Association of Competition Volume, Club Sports, and Sport Specialization With Sex and Lower Extremity Injury History in High School Athletes

Abstract

Background:High school athletes are increasingly encouraged to participate in 1 sport year-round to increase their sport skills. However, no study has examined the association of competition volume, club sport participation, and sport specialization with sex and lower extremity injury (LEI) in a large sample of high school athletes.Hypothesis:Increased competition volume, participating on a club team outside of school sports, and high levels of specialization will all be associated with a history of LEI. Girls will be more likely to engage in higher competition volume, participate on a club team, and be classified as highly specialized.Study Design:Cross-sectional study.Level of Evidence:Level 3.Methods:High school athletes completed a questionnaire prior to the start of their competitive season regarding their sport participation and previous injury history. Multivariable logistic regression analyses were used to investigate associations of competition volume, club sport participation, and sport specialization with history of LEI, adjusting for sex.Results:A cohort of 1544 high school athletes (780 girls; grades 9-12) from 29 high schools completed the questionnaire. Girls were more likely to participate at high competition volume (23.2% vs 11.0%, χ2 = 84.7, P < 0.001), participate on a club team (61.2% vs 37.2%, χ2 = 88.3, P < 0.001), and be highly specialized (16.4% vs 10.4%, χ2 = 19.7, P < 0.001). Athletes with high competition volume, who participated in a club sport, or who were highly specialized had greater odds of reporting a previous LEI than those with low competition volume (odds ratio [OR], 2.08; 95% CI, 1.55-2.80; P < 0.001), no club sport participation (OR, 1.50; 95% CI, 1.20-1.88; P < 0.001), or low specialization (OR, 2.58; 95% CI, 1.88-3.54; P < 0.001), even after adjusting for sex.Conclusion:Participating in high sport volume, on a club team, or being highly specialized was associated with history of LEI. Girls were more likely to participate at high volumes, be active on club teams, or be highly specialized, potentially placing them at increased risk of injury.Clinical Relevance:Youth athletes, parents, and clinicians should be aware of the potential risks of intense, year-round participation in organized sports.

Sport Specialization and Risk of Overuse Injuries: A Systematic Review With Meta-analysis

“…The application of the inclusion and exclusion criteria during the full-text review resulted in the exclusion of 7 studies. Two studies were removed because they were not explicitly focused on overuse injury, 24,25 1 was removed because the comparison was between athletes with high specialization in team sports and athletes with high specialization in individual sports, 26 1 was removed because the authors did not directly compare specialized and nonspecialized groups and the measurement of specialization was not clearly defined, 27 and 3 studies were removed because the athletes fell outside of the established age range, 28 -30 leaving 5 studies from which data were abstracted and synthesized in the results.…”

“…Post et al 24 examined the association between specialization and injury and found that athletes with specialization were more likely to report a history of any type of injury in the previous year. Unfortunately, the authors did not explicitly focus on overuse injury, and we were unable to include this article in the review.…”

Different Perceptions of Parents and Children on Factors Influencing Sport Specialization

“…Currently, a widely used 3-point sport specialization classification system exists to better classify (low, moderate, and high) youth athletes to help quantify and evaluate the risk factors outlined in these recommendations. 9,10,16,17 This classification system has been used to identify an association between highly specialized youth athletes and overuse injuries. The athletes were categorized in the 3-point specialization classification system as either lowly, moderately, or highly specialized, dependent upon their answers or the parents' answers about their child.…”

“…9 The consequences of sport specialization include overuse injuries and burnout. 1,4,6,[8][9][10][11][12] These consequences have prompted various medical organizations to release position statements warning against sport specialization, as well as recommending the need for more research on the limited data supporting these recommendations. 1,7 These recommendations include time-based measurements for sport participation-such as months per year and hours per week, as well as avoiding participating in multiple leagues at the same time-to provide guidelines for youth athletes in organized sport to help prevent overuse injury.…”

Patellofemoral Chondral Defect in a Preadolescent Skier: A Case Report in Early Sport Specialization

“…This approach to training is highly controversial; recent literature suggests that this type of specialized training may increase the rate of acute injuries, overuse injuries, and ultimately lead to decreased sports participation. [2][3][4] Sports which require high velocity movement and change of direction demands, for example alpine skiing, can lead to lower extremity overuse injuries. 5,6 Anterior knee pain (AKP) is a common complaint in youth athletes.…”