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Risk of injury and specialization in young athletes

Summary of an article investigating how the age of specialization influences the risk of injuries in young athletes.

Who

579 children and adolescents (males: 269, females: 310) participating in at least one oranized sport aged 7 to 18 years (average at baseline 14 ±2.3) recruited through sports injury clinics (USA).

Design

Prospective survey on current sport specialization, pubertal maturation every 6 months (up to 3 years) and an additional surveys related to injuries.

Outcome measures

  • Tanner stage of pubertal maturation
  • specialization, scored on a presence or absence of these aspects (1 - low specializer, 2 - moderate specilizer, 3 - high specializer, 4 - extreme specializer):
    • single-sport training
    • exclusion of other sports
    • year-round training (more than 8 months)
    • specialization before the age of 12 years
  • injuries acute (related to single traumatic event), overuse (gradual onset, no specific traumatic event), and serious overuse (at least 1 month rest from training)
  • re-injury (repeat of an old injury)

Main results

  • The most common injury body parts were:
    • knee (22%)
    • ankle and foot (18%)
    • low back (14%)
  • Over the 3 years of study, there was a trend of increasing number of extreme specializers and decreasing number of low specializers.
  • High specializers had 1.72 times greater odds of (all-cause) injury than low specializers (95%CI: 1.35-2.20) and 1.52 times greater odds than moderate specializers (95%CI: 1.18-1.96) (univariate analysis).
  • Adjusting for sex, age, time from baseline, BMI, weekly hours in organized sports, high specializers had 1.41 times more likely to have an (all-cause) injury than low specializers (95%CI: 1.06-1.87), as were the moderate specializers (OR: 1.38, 95%CI: 1.04-1.84). The odds of injury increased by 31% for every 5 hours of organized sports per week.
  • Female athletes, athletes with increased weekly hours of activity and hours of organized sports were associated with overuse injuries (univariate analysis). Females had increased odds of an overuse injury by 43% comparing to male athletes.
  • High specializers were 1.46 times more likely to have an overuse injury than low specializers.
  • No association between reinjury and specialization (and other variables) was found.

Take home message

For a clinician
Among young athletes, the ones who were highly specialized were >40% more likely to get injured (both all-cause and overuse injuries). Also, female athletes were 43% more likely to develop an overuse injury than male athletes.
For a parent
Among young athletes, the ones who were highly specialized were more likely to get injured (both all-cause and overuse injuries). Also, female athletes were more likely to develop an overuse injury than male athletes.
For an athlete
High specialization increases your risk for having an injury, especially if you are a girl.

Original article

Jayanthi N, Kleithermes S, Dugas L, Pasulka J, Iqbal S, LaBella C. Risk of injuries associated with sport specialization and intense training patterns in young athletes: a longitudinal clinical case-control study. Orthopaedic journal of sports medicine. 2020 Jun 23;8(6):2325967120922764.

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