Monday, July 13, 2020

Does Sport Specialization Increase Risk for Injury?

Sports has a lot of positive impacts on kids.  Studies show that kids that participate in sports have an improved quality of life, are less likely to smoke, to be truant and more likely to get better grades and stay in school.  Under the right coach and with the right team, this can also provide a lot of positive influences to kids in a time and age where they really need this.  With over 7.8 million kids participating in interscholastic sports each year, sports injuries are  going to happen.  Our goal is always to minimize those that we can.

Obviously with the focus of our discussions through the history of this blog, we tend to focus a lot on lower extremity injuries and specifically knee injuries.  Why is that?  Ingram et al AM J Sport Med 2008 showed that the most commonly reported athletic injury between the ages of 15 and 25 is an injury to the knee.  Further, Fernandez et al Acad Emerg Med 2007 showed that lower extremity injuries accont for 60-75% of all injuries in high school athlete populations.  Rechel et al J Trauma 2011 showed that 50-60% of all athletic injuries requiring surgery where injuries to the knee.  If you include the low back injuries in these numbers, then you encompass >75% of athletic injuries that occur and hence why our focus primarily on the lower kinetic chain.

Over the course of the last several years, we have discussed various strategies on how we can help reduce these injury rates, especially in our younger athletes.  I have been blessed throughout my career to work along side some of the industries best in the field of sports medicine.  As such, it has led to some amazing learning opportunities.  Two of the pioneers in this area,  from an educational perspective, innovation perspective and research perspective, is Kevin Wilk, DPT, FAPTA (with Champion Sports Medicine - Alabama) and Dr. James Andrews (Andrews Institute - Florida).  Both of these sports medicine legends have and continue to be a huge influence on who I am professionally and what we do.  Dr. Andrews is the founding member of the American Orthopaedic Society for Sports Medicine's STOP Campaign.  STOP (link on the right hand of this blog) stands for Sports Trauma and Overuse Prevention and is a national campaign to help educate and prevent youth sports injuries.

According to Dr. James Andrews, the nation's leading expert in sports related injuries, one of the leading causes of preventable sports related injuries is early sports specialization.  Why is that?  It use to be when I played sports, it was a seasonal thing.  You played your sport during the spring or fall and then when the season was over you either played another sport or you did something else.  Today however, sports are all year round.  Where a soccer player may start their season with the school, then once that is over, the athlete then move on to play with their club or travel team resulting in the athlete sometimes playing the same sport all year long.  Parents unknowingly think this will help them become a better athlete.  Give them a competitive edge.  Yet the reality is, they are also increasing their risk for injury.  Is this true?  What does the research tell us?

Reference Article
McGuine T, Post E, Hetzel S, Brooks A, Trigsted S, Bell D.  A prospective study on the effect of sport specialization on lower extremity injury rates in high school athletes.  Am J Sports Med. 45:2706-2712. 2017.

In this prospective study, the authors set out to determine if sport specialization was associated with increase risk for lower extremity injuries in high school athletes.

Methods:  Participants in this study where interscholastic athletes in grades 9 through 12th.  Athletes were recruited from 29 Wisconsin high schools during the 2015-2016 school year.  Participants completed a questionnaire identifying their sport and history of lower extremity injuries.  Sports specialization of low, moderate or high was determined using a previously published 3-point sale.  Athletic trainers reported all lower extremity injuries that occurred during the school year.  Statistical analysis was performed on the data.

Results: A total of 1544 athletes participated in the study, 780 females and 764 males.  A break down of the subject by sport is in the table below.  Mean age was 16.1 y/o +/- 1.1 years.  These athletes completed 2843 athletic seasons and participated in 167,349 athletic exposures.


235 participants (15.2%) sustained a total of 276 lower extremity injuries that caused them to miss a median of 7.0 days.  Injuries occurred most often to the ankle (34.4%), knee (25%) and upper leg (12.7%).  Injuries included ligament sprains (40.9%), muscle/tendon strains (25.4%) and tendinitis/tenosynovitis (19.6%).  Statistical significance is determined by a P value <.05.  The incidence for lower extremity injury for those that had moderate sport specialization was p = .03 and for those that had high sport specialization was p = .02.

What this indicates is that the more the athlete specializes in a single sport versus multiple sports, the higher the likelihood for them to suffer a lower extremity injury.  Next week we will look at one additional study and why sport specialization may be leading to an increase in risk.

Help us ring in 2018 right by spreading the word and helping to prevent athletic injuries. #ViPerformAMI #ACLPlayItSafe #ResearchThatWorks


Dr. Nessler is a practicing physical therapist with over 20 years sports medicine clinical experience and a nationally recognized expert in the area of athletic movement assessment.  He is the developer of a 3D athletic biomechanical analysis, ACL Play It Safe and Run Safe programs, is an author of a college textbook on this subject  and has personally performed >5000 athletic movement assessments.  He is president of Vitality (a Divsion of Rebound), involved in several national research projects in the area of movement assessment and serves as a consultant to teams and organizations in the area of athletic movement assessment and RTSport testing.   He is also a competitive purple belt in Brazilian Jiu Jitsu and team physical therapist for several competitive teams. 

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