Sex Differences in Competition Volume, Club Sport Participation, Specialization, and Injury Among High School Athletes

Abstract

Female adolescent athletes are at greater risk for certain injuries, such as ACL injuries or overuse knee injuries. One theory for this increased risk is the increasing trend towards intense, year-round sport participation and specialization. However, it is unknown whether characteristics of sport participation, including competition volume, club sport participation, specialization, or history of lower extremity injury (LEI) differ between female and male athletes. PURPOSE: To compare level of competition volume, club sport participation, sport specialization, and previous lower LEI between males and females in high school athletes. METHODS: 1525 high school athletes (780 female, age=16.1 ± 1.1 years old, grades 9-12) from 29 high schools were recruited to complete a pre-season questionnaire regarding their sport participation patterns and previous injury history. Sport competition volume in the previous 12 months was classified as high (>60 competitions), moderate (30-60 competitions), or low (<30 competitions). Sport specialization status was classified as low, moderate, or high using a widely utilized 3-point specialization scale. Chi-square tests were used to investigate associations of competition volume, club sport participation, specialization, and LEI by sex (a-priori p<.05). RESULTS: Females were more likely than males to participate in 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). A total of 487 subjects (31.5%) reported sustaining a total of 599 previous time-loss LEI. Female athletes were more likely to report a previous LEI than males when considering all sports (36.5% vs. 27.0%, χ2=15.9, p < 0.001) and when the sample was restricted to sex-equivalent sports (37.3% vs. 28.2%, χ2=9.0, p = 0.003). CONCLUSIONS: Female athletes were more likely to participate in sports at high volumes, on club teams in addition to their high school teams, be highly specialized, and report previous LEI. Female high school athletes may be at greater risk of injury due to these differences in sport participation patterns. Supported by grants from the American Medical Society for Sports Medicine and the National Federation of State High School Associations.