Level Of Sport Specialization Research Articles

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.

Sports Specialization, Physical Literacy, and Physical Activity Levels in Young Adults.

Youth sport specialization may be associated with physical literacy and physical activity in young adulthood. The purposes of this study were to compare young adult (18-25y) physical literacy and physical activity by high school sport specialization status and to examine the relationship between current physical activity and physical literacy. Retrospective, cross-sectional study design. Participants were recruited from ResearchMatch, university classes, and social media posts. Participants (N = 172; aged 22.1 [2.1] y; 80.1% female) completed the following anonymous surveys on REDCap to assess: demographics and injury history, sport specialization, physical literacy (PLAYself), and physical activity (Godin Leisure-Time Exercise Questionnaire). When controlling for age, there were no statistically significant differences in physical literacy (F2,166 = 2.02, P = .14) or moderate to vigorous physical activity (F2,161 = 0.24, P = .79) between sport specialization groups. There was a moderate, positive relationship between physical literacy and physical activity (r = .33, P < .001). Young adult physical literacy and physical activity were similar regardless of youth sport specialization level. Young adult physical literacy was positively associated with physical activity. Future studies should consider physical literacy as a possible correlate of physical activity among young adults.

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

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. Cross-sectional study. High schools, Alberta, Canada. High school students (14-19 years) participating in various sports. Level of sport specialization (high, moderate, low) and sport participation volume (hours per week and months per year). Twelve-month injury history (musculoskeletal and concussion). 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). 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.

Moderate and High Sport Specialization Level in Ice Hockey Athletes Is Associated With Symptomatic Cam Deformity.

There is a known association between ice hockey and cam deformity in growing athletes. Similarly, the association between sport specialization and overuse injury in youth athletes has been well established. Limited research exists examining the relationship between cam deformity and sport specialization. Our hypothesis was that there would be a positive association with cam deformity and sport specialization category. Retrospective chart review and cross-sectional questionnaire study. Level 4. Study participants included athletes aged 15 to 25 years with symptomatic femoroacetabular impingement (FAI) and considered ice hockey as their primary sport. All participants had completed Dunn lateral radiographs or hip magnetic resonance imaging as part of their clinical evaluation. All participants completed a survey regarding sport specialization level. Multivariable linear regression analysis controlling for sex was used to analyze the association between degree of sport specialization, age of sport specialization, position played, and level played. Comparisons in radiographic parameters across ice hockey groups were conducted using Student t tests and chi-square tests. Sixty-six ice hockey participants made up the cohort. The majority reported high sport specialization (41/66, 62%). The mean age of sport specialization was 10.7 years (SD 3.5). Participants with moderate specialization had 25 times the odds of a cam deformity (odds ratio [OR] 25.2; 95% CI 1.5-410.7; P = 0.02) and those with high specialization had 9 times the odds of cam deformity (OR 9.3; 95% CI 1.2-74.2; P = 0.04) compared with those with a low degree of specialization, controlling for patient sex. No association was detected between the age of specialization and the likelihood of cam deformity when controlling for patient sex. Level of sport specialization was associated with a cam deformity in this cohort of youth ice hockey athletes. This study suggests that an association exists.

Training volume recommendations and psychosocial outcomes in adolescent athletes

ABSTRACT 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.

A Comparison of Pitching Biomechanics and Sport Specialization in High School Pitchers.

BackgroundThe prevalence of sport specialization in high school athletes continues to rise, particularly among baseball players. Previous research has focused on the incidence of injury among specialized and non-specialized athletes but has yet to examine the level of sport specialization and pitching biomechanics.Hypotheses/PurposeThe purpose of this study was to investigate differences in pitching volume and biomechanics between low-, moderate-, and high-level specialized baseball pitchers. It was hypothesized that high-level specialized pitchers would have the most pitching volume within the current and previous years while low-level specialized pitchers would exhibit the least amount. The second hypothesis states that kinematics and kinetics commonly associated with performance and injury risk would differ between low-, moderate-, and high-level specialized pitchers.Study DesignCase-Control StudyMethodsThirty-six high school baseball pitchers completed a custom sport specialization questionnaire before participating in a three-dimensional pitching motion analysis. Sport specialization was based off current guidelines and categorized as low-, moderate-, and high-level specialized based upon self-reported outcomes. Pitchers then threw ≈10 fastballs from a mound engineered to professional specifications. Data averaged across fastballs was used for biomechanics variables. Key pitching biomechanical and pitching volume variables were compared between low-, moderate-, and high-level specialized pitchers.ResultsHigh-level specialized pitchers were older (p = 0.003), had larger body mass (p = 0.05) and BMI (p = 0.045), and threw faster (p = 0.01) compared to low-level specialized pitchers. Pitching volume and pitching biomechanics were similar across groups.ConclusionsPitching biomechanics were similar across groups, although high-level specialized pitchers threw with significantly higher throwing velocity compared to low-level pitchers. The low amount of pitching volume throughout the season may be responsible for the lack of additional observed differences. Further research should examine the relationship between pitching biomechanics, upper extremity strength and flexibility, and sport specialization.Level of EvidenceLevel III

Sport Specialization and Quality of Life among Middle- and High-School Long-Distance Runners of Different Injury Status: A Retrospective Study

ABSTRACT Running-related injuries are prevalent in adolescent long-distance runners. The aim of our retrospective study was to compare differences in sport specialization, running habits,quality of life, and sleep habits among middle-and high-school long-distance runners of different injury statuses. Middle- and high-school long-distance runners across the United States were recruited via cross-country coaches and athletic directors between January and May 2020. Participants completed an online survey with questions related to demographics, sport specialization, running habits, quality of life, sleep, and self-reported injury history. Overall, 306 participants completed the survey (male = 107, female = 176, unspecified = 23; age = 15.7 ± 1.1 years). Of the participants, 178 (58.2%) reported no history of injury, 101 (33.0%) reported a previous injury, and 27 (8.8%) reported a current injury. Middle- and high-school runners with a current injury reported significantly lower overall health (p= .01) and average distance per run (p = .05) than uninjured runners. No significant differences were found among injury status and sport specialization level, quality of life, sleep habits, or running volume (p> .05). Runners with a self-reported previous or current injury do not appear to be classified as high-specialized runners more frequently than uninjured runners.

Sport specialization, sleep, fatigue, and psychosocial ratings: do highly specialized athletes differ from their less specialized peers?

ABSTRACT Objectives To determine if sleep quality, fatigue, anxiety, depressive symptoms, or perceptions of sport participation differ between high-, moderate-, and low-specialized high school athletes with or without prior injuries. Methods During pre-participation physical examinations (PPE), high school athletes completed questionnaires on sport specialization level, history of time-loss orthopedic injury, perceptions of sport participation, as well as sleep quality (Pittsburgh Sleep Quality Index (PSQI)), fatigue, anxiety, and depressive symptoms (Patient-Reported Outcomes Measurement Information System (PROMIS®)). Athletes were grouped according to sport specialization level and history of prior time-loss orthopedic injury. Results A total of 186 athletes completed the study: 49% (n = 92; mean age = 15.3 ± 2.0 yrs; 50% female) were low specialized, 34% (n = 64; mean age = 15.3 ± 1.3 yrs; 47% female) were moderately specialized, and 16% (n = 30; mean age = 15.7 ± 1.1 yrs; 57% female) were highly specialized. Groups were similar for demographics, training volume, and injury history. Compared to the moderate-specialization group, highly specialized athletes reported higher levels of fatigue (3.1 ± 3.7 vs. 1.5 ± 2.2; p = 0.02), anxiety (3.6 ± 4.1 vs. 1.8 ± 2.6; p = 0.02), and depressive symptoms (2.4 ± 4.0 vs. 0.8 ± 2.0; p = 0.02). No differences in psychometric ratings, sleep quality, or perceptions of sport participation were observed between the low/moderate- or low/high-specialization groups. We did not observe any significant differences between groups who did and did not report a history of prior time-loss orthopedic injury. Conclusions Highly specialized high school athletes report higher levels of fatigue, more anxiety symptoms, and more depressive symptoms than their moderately specialized peers, despite no differences in training volume or injury history. Low specialized athletes did not differ from moderately specialized or highly specialized athletes in the aforementioned domains, and there were no differences in sleep quality across specialization groups. These findings add to the current body of literature on early sport specialization by illustrating the distinctive psychosocial implications of sport specialization and demonstrating the need for further prospective research.

Differences in Lower Extremity Movement Quality by Level of Sport Specialization in Cadets Entering a United States Service Academy.

Sport specialization in youth athletes is associated with increased risk for musculoskeletal injury; however, little is known about whether sport specialization is associated with lower extremity movement quality. The purpose of this study was to examine differences in lower extremity movement quality by level of sport specialization in US Service Academy cadets. Cadets who report an increased level of sport specialization would have a lower level of movement quality than those who are less specialized. Cross-sectional analysis from an ongoing prospective cohort study. Level 3. Cadets completed the Landing Error Scoring System (LESS) and a baseline questionnaire evaluating level of sport specialization during high school. Data were analyzed using separate 1-way analysis of variance models. Among all participants (n = 1950), 1045 (53.6%) reported low sport specialization, 600 (30.8%) reported moderate sport specialization, and 305 (15.6%) reported high sport specialization at the time of data collection during the first week. Ages ranged from 17 to 23 years. Men (1491) and women (459) reported comparable specialization levels (P = 0.45). There were no statistically significant differences in lower extremity movement quality by level of specialization for all subjects combined (P = 0.15) or when only men were included in the analyses (P = 0.69). However, there were statistically significant differences in movement quality by level of specialization in women (P = 0.02). Moderately specialized women had the best movement quality (mean, 4.63; SD, 2.21) followed by those with high specialization (mean, 4.90; SD, 2.08) and those with low levels of specialization (mean, 5.23; SD, 2.07). Women reporting moderate sport specialization had improved movement quality and significantly better LESS scores compared to those with high/low specialization. Athletes, especially women, should be encouraged to avoid early sport specialization to optimize movement quality, which may affect injury risk.

Sport Specialization in Middle School and High School Long-Distance Runners.

Previous reports suggested that highly specialized adolescent athletes may be at a higher risk of injury, worse sleep quality, and less sport enjoyment than low-level specialized athletes. To date, the sport specialization literature has primarily addressed adolescent athletes in a variety of sports. However, whether the findings on sport specialization in predominantly nonrunning athletes are generalizable to adolescent long-distance runners is unknown. To compare injury history, running volume, quality of life, sleep habits, and running enjoyment among male and female middle school and high school long-distance runners at different sport specialization levels. Cross-sectional study. Online survey. A total of 102 male (age = 15.8 ± 0.9 years) and 156 female (age = 15.6 ± 1.4 years) uninjured middle school and high school athletes who participated in long-distance running activities (completion rate = 50.7%). Participants were stratified by sex and sport specialization level (low, moderate, or high). Group differences were assessed in self-reported running-related injuries, running habits, EQ-5D-Y quality of life, Pittsburgh Sleep Quality Index sleep quality, sleep duration, and running enjoyment. Highly specialized male and female middle school and high school long-distance runners reported more months of competition per year (P < .001), higher weekly run distance (P < .001), more runs per week (P < .001), higher average distance per run (P < .001), and greater running enjoyment (P < .001) than low-level specialized runners. Adolescent boys reported a higher average weekly run distance (P = .01), higher average distance per run (P = .01), and better sleep quality (P = .01) than adolescent girls. No differences among sport specialization levels were found for running-related injuries (P = .25), quality of life (P = .07), sleep quality (P = .19), or sleep duration (P = .11) among male or female middle school and high school runners. Highly specialized male and female middle school and high school long-distance runners reported higher running volumes and running enjoyment than low-level specialized runners. However, high-level specialized runners did not describe a greater number of running-related injuries, lower quality of life, or lower sleep quality or duration as expected.

Sport Specialization and Low Bone Mineral Density in Female High School Distance Runners.

Sport specialization may contribute to sport injury and menstrual dysfunction in female high school distance runners. Despite the recent growth in sport specialization, including among high school-aged runners, the association of sport specialization with bone mineral density (BMD) remains poorly described. To evaluate whether sport specialization was associated with BMD in female high school distance runners. Cross-sectional study. Six high schools. Sixty-four female runners (age = 15.6 ± 1.4 years) who competed in cross-country or track distance events and were not currently on birth control medication. Each runner completed a survey on menstrual history and sport participation. Height and weight were measured, and dual-energy x-ray absorptiometry was used to measure whole-body, spine, and hip BMD. Each runner was assigned a sport specialization status: low (participation in ≥1 nonrunning sport and distance-running sport(s) for ≤8 mo/y); moderate (participation in both distance-running sport(s) ≥9 mo/y and ≥1 nonrunning sport(s) or limited to distance-running sport(s) for ≤8 mo/y); or high (participation only in distance-running sport(s) for ≥9 mo/y). Multivariable logistic regression was performed to determine the adjusted odds ratio and 95% confidence interval for sport specialization to BMD values, adjusting for body mass index and gynecological age. Overall, 21.9%, 37.5%, and 40.6% of participants were high, moderate, or low sport specializers, respectively. Low BMD (spine or whole-body BMD z score < -1.0 [standardized by age and sex normative values]) was present in 23 (35.9%) runners. Compared with low sport specializers, high sport specializers were 5 times more likely (adjusted odds ratio = 5.42, 95% confidence interval = 1.3, 23.3; P = .02) to have low BMD. A high level of sport specialization in high school female distance runners may be associated with a heightened risk for low BMD. Further investigation of this association is warranted due to the health concerns about low BMD in adolescent female runners.

Family Affluence Relationship to Sports Specialization in Youth Athletes.

Our objective was to examine the association between participant-reported family affluence and sport specialization level. We conducted a cross-sectional investigation of adolescent athletes. Specifically, participants completed a level of sport specialization (low/moderate/high) questionnaire and the Family Affluence Scale. The majority (52%) of the 195 youth athlete participants reported low, 33% reported moderate, and 15% reported high sport specialization. Sport specialization groups were similar in age (mean = 15.3 ± 1.6 years), proportion of females (49%), and time spent training (mean = 11.9 ± 5.0 hours per week). The high sport specialization group reported significantly greater family affluence than the low sport specialization group (Family Affluence Scale = 10.4 ± 1.7 vs 9.2 ± 1.9; P = .005). After covariate adjustment, higher levels of sport specialization remained significantly associated with greater family affluence (β = 0.48, 95% confidence interval = 0.11-0.86). Understanding the relationship between family affluence and sports specialization affords an opportunity to better identify and monitor populations likely to specialize in a single sport during high school.

Association Between Sport Specialization, Athlete Burnout, And Past Injury In High School Athletes

With the rise in early sport specialization, understanding its psychological impacts on young athletes is increasingly important. PURPOSE: To determine whether sport specialization level, past injuries, or other demographic factors are associated with burnout symptoms among high school (HS) athletes. We hypothesized that athletes with high specialization level or a history of prior injuries would report increased burnout compared to peers with lower specialization level and those without past injuries. METHODS: We conducted a cross-sectional assessment of HS athletes who completed questionnaires during pre-participation physicals. The survey included the Athlete Burnout Questionnaire (ABQ) and Jayanthi sport specialization scale, as well as questions on injury history (stress fracture, concussion, time-loss orthopedic injuries), competition level (varsity or non-varsity) and weekly training hours. The primary dependent variable was total ABQ score. Our independent variables were low, medium, or high specialization level and history of time-loss orthopedic injury, stress fracture or concussion. RESULTS: 186 athletes completed the survey: 49% were categorized as low specialization (mean age=15.3±2.0 yrs; 50% female), 35% medium specialization (mean age=15.3±1.3 yrs; 47% female), and 16% high specialization (mean age=15.7±1.1 yrs; 57% female). The specialization groups did not significantly differ on their total ABQ scores (mean scores: low=29±7.6, medium=28.3±6.5, high=29.9±8.8; p=0.64). Athletes with prior orthopedic injuries had significantly higher ABQ scores than those without such history (30.6±6.8 vs 27.8±7.7; p=0.01). There were no differences in ABQ scores based on history of stress fractures (31.8±7.8 vs 28.7±7.4; p=0.17) or concussion (28.8±7.2 vs 28.9±7.2; p=0.94), or whether an athlete was currently ailing from an injury (29.1±7.5 vs 28.9±7.5; p=0.91). After covariate adjustment, history of orthopedic injury was significantly associated with higher ABQ scores (β=2.81; 95% CI 0.44 - 5.18; p=0.02). CONCLUSION: Prior history of time-loss orthopedic injuries, but not a HS athlete’s level of sport specialization, was associated with higher burnout symptoms.

FAMILY AFFLUENCE RELATIONSHIP TO SPORTS SPECIALIZATION IN YOUTH ATHLETES

Background:Specializing in a single sport while excluding others, also known as sports specialization, is increasing in prevalence in the United States. The effect of socioeconomic status (SES) on rates of sports specialization has been previously described in the specialty clinic setting using zip code as a surrogate for SES. Patient-reported family affluence, a validated surrogate for SES, may provide more specific information about how family SES is associated with sport specialization.Purpose/Hypothesis:Our purpose was to examine the association between patient-reported SES and sport specialization level. We hypothesized that athletes who reported higher levels of sports specialization would report greater family affluence.Methods:We conducted a cross-sectional study of youth athletes undergoing a pre-participation evaluation. During the assessment, participants specified their level of sport specialization on a 3-point scale described originally by Jayanthi and colleagues. Participants also completed the Family Affluence Scale, a 6-item scale which is a valid correlate of parental income. We compared family affluence among the sport specialization groups (low/medium/high) using ANOVA with Tukey post-hoc comparisons. We then constructed a multivariable linear regression model to assess the association between family affluence and sport specialization level while controlling for potential confounding variables.Results:A total of 195 youth athletes participated in the study. The majority (52%) reported low levels of sport specialization, 33% reported medium sport specialization, and 15% reported high sport specialization. The sport specialization groups were similar in age, proportion of females, and time spent training in their sport (Table 1). A significantly larger proportion of highly specialized athletes were varsity athletes compared to the low specialization group (Table 1). The high sport specialization group reported significantly greater family affluence than the low sport specialization group (Figure 1). After covariate adjustment, higher levels of sport specialization remained significantly associated with greater reported family affluence (Table 2).Conclusion:In our population of youth athletes, high sports specialization was associated with greater family affluence. Additionally, we found a significantly higher proportion of varsity level athletes in the high sports specialization groups. This study extends previous studies identifying greater sports specialization levels among those with higher SES. By using the Family Affluence Scale and sampling from a large and diverse population during a pre-participation evaluation, our findings reflect accurate patient-level associations. Examining SES and sports specialization affords the sports medicine community an opportunity to better identify and monitor populations who are likely to specialize in a single sport during high school.Table 1.Characteristics of the three sport specialization groups. Continuous variables are presented as means (95% confidence intervals), categorical variables are presented as n (%).VariableLow Sport Specialized(n=101)Medium Sport Specialized(n=64)High Sport Specialized(n=30)P valueAge (years)15.2 (14.8, 15.6)15.3 (15.0, 15.6)15.7 (15.3, 16.1)0.26Female sex49 (49%)29 (45%)17 (57%)0.60Time spent training in sport(hours per week)11.9 (10.8, 13.1)11.6 (10.3, 13.0)12.5 (10.8, 14.1)0.75Varsity athlete28 (28%)26 (41%)15 (50%)0.04** A significantly higher proportion of high sport specialized athletes reported competing at the varsity level compared to low specialized athletes.Figure 1.Family Affluence Ratings between the low, medium, and high sports specialization groups. Data are presented as means (95% confidence intervals). Higher values on the family affluence scale reflect higher socioeconomic status. ANOVA analysis indicated a significant effect between groups (F=5.73; p= 0.0038). Tukey post-hoc comparisons indicated the high sport specialization group had significantly greater family affluence compared to the low sport specialization group (contrast= 1.19; p=0.005; 95% confidence interval for difference= 0.30, 2.08).Table 2.Multivariable regression model results for the association between sport specialization level and family affluence, while controlling for potential confounding variables.Variableβ coefficientStandard error95% confidence intervalP valueSport Specialization Level0.480.190.11, 0.860.012*Varsity athlete0.340.32-0.29, 0.980.29Age-0.040.09-0.21, 0.140.69Sex0.160.29-0.40, 0.730.57Hours per week training in sport-0.020.03-0.08, 0.030.41*After covariate adjustment, higher levels of sport specialization were significantly associated with greater family affluence.

PREVALENCE OF OVER THE COUNTER PAIN MEDICATION USE AMONG HIGH SCHOOL VOLLEYBALL PLAYERS

Background:Volleyball’s popularity among middle and high school girls continues to rise with many athletes playing the sport year-round. While up to 40% of high school basketball players consume analgesics frequently to manage sport related pain, there is limited evidence regarding the prevalence of over the counter (OTC) pain medicine use among high school volleyball players.Hypothesis/Purpose:Identify the prevalence of OTC pain medicine use in high school volleyball players and assess its association with prior injury and sports specialization level.Methods:Female volleyball players from 78 high schools were recruited to enroll in this prospective cohort study during the fall 2018 volleyball season. Baseline data were collected on demographic and volleyball characteristics including volume and type of volleyball participation, sport-related injuries over the previous twelve months, and level of sport specialization. The frequency of OTC pain medication use for pain management not related to menstrual cramps over the previous seven days was also collected. Participants were asked to describe their OTC pain medicine use during practice, matches, or conditioning and the location of pain they were treating.Results:In total, 2,073 female athletes (Age: 15.6 ± 1.1, BMI: 22.4 ± 3.5, Grade: 9-12) enrolled in the study. Sixty-nine percent (n=1425) reported no OTC pain medication use over the past seven days, 16.0% (n=332) reported seldom (one day/week) OTC medication use, 12.6% (n=261) reported sometimes (2-3 days/week) using OTC medications, and 2.7% (n=55) reported frequent (4-5 days/week) OTC medication use. In the same time period, 24.8% (n=513) used OTC medications during practice, 16.0% (n=331) during matches, and 21.4% (n=443) during conditioning. Across practice, matches, and conditioning OTC medications were most frequently used to control headaches (7-13%) and knee pain (4-6%). Highly specialized volleyball players were more likely to frequently use OTC medications (4.5%) compared to low (1.97%) and moderately specialized (2.5%) athletes (p=0.001). Of those reporting no OTC medications use, 16.7% (n=238) had an injury in the last year compared 36.4% (n=20) of athletes who frequently used OTC medications also reporting an injury in the last year (p<0.001).Conclusion:Almost one third of female high school volleyball athletes reported using OTC pain medications in the past week. Those with a history of injury and highly specialized athletes were more likely to use OTC medications. Coaches, athletic trainers, and healthcare providers should be aware of trends in the use of OTC medications among volleyball athletes as its popularity continues to rise.

Sport Specialization, Club Sport Participation, Quality of Life, and Injury History Among High School Athletes.

Many factors can affect the injury risk and quality of life among high school athletes. Early sport specialization and club sport participation may be components to consider when assessing the injury risk and quality of life. To investigate patient-reported quality-of-life and injury-history measures among adolescent athletes at different sport-specialization levels and to compare these measures between those who did and those who did not report participating in club sports. Cross-sectional study. High school athletic facility. High school student athletes 13 to 18 years of age were recruited and tested during their annual preseason athletic physical examinations. Our primary grouping variables were sport-specialization level (classified as low, moderate, or high) and club sport participation (organized sport outside of traditional school athletics). Our outcome variables were the Patient-Reported Outcome Measurement Information System Pediatric Profile-37 rating, Severity Measure for Depression-Child score, and injury history. A total of 97 individuals participated (mean age = 15.2 ± 1.1 years; 38% female). Relatively similar proportions of individuals reported participating at each level of sport specialization (low = 34%, moderate = 40%, high = 26%). Forty-six (48%) participants stated they participated in club sports. No differences were evident in quality of life (P values = .15-.92 across domains), depression (P = .60), or injury history (P > .70) among the specialization groups. Those who described participating in club sports had a higher proportion of time-loss musculoskeletal injuries (63% versus 29%; P = .002) and of injuries requiring imaging, injection, a cast, a brace, or crutches (72% versus 46%; P = .013) than those who did not. Although no injury-history differences were found among the sport-specialization groups, a higher proportion of club sport athletes than nonclub sport athletes reported a history of injury. Club sports are generally seen as more competitive, and the higher number of injuries seen in this setting could be related to a higher level of play among club sport athletes.

Evaluating a Commonly Used Tool for Measuring Sport Specialization in Young Athletes.

Sport specialization has been defined as year-round intensive training in a single sport to the exclusion of other sports. A commonly used survey tool created by Jayanthi et al, which classifies athletes as having a low, moderate, or high level of specialization, categorizes only athletes answering yes to "Have you quit other sports to focus on a main sport?" as highly specialized. We hypothesized that a measureable number of year-round, single-sport athletes have never played other sports and, therefore, may be inaccurately classified as moderately specialized when using this tool, even though most experts would agree they should be viewed as highly specialized. To determine the proportion of athletes misclassified as moderately rather than highly specialized because they never played a previous sport. Cross-sectional study. Hospital-based pediatric outpatient sports medicine clinic. Injured athletes aged 12 to 17 years who presented to the clinic between 2015 and 2017 and completed a sports-participation survey (n = 917). Sport-specialization level. Of 917 participants, 299 (32.6%) played a single sport more than 8 months per year, and 208/299 (69.6%) had previously quit other sports (highly specialized), whereas 91 (30.4%) had never played other sports (highly specialized and misclassified as moderate). Individual-sport athletes had a 2.03 times greater risk of being highly specialized and misclassified as moderate than team-sport athletes (relative risk = 2.03 [95% confidence interval = 1.37, 3.00]). Females had a 1.70 times greater risk of being misclassified as moderately specialized than males (relative risk 1.70 [95% confidence interval = 1.07, 2.70]). Of the 3 sports with the largest number of athletes, artistic gymnastics had the highest proportion (51.2%) who had never played other sports. The commonly used specialization survey misclassified a substantial number of highly specialized athletes as moderately specialized. Researchers should consider adding a fourth survey question, "Have you only ever played 1 sport?" to identify and better study this unique subset of misclassified athletes.

Knowledge, Attitudes, and Beliefs of Youth Club Athletes Toward Sport Specialization and Sport Participation.

Background:There are a variety of proposed motivations for sport specialization, such as improving sport skills to an elite level, making all-star or travel teams, or receiving a scholarship or professional contract. However, there has not been a quantitative examination of the attitudes and beliefs that may be contributing to the trend of sport specialization and year-round sport participation.Purpose:The primary aim was to describe the attitudes and beliefs of youth club sport athletes regarding sport specialization and sport participation. A secondary objective was to investigate whether an association exists between the level of sport specialization and the belief in receiving a college scholarship.Study Design:Cross-sectional study; Level of evidence, 3.Methods:A total of 974 youth athletes (578 female; mean age, 14.2 ± 1.6 years) completed an anonymous questionnaire that focused on attitudes and beliefs toward sport specialization and sport participation. Questions were developed utilizing the feedback of a panel of content area experts and the University of Wisconsin Survey Center. Data were summarized using frequencies, proportions (%), and means ± SDs.Results:Fewer than half of all athletes (45.8%) believed that specialization increased their chances of getting injured either “quite a bit” or “a great deal.” However, 91% of athletes believed that specialization increased their chances of getting better at their sport either “quite a bit” or “a great deal.” Similarly, the majority of athletes believed that specialization increased their chances of making their high school team (80.9%) or a college team (66.9%) either “quite a bit” or “a great deal.” Overall, 15.7% of athletes believed that they were either “very” or “extremely” likely to receive a college scholarship based on athletic performance. Highly specialized athletes were nearly twice as likely to have a high belief in receiving a college scholarship compared with low-specialization athletes (20.2% vs 10.2%, respectively; χ2 = 18.8; P = .001).Conclusion:Most youth athletes in this study believe that specialization increases their sport performance and ability to make not only a college team but also their high school team. Highly specialized athletes were more likely to believe that they will receive a college scholarship.

A Prospective Study on the Effect of Sport Specialization on Lower Extremity Injury Rates in High School Athletes

Background: Sport specialization is associated with an increased risk of musculoskeletal lower extremity injuries (LEIs) in adolescent athletes presenting in clinical settings. However, sport specialization and the incidence of LEIs have not been investigated prospectively in a large population of adolescent athletes. Purpose: To determine if sport specialization was associated with an increased risk of LEIs in high school athletes. Study Design: Cohort study; Level of evidence, 2. Methods: Participants (interscholastic athletes in grades 9-12) were recruited from 29 Wisconsin high schools during the 2015-2016 school year. Participants completed a questionnaire identifying their sport participation and history of LEIs. Sport specialization of low, moderate, or high was determined using a previously published 3-point scale. Athletic trainers reported all LEIs that occurred during the school year. Analyses included group proportions, odds ratios (ORs) and 95% CIs, and days lost due to injury (median and interquartile range [IQR]). Multivariate Cox proportional hazard ratios (HRs) with 95% CIs were calculated to investigate the association between the incidence of LEIs and sport specialization level. Results: A total of 1544 participants (50.5% female; mean age, 16.1 ± 1.1 years) enrolled in the study, competed in 2843 athletic seasons, and participated in 167,349 athlete-exposures. Sport specialization was classified as low (59.5%), moderate (27.1%), or high (13.4%). Two hundred thirty-five participants (15.2%) sustained a total of 276 LEIs that caused them to miss a median of 7.0 days (IQR, 2.0-22.8). Injuries occurred most often to the ankle (34.4%), knee (25.0%), and upper leg (12.7%) and included ligament sprains (40.9%), muscle/tendon strains (25.4%), and tendinitis/tenosynovitis (19.6%). The incidence of LEIs for moderate participants was higher than for low participants (HR, 1.51 [95% CI, 1.04-2.20]; P = .03). The incidence of LEIs for high participants was higher than for low participants (HR, 1.85 [95% CI, 1.12-3.06]; P = .02). Conclusion: Athletes with moderate or high sport specialization were more likely to sustain an LEI than athletes with low specialization. Sports medicine providers need to educate coaches, parents, and interscholastic athletes regarding the increased risk of LEIs for athletes who specialize in a single sport.

The Effect of Sport Specialization on Lower Extremity Injury Rates in High School Athletes

Objectives:Sport specialization has been shown to be associated with increased risk of musculoskeletal lower extremity injuries (LEI) in adolescent athletes presenting in clinical settings. However, the association of sport specialization and incidence of LEI has not been studied prospectively in a large population of adolescent athletes. The objective of this study was to compare the incidence of LEI in high school athletes identified as having low (LOW), moderate (MOD) or high (HIGH) levels of sport specialization.Methods:Subjects (male and female, interscholastic athletes, grades 9 - 12) were recruited from a diverse sample of 29 Wisconsin high schools during the 2015/16 school year to participate in the study. Subjects d a questionnaire identifying all of the interscholastic and club sports they participated in during the previous and current school years, history of previous LEI, their primary sport and the number of primary sport competitions in which they participated in within the previous 12 months. Sport specialization status was determined using a previously published 3 item specialization scale (total score: 0 - 1 = LOW, 2 = MOD, 3 = HIGH). Athletic trainers at each school reported all athletic exposures and LEI that occurred for each subject during each interscholastic sport season they participated in during the school year. Analyses included group proportions, Odds Ratios (OR, [95%CI]) and median days lost due to injury (Med [IQR 25th,75th]. Multivariate Cox Proportional Hazards Ratios (HR, [95%CI]) were calculated to investigate the association between the incidence of LEI and sport specialization level while controlling for gender, grade, history of previous LEI, primary sport and the number of primary sport competitions.Results:A total of N =1,544 subjects (Female = 50%, Age =16.1+1.1 yrs.) enrolled in the study, competed in 2,843 athletic seasons and participated in 167,349 athletic exposures during the school year. Subjects were classified as being LOW (60%), MOD (27%) or HIGH (13%) specialization. Females were more likely to be classified as HIGH than males (OR = 2.07 [1.53 - 2.81, p < 0.001]. The sports with the greatest percentage of HIGH participants were soccer (22%), baseball/softball (19%), volleyball (17%), and basketball (13%). Two hundred thirty five subjects (15%) sustained a total of n = 276 LEI that caused them to miss a median of 7.0 [2.0, 22.8] days. Injuries occurred most often to the ankle (34%), knee (25%), upper leg (13%) and lower leg (12%). LEI were acute (66%) or gradual / recurrent (34%) onset. Common injuries included ligament sprains (41%), muscle / tendon strains (25%) and tendonitis / tenosynovitis (20%). Surgical treatment was required for n = 23 (8%) of the LEI. The incidence of LEI for MOD subjects was higher than LOW subjects (HR = 1.51 [1.04 - 2.20], p = 0.029). The incidence of LEI for HIGH subjects was higher than LOW subjects (HR = 1.85 [1.12 - 3.06], p = 0.017).Conclusion:Interscholastic athletes with MOD or HIGH sport specialization were more likely to sustain a LEI than athletes with LOW specialization. Sports medicine providers need to educate officials of sport governing bodies, school coaches, parents and interscholastic athletes regarding the increased risk of LEI for athletes who specialize in a single sport.