Year-round Participation Research Articles

Overuse Injury of the Epiphyseal Primary Physis.

Year-round participation in youth sport that involves high levels of repetitive movement fosters an environment in which overuse injuries are likely to occur. Epiphyseal primary physeal stress injuries (PSIs), unique to skeletally immature athletes, are a particular concern, given their potential for growth disturbance. Initially observed in Little League baseball players, these injuries are now known to affect the long bones around the shoulder, elbow, wrist, hand, knee, ankle, and foot of skeletally immature athletes involved in a variety of sport activities.This article offers an epidemiological and radiologic perspective on the extent and distribution of epiphyseal PSIs in youth sport. We also review a novel framework for understanding the pathophysiologic mechanisms causing these injuries. This information is essential for the early identification of epiphyseal PSIs and devising preventive measures that can reduce a delayed diagnosis and long-term morbidity. Preventing and reducing injury to the epiphyseal growth plates is essential because impairment and dysfunction can result in lifelong morbidity and a risk of premature osteoarthritis.

Track and Field Injuries in Children and Adolescents Presenting to us Emergency Departments-An Updated Review of the National Electronic Injury Surveillance System

Background:Running is a highly popular activity that fosters healthy lifestyle habits in athletes of all ages. Track and field is a popular competitive youth sport with injuries estimated at 0.84 per 1000 athlete exposures among high school athletes. Injury patterns have been noted to vary by age and differ from those sustained in adult runners. Prior work has examined the epidemiology of youth track and field and running related injuries, but data from the recent decade in the setting of increasing sport specialization and year-round participation is lacking.Purpose:To examine the evolving epidemiology of track and field and running related injuries prompting emergency department presentation.Methods:A retrospective review of data obtained from the National Electronic Injury Surveillance System (NEISS) database was performed identifying children 10-18 with injuries associated with the Track & Field/Running product code (5030) from 2008-2020. National injury estimates were calculated annually and overall. Descriptive statistics were utilized to summarize injury characteristics of the entire cohort. Annual injury estimates were calculated to identify trends over the study period, which included the 2020 season interrupted by the COVID-19 pandemic.Results:We identified 8,399 track and field associated NEISS cases occurring from 2008-2020 representing a national estimate of 271,788 injuries [95% Confidence Interval: 250,288 to 294,24]. The majority (52%) of injuries occurred among patients 15 to 18 years of age. Injuries occurred most frequently in the lower extremity (52%) and most commonly involved the ankle (17%) and knee (15%). Sprain/strains were the most frequent injury type (40%). The majority of patients (97%) did not require hospitalization. Injury estimates of each demographic and injury characteristic with 95% confidence intervals are reported in Table 1. There was a rising annual frequency of track and field injuries seen peaking in 2017 with a notable decline in 2020 during the COVID-19 pandemic.Conclusion:Track and field injuries requiring emergency department presentation appear to be increasing from prior study estimates, but demonstrate similar distribution of injury characteristics. Severe injuries requiring hospitalization remain rare. The majority of injuries involve the knee and ankle and involve older adolescents. This data provides meaningful data for providers caring for and counseling adolescent athletes.Table 1:Track-Related Injuries in Children aged 10-18 Treated in US Emergency Departments

Using value equity drivers to understand parents’ perspectives of youth summer Hockey camps: an importance-performance analysis

ABSTRACT Like many sports, ice hockey has become subject to year-round participation; here, many summer hockey camp operators compete against each other for consumers (players). Using Importance-Performance Analysis (IPA) and Customer Equity (CE) theory, where customer acquisition and retention are the foundational concepts, the purpose of the research was twofold. First, the aim was to understand what Value Equity (VE) drivers are most important to parents when deciding to register their child for a summer hockey camp. A second goal was to ascertain if summer hockey camp operators are performing to the level of importance ascribed to those factors, as determined by parents of camp attendees. Surveys with 148 parents, who registered their child in a summer hockey camp in the Niagara Region of Ontario, Canada, were used in order to complete the IPA. The findings indicate that parents deem ‘quality’ factors, versus elements of convenience and/or price, as both ‘most important’ and ‘most in need of managerial attention’.

Protocol for a multicenter prospective cohort study evaluating sport activity and development of femoroacetabular impingement in the adolescent hip

BackgroundFemoroacetabular impingement (FAI) is an important cause of hip pain in young and active individuals and occurs as a result of size and shape mismatch between the femoral head and acetabulum. Open physes in children can make hips more susceptible to injury, and high impact forces have been suggested to affect the developing femur. The diagnosis of FAI has recently risen, especially within adolescent populations, and there is an increasing trend towards year-round participation in sports with early specialization. The PREVIEW study is an international longitudinal study designed to determine the association between sport specialization in adolescence and the development of hip impingement.MethodsThis is a multicentre prospective cohort study evaluating 200 participants between the ages of 12–14 that include sport specialists at the moderate to vigorous physical activity (MVPA) level and non-sport specialists at any activity level. We will monitor physical activity levels of all participants using an activity log and a wrist-mounted activity tracker, with synced data collected every 3 months during the study period. In addition, participants will be evaluated clinically at 6, 12, and 18 months and radiographically at the time of enrolment and 24 months. The primary outcome is the incidence of FAI between groups at 2 years, determined via MRI. Secondary outcomes include hip function and health-related quality of life between subjects diagnosed with FAI versus no FAI at 2 years, as determined by the Hip Outcome Score (HOS) and Pediatric Quality of Life (PedsQL) questionnaires.DiscussionIt is important to mitigate the risk of developing hip deformities at a young age. Our proposed prospective evaluation of the impact of sport activity and hip development is relevant in this era of early sport specialization in youth. Improving the understanding between sport specialization and the development of pre-arthritic hip disease such as FAI can lead to the development of training protocols that protect the millions of adolescents involved in sports annually.Trial registrationPREVIEW is registered with clinicaltrials.gov (NCT03891563).

Sport-Specific Associations of Sport Specialization and Sport Volume with Overuse Injury in Youth Athletes

Year-round participation in a single sport at the exclusion of other sports, also known as sport specialization, is associated with increased risk of overuse injury in youth athletes. To reduce this risk, several recommendations for participation volume have been developed. However, risk of overuse injuries may be dependent on specific movement profiles required by a given sport. PURPOSE: To examine sport-specific associations of sport specialization and exceeding sport volume recommendations with overuse injuries in adolescent basketball, soccer, and volleyball athletes. METHODS: 716 youth athletes (70.8% female, age 14.21.5 years old, 43.2% basketball, 19.4% soccer, 37.4% volleyball) were recruited to complete an anonymous questionnaire regarding their sport participation patterns and previous injury history. Sport specialization status was classified as low, moderate, or high using a widely utilized 3-point scale. Self-reported sport volume was used to classify athletes as either meeting or exceeding sport volume recommendations (playing their primary sport >8 months/year, hours/week of organized sport > age, days of sport participation per week >5). Multivariable logistic regression analyses were utilized to examine associations between variables of interest and overuse injury in the previous year. RESULTS: Highly specialized volleyball athletes were more likely to report an overuse injury compared to low specialization volleyball athletes (OR [95% CI]: 2.3 [1.1-4.8], p<.01). Volleyball athletes who trained: more than 8 months per year (OR [95% CI]: 2.0 [1.1-3.5], p<.05), more hours per week than their age (OR [95% CI]: 2.0 [1.2-3.4], p<.01), or more than 5 days per week (OR [95% CI]: 2.1 [1.2-3.9], p<.05) were more likely to report an overuse injury compared to volleyball athletes who did not violate these recommendations. No significant associations were observed in soccer or basketball athletes (P>0.05). CONCLUSIONS: The association between sport specialization, excessive sport volume, and overuse injuries may be specific to sports that are more repetitive or technical in nature, such as volleyball. Dissemination of sport-volume recommendations should be focused towards athletes, parents, and coaches in these sports.

OVERUSE INJURY RISK INCREASES WITH YEAR-ROUND SPORT PARTICIPATION IN MIDDLE SCHOOL AGED ATHLETES

BACKGROUND: Retrospective studies of high school aged athletes have demonstrated that participating in one sport for more than 8 months of the year is a risk factor for overuse musculoskeletal injuries. This research has driven the recommendation that suggests youth athletes should not play a single organized sport for more than 8 months out of the year. However, these recommendations have never been prospectively examined in middle school aged athletes. The purpose of this study is to determine if year-round participation, operationally defined as participating in one sport for more than 8 months of the year, is associated with increased risk of overuse injuries in middle school aged athletes. METHODS: A total of 281 children (female N= 113, 40.2%, age= 12.1±1.2 years; range 10-14 years of age) completed an anonymous online survey with their parents for 39 weeks. A baseline survey was conducted in the first week of September 2017 and then weekly surveys were completed until June 2018. The baseline survey consisted of demographic information, previous injury history, and sport participation volume (months per year in primary sport). The weekly surveys asked participants to report their sleep habits, musculoskeletal injuries, and illnesses. Parents and children were asked to complete the surveys together. Participants were included in the analysis if they completed at least 80% of the total surveys. In the baseline survey, participants identified the previous months for which they played their primary sport. Those who marked more than 8 months out of the past 12 months were classified as “year-round participants.” Logistic regression was used to determine if year-round participation (&gt;8 months/year) was a significant predictor of overuse musculoskeletal injuries during the study period. A second logistic regression model was created using the participant’s total reported months participating in a single sport as a predictor of overuse injuries. RESULTS: 80 (28.5%) participants were identified as participating year-round in a single sport and 49 overuse injuries were reported during the study period. Athletes who participated in a single sport year-round were more than twice as likely to sustain an overuse injury during the study period compared to non-year-round athletes (OR [95%CI]: 2.20[1.10-4.39], p=0.025), even after adjusting for sex, age, and previous injury history. The odds of sustaining an overuse injury increased approximately 17% for every additional month of participating in a single sport (OR [95%CI]: 1.17 [1.04 -1.32], p=0.012) again while controlling for sex, age, and previous injury. CONCLUSION: This is the first prospective study in middle school aged athletes examining year-round participation and overuse musculoskeletal injuries. Middle school aged athletes are at a 2-times increased risk of overuse musculoskeletal injuries when participating in a single sport for more than 8 months of the year compared to middle school aged athletes who participated 8 or less months in a single sport. Sport specialization has been identified as a risk factor for high school aged athletes for overuse injury – and our observations indicate that a similar trend may exist in middle school aged athletes. Recommendations regarding monthly sport participation for adolescents have been supported in the high school aged population and these recommendations may extend to an even younger population.

Ranges and drivers of risk associated with sports and recreational activities in people with haemophilia: results of the Activity-Intensity-Risk Consensus Survey of US physical therapists.

Limited evidence describes physical activity-associated bleeding risks for people with haemophilia, and risks are usually described only generically. To assess activity-specific ranges of risk for joint, soft tissue and head bleeds by identifying inherent and modifiable risk factors associated with each activity, based on opinions of expert physical therapists (PTs). Physical therapists from US haemophilia treatment centres (HTCs) participated in a survey of 101 physical activities. For each activity, PTs provided minimum/maximum risk scores (low=1; high=5), and indicated specific bleeding risks in six joints and three injury types (bruising, muscle bleeding, head injury). Risk drivers were identified from free-text comments and explored at a consensus meeting, where they were categorized as inherent or modifiable and activity-driven or patient-driven. Of 32 invited PTs, 17 participated; median experience was 24years as a PT and 16years at an HTC. Only a few activities had a wide range of risk assessments encompassing both lower and upper ends of the response range. Joint injury risks were consistent with position and physical requirements, and head and muscle bleed risks were associated with physical contact. Eight PTs participated in the consensus meeting; key risk drivers identified included progression from seasonal to year-round participation, overtraining and improper body mechanics. Inherent risks included impact with surface/ball/equipment and field/surface condition; modifiable risks included safety equipment and tricks/stunts. These data provide a framework for discussion with patients/families, recognizing how certain activities may be modified to decrease risk, and identifying activities with nonmodifiable inherent risks.

Socioeconomic status of parents with children participating on youth club sport teams

ObjectivesTo describe the socioeconomic status, measured by household income and educational attainment, of parents with children participating on youth club sport teams. DesignCross-sectional survey. SettingLocal sport events. Participants949 parents (571 female) of youth athletes between 10 and 18 years old were recruited at club team events and practices to complete an anonymous questionnaire. Main Outcome MeasuresSES variables included total household income (THI) and educational attainment. Sport specialization was classified as low, moderate, or high using a previously utilized 3-point specialization scale. Chi-square tests were used to compare frequencies SES categories with child specialization. ResultsParents reported spending a median of 1500 [500-3000] USD per year on their children's club sports activities. Most parents reported a THI greater than 100,000 USD per year and a bachelor's degree or higher level of education. Parents in the higher THI categories were more likely to have a child that is highly specialized in one sport. ConclusionThe current youth sports system in the United States, which emphasizes year-round participation on club teams, may be limiting the participation of families without the resources to participate in this system.

Knowledge, Attitudes, and Beliefs of Youth Sports Coaches Regarding Sport Volume Recommendations and Sport Specialization.

Post, EG, Trigsted, SM, Schaefer, DA, Cadmus-Bertram, LA, Watson, AM, McGuine, TA, Brooks, MA, and Bell, DR. Knowledge, attitudes, and beliefs of youth sports coaches regarding sport volume recommendations and sport specialization. J Strength Cond Res 34(10): 2911-2919, 2020-Overuse injuries in youth athletes are becoming increasingly common, which may be a result of the prevalence of year-round specialized sport participation. Previous research has identified sport volume recommendations related to months per year, hours per week, and simultaneous participation in multiple sports leagues. Coaches are a primary influence on a youth athlete's decision to specialize in a single sport. Therefore, identifying coaches' baseline beliefs and perceptions is important for developing strategies to educate coaches about safe sport participation. A total of 253 youth sport coaches (207 males) completed an anonymous online questionnaire regarding knowledge of sport volume recommendations and attitudes and beliefs regarding sport specialization. Eligible participants were required to serve as a head or assistant coach of a youth sport team in the past 12 months whose members were between the ages of 12 and 18 years. Most coaches were unaware of recommendations regarding the maximum number of months per year (79.4%), hours per week in 1 sport (79.3%), or number of simultaneous leagues for an athlete to participate in to reduce injury (77.6%). Fewer than half (43.2%) of all coaches were "very" or "extremely" concerned about the risk of injury in youth sports. A majority (60.1%) believed that sport specialization was either "quite a bit" or "a great deal" of a problem. Two-thirds (67.2%) responded that year-round participation in a single sport was either "very" or "extremely" likely to increase an athlete's risk of injury. Although the responses to this survey were predominantly from coaches from 1 state, our results suggest that coaches are unaware of sport volume recommendations but are concerned about specialization. Future efforts are needed to communicate these recommendations to coaches to reduce the risk of overuse injury in youth sports.

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

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.

Reducing Cumulative Arm Overuse Injuries in Young Throwers.

As year-round participation in youth sports continues to increase, health care practitioners treating child and adolescent athletes will commonly see injuries that are secondary to overuse. Starting with a clinical vignette, this article describes proximal humeral physeal injuries in youth throwers, examines causative factors, reviews common therapeutic modalities, and focuses on preventive measures aimed at reducing such cumulative arm overuse injuries.

Seasonal variation in physical activity, sedentary behaviour and sleep in a sample of UK adults

Background: Physical activity (PA), sedentary behaviour (SB), sleep and diet have all been associated with increased risk for chronic disease. Seasonality is often overlooked as a determinant of these behaviours in adults. Currently, no study has simultaneously monitored these behaviours in UK adults to assess seasonal variation.Aim: The present study investigated whether PA, SB, sleep and diet differed over season in UK adults.Subjects and methods: Forty-six adults (72% female; age = 41.7 ± 14.4 years, BMI = 24.9 ± 4.4 kg/m2) completed four 7-day monitoring periods; one during each season of the year. The ActiGraph GT1M was used to monitor PA and SB. Daily sleep diaries monitored time spent in bed (TIB) and total sleep time (TST). The European Prospective Investigation of Cancer (EPIC) food frequency questionnaire (FFQ) assessed diet. Repeated measures ANOVAs were used to identify seasonal differences in behaviours.Results: Light-intensity PA was significantly higher in summer and spring (p < 0.001). SB and TIB were significantly higher in winter (p < 0.01). There were no seasonal variations detected in moderate–vigorous PA, TST or diet (p > 0.05).Conclusions: Findings support the concept that health promotion campaigns need to encourage year-round participation in light intensity PA, whilst limiting SB, particularly during the winter months.

Body composition is associated with physical activity in daily life as measured using a triaxial accelerometer in both men and women

Activity-related energy expenditure is the most variable component of total energy expenditure and thus an important determinant of energy balance. To determine whether body composition is related to physical activity in both men and women. A total of 134 healthy participants were recruited (80 women, 54 men; aged 21+/-2 years; body mass index, 22.0+/-2.4). Physical activity was measured for a period of 2 weeks using a triaxial accelerometer for movement registration (Tracmor). Percentage body fat (%BF) was determined by underwater weighing and deuterium dilution according to Siri's three-compartment model. The participant characteristics-body mass, height and gender together explained a substantial part of the variation in %BF (R(2)=0.75, SEE=4.0%). Adding physical activity to the model increased the explained variation in %BF with 4% (R(2)=0.79, SEE=3.7%, P<0.001). Taking seasonality into account by adding the number of daylight hours as an independent variable further increased the explained variation with 1% (R(2)=0.80, SEE=3.7%, P<0.05). In analogy, the association was evaluated for both genders separately. In women, %BF and physical activity were significantly associated (P<0.001). In men, %BF was only associated with physical activity when seasonality was taken into account as well (P<0.05). This probably resulted from men participating more in season bound sports, because an association was found without adjusting for seasonality when only men with a consistent year-round participation in sports were considered. Evidence was found for an association between body composition and physical activity in both genders. A consistent year-round degree of physical activity appears to be a prerequisite to reveal the association. Moreover, Tracmor-assessed physical activity improves the estimate of %BF when a participant's characteristics are taken into account.

Influence of sports participation and menarche on bone mineral density of female high school athletes

Weight-bearing exercise during adolescence may enhance peak bone mineral density (BMD) and reduce osteoporosis risk. The association of sports participation before and after menarche with areal BMD (by central DXA) was investigated in 99 female high school athletes (age 15.5+/-1.3 year). The frequency and duration of structured sports (school-based or other organized team) were assessed using an interviewer-assisted questionnaire. Overall, the average number of years of weight-bearing sport participation was 7.4+/-3.4 years; 72% of the athletes began sport participation before menarche. Training patterns and BMD were examined by tertiles of yearly weight-bearing sport participation (hours/year) before (WBpre), after (WBpost) menarche, and in total (WBtotal). After adjusting for chronological age, gynecological age, and BMI, compared to athletes in the WBtotal low tertile, athletes in the WBtotal high tertile had significantly greater BMD at the spine (p=0.009), total hip (p=0.03), trochanter (p=0.03), and total body (p=0.009). Similar patterns were found by WBpre or WBpost status, separately, with the exception of spine BMD which was significantly different across tertiles in WBpost only (p<0.01). While the number of years of participation was similar across tertiles of WBtotal, the number of months/year was significantly greater among athletes in the high tertile than athletes in the low tertile (9.2+/-3.4 month/year versus 5.0+/-2.9 month/year, respectively (p<0.001)). These results indicate that near year-round participation in structured weight-bearing sports during early adolescence may help young girls optimize bone mineral accrual during these critical years, and may decrease their risk of osteoporosis with advancing age.