. Prevalence of Sport Specialization in High School Athletics A 1-Year Observational Study.

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