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Implications for Training in Youth: Is Specialization Benefiting Kids?

  • Waseda University / The Micheli Center for Sports Injury Prevention

Abstract and Figures

Early sports specialization has been a controversial topic in the field of sports medicine, training, and conditioning. Recent studies report increased sportsrelated injuries in singlesport specialized athletes compared with multisport specialized athletes. Two studies demonstrate the proportions of athletes who focused on a single sport in early ages and advanced to elite level in their later careers are ,1%. Furthermore, performing multiple sports was identified as an indicator for greater future athletic success. Synthesizing available evidence, participating in multiple sports seems more beneficial than focusing on a single sport. It is important to provide adequate recovery time for pediatric and adolescent athletes because they are in a growth spurt process. Finally, because a history of previous injury is evidenced as a risk factor for future sports-related injuries, preventive approaches such as resistance training need to be implemented within a training regimen for youth.
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Implications for Training
in Youth: Is Specialization
Benefiting Kids?
Dai Sugimoto, PhD, ATC, CSCS,
Andrea Stracciolini, MD,
Corey I. Dawkins, MS, ATC,
William P. Meehan, III, MD,
and Lyle J. Micheli, MD
The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts;
Division of Sports Medicine, Department
of Orthopedics, Boston Children’s Hospital, Boston, Massachusetts; and
Harvard Medical School, Boston,
The decision by young athletes to
focus on a single sport early in
their athletic careers is currently
debated among those involved within
sports medicine, training, and condi-
tioning. Some believe that year-round,
high-intensity training specialized to
a single sport at an early age promotes
superior skill sets and leads young ath-
letes to successful future athletic ca-
reers. This notion is often offered to
parents and legal guardians from coach-
ing staffs as an opportunity to move to
a more advanced class/team such as an
elite-level class and traveling team
squad. The promotion to the more
advanced level and team usually entails
even greater time commitments for
young athletes. Increasing off-field time
commitments by both athletes and
their care givers, who often are involved
in transportation, may factor into deci-
sions to focus on one sport and drop
out of other sports. Another potential
factor may stem from friendships culti-
vated among young athletes. They
likely enjoy spending significant
amount of time through practices and
competitions and develop cohesiveness
among friends in a particular sport,
which may play a key role. For excep-
tional athletes, demonstrating superior
athletic abilities relative to their peers
at middle school– and high school–
level competitions often gains atten-
tion from college coaches and scouts.
Complementary comments received
from college coaches and scouts tend to
promote interests in pursuing further
athletic success, and some may be
looking for athletic scholarship oppor-
tunities. This phenomenon is often
referred as “early sports specializa-
tion” (8,22,29).
Serious sport-related injuries, especially
overuse injuries, are currently more
prevalent in this age group than they
were several decades ago (1,6,12). As
a result, there is concern that this trend
toward early sports specialization may
be a contributing factor for the increase
in overuse injuries in young athletes.
The American Medical Society for
Sports Medicine published a position
statement on overuse injuries and burn-
out in youth sports in 2013 (4), which
stated that “early sport specialization
may not lead to long-term success in
sports and may increase risk for overuse
injury and burnout” (4). The American
Address correspondence to Dr. Dai Sugimoto,
training strategies; pediatric and
adolescent athletes; early sports
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Academy of Pediatrics also highlighted
the potential risk of focusing on a single
sport in early ages from physical, phys-
iological, and psychological standpoints
(14). The American College of Sports
Medicine further recommended a well-
rounded general fitness program to pre-
vent sports-related injuries (2). The
American Orthopedic Society for
Sports Medicine recently suggested
the importance of developing a sound
environment for the long-term health of
the physically active youth with support
of parents, clinicians, and coaches in
their consensus statement (17). In short,
some sports medicine organizations
have announced their concerns for
sports specialization through their state-
ments. Scientific studies that focus on
early sports specialization are limited.
However, several recently published
studies offer valuable insights in regards
to the effects of sports specialization on
athletic injuries and long-term athletic
success. Thus, this article is focused on
synthesizing scientific evidence of early
sports specialization on musculoskeletal
injury and future athleticism develop-
ment in the youth population.
Several studies have identified an effect
of early sports specialization on the
prevalence and incidence of sport-
related injuries. A retrospective cohort
study conducted by Hall et al.(11) re-
ported a 1.5-fold increase in relative risk
of patellofemoral pain in single-sport
specialized female athletes compared
with multisport female athletes. In addi-
tion, single-sport female athletes had 4
times greater risk of Sinding-Larsen
Johansson disease/patellar tendinop-
athy and Osgood–Schlatter disease than
multisport female athletes (11). Another
study by Jayanthi et al.(15) analyzed
approximately 500 teenage tennis
players for 1 year and found a higher
likelihood of reporting musculoskeletal
injuries among young tennis players
who solely participated in tennis.
Another investigation of 1,200 young
athletes conducted by Jayanthi et al.(16)
reported that total time spent in training
per week and sports specialization was
an independent risk factor for serious
overuse injuries such as spondylolysis,
osteochondritis dissecans, and stress
fractures among young athletes who
participate in a single sport. Further-
more, a recent clinical review high-
lighted a positive linear association
between risk of serious overuse injuries
and the level ofsport specialization such
as number of sports participations, .8
months per year training, and dropping
out of other sports (23). Two other
studies also indicated increased sports-
related injury incidences in young ath-
letes who participate in a single sport
compared with multiple sports (11,15).
Based on the reported evidence, experts
in this field recommended participating
in a variety of athletic activities to
enhance motor skill developments and
to promote ideal growth in young ath-
letes (24).
In regard to age, a cross-sectional
study examining the starting ages of
2004 Olympians reported that the
mean age of initial sports participation
was 11.5 years (34). Although this
study did not examine age of sports
specialization and injury data, it is
intriguing that the mean age of sports
participation in Olympic athletes is
approximately 11–12 years old, which
seems remarkably later than many pa-
rents and coaches believe. However,
another study supports this finding.
To investigate optimum time to
enhance athletic development, Danish
scientists analyzed approximately 200
elite cyclists, rowers, weightlifters,
swimmers, and track and field compet-
itors (21). The conclusion was that the
period of middle teens is vital to facil-
itate international level of athletic suc-
cess (21). Based on this evidence, the
age of athletic participation to deter-
mine future athletic success does not
have to be below 10 years.
Although mass media tends to high-
light successful stories of high profile
athletes who started participating in
a certain sport at an early age, studies
indicate that a relatively low propor-
tion of young athletes who specialize
in a single sport become international-
level athletes later in their careers.
According to a longitudinal study con-
ducted in Germany, only 0.3% of
young athletes who specialized in a sin-
gle sport became international-level
athletes (10). Similarly, another study
conducted in Russia followed approx-
imately 35,000 young athletes who
were selected to train at a high-level
training institution and found that only
0.14% became elite athletes (20). Find-
ings from both studies implied that
a chance to be an elite-level athlete is
a low fraction, even if one is specialized
to a single sport.
To determine a link between early
sports specialization and future athletic
successes, German researchers con-
ducted a retrospective study of 1,558
German national-level athletes who
were classified either as world class ath-
letes (those who finished in the top 10
places at the Olympic competitions
and/or senior world championships)
or national-level athletes (those who
were ranked in the top 10 at national
senior championships, but not at inter-
national competitions) (10). The results
indicated that single-sport athletes who
started their athletic careers early dem-
onstrated successful competition out-
comes during the middle teenage
period (,14 years old) (10); however,
a later age of specialization was associ-
ated with senior world class success. In
addition, more world class athletes not
only participated in additional sports
compared with the national-level ath-
letes, but practiced additional sports
for longer periods of time compared
with the national-level competitors
(10). Interestingly, when the world class
athletes were categorized by the num-
ber of additional sports they partici-
pated in, the proportions of the world
class athletes showed an increase. The
proportions in number of participated
sports among the world class athletes
Training, Youth, Specialization, Kids
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were as follows: zero: 56%, 1 additional
sport: 67%, 2 additional sports: 69%, and
3 or more additional sports: 76% (10).
The overall training volumes were not
different between the world class ath-
letes and national-level athletes. How-
ever, the training volume for additional
sport(s) was significantly greater in the
world class athletes than that of the
national-level athletes until the age of
10 years. Furthermore, the world class
athletesfocused on a single sport later in
their careers compared with the
national-level athletes (10). The authors
of this study concluded that performing
additional sport(s) is a predictor for
greater athletic successes later in ath-
letes’ careers.
According to the study by German re-
searchers (10), early sports specializa-
tion may result in early athletic
successes, but it is less likely to result
in longer, senior-level success. Con-
versely, the evidence suggests that per-
forming multiple sports at early ages is
more beneficial for young athletes and
more likely to generate greater suc-
cesses later in their careers. Participat-
ing in different sports activities likely
facilitates the development of better-
rounded motor skill sets. According
to Myer et al.(24), this approach helps
develop the positive implications of
skill transfer with sport diversification
in youth. The transfer of skills from
sport to sport as well as training of
opposing muscle groups and flexibility
patterns may promote and contribute
to the development of superior overall
athletic capability, which may more
positively influence young athletes’
well-rounded athleticism later in their
careers. It is critical to keep in mind
that young athletes are still in the pro-
cess of growing. Among teenage
athletes, especially prepubescent and
pubescent athletes, adequate recovery
time is necessary to promote appropri-
ate growth. Jayanthi et al.(16) offer
a simple and practical ratio: once the
time spent for organized athletic activ-
ities exceeds twice that of free play
time, the odds of sustaining serious
overuse injuries increase significantly.
Several studies also indicate that par-
ticipating in athletic activities more
than 16 hours per week may increase
risk of athletic injuries (15,19,27).
Therefore, providing an environment
in which young athletes can engage
in multiple sports with proper recovery
time would be ideal to enhance their
athletic activities and success later in
their lives.
Another important training consider-
ation in youth is to protect young ath-
letes from serious injuries. An example
might include the early specialized
young baseball pitcher. Lack of shoul-
der internal rotation range of motion
called glenohumeral internal rotation
deficit (GIRD) is a particularly alarm-
ing finding among young throwers
(5,25,33) because it remains unknown
whether or not the GIRD is fully
reversible once it develops. To reduce
the number of pitches, guidelines of
less than 75 pitches per game, 600
pitches per season, and 2,000–3,000
pitches per year were proposed for
9–14-year-old athletes (35). In baseball,
pitchers have a substantially greater
number of skilled throws than field
players. To avoid overpitching, it may
be a good alternative to rotate players’
positions frequently instead of focusing
on solely pitching, especially while the
players are still in the growth spurt.
These tactics may not only protect
young athletes from overpitching but
provide all players experience at vari-
ous positions, which may help to foster
more comprehensive baseball skill
Furthermore, several studies showed
that a previous injury history is a risk
factor for future injury (7,26). A previous
history of traumatic knee injury such as
anterior cruciate ligament (ACL) injury,
increases the risk of subsequent ACL
injury and other knee injuries. More
specifically, athletes who sustained an
ACL injury 1 time have 15 times greater
risk of sustaining a second ACL injury
relative tothose who never had an ACL
injury (26). Furthermore, previous knee
surgery itself can be a risk factor. A
study performed by Rugg et al.(28)
documented that those who underwent
knee surgery before college showed 7–
20 times higher likelihood of sustaining
another knee injury in their college ca-
reers. To decrease the risk of ACL
injury, prophylactic effectiveness of neu-
romuscular training was examined, and
the results demonstrated a 74% risk
reduction for noncontact ACL injury
(31,32). One of the important compo-
nents of neuromuscular training is the
incorporation of strength training (30).
Enhancing muscular strength seemed
to be beneficial to prevent ACL injury
(30). Historically, concerns for young
athletes engaged in resistance training
have been raised, particularly about risk
of injury to growth cartilage. How-
ever, a recent international consensus
statement based on available studies
found no evidence to support this
notion (18), and actually a few studies
documented greater bone mass devel-
opment in young athletes who regu-
larly performed resistance training
(3,9,13). In short, it is key to integrate
preventive exercises to reduce poten-
tial risk of serious injuries among
young athletes, and resistance train-
ing with proper form can be used as
an effective intervention.
In summary, there is a growing concern
among clinicians in the field of sports
medicine regarding early sports special-
ization, which was reflected in their
organizational statements (2,4,14,17).
Recent research studies show increased
sport-related injuries, especially overuse
injuries, among young athletes who spe-
cialized in a single sport (11,15,16). In
terms of age of participation, several
studies showed that internationally pro-
lific athletes begin participating in their
sports around 11–12 years old (34), and
future athletic success (21). Another
study suggested that performing multi-
ple sports is more beneficial than par-
ticipating in a single sport at early ages,
which also demonstrates an association
Strength and Conditioning Journal | 79
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with greater athletic success later in their
careers (20).
Based on the documented evidence, it
seems to be more beneficial for young
athletes to perform multiple sports
rather than focusing on a single sport
in early ages, which may potentially
reduce overuse injuries among young
athletes. In addition, adequate recovery
periods need to be programmed into
young athletes’ training regimens while
they are still growing. Avoidance of
sports-related injuries should be one of
the priorities in young athletes’ training
because past studies have shown that
a previous injury history is a predictor
for subsequent injuries (7,26). Preventive
training such as resistance training can
be used as a part of young athletes’
training regiments. Incorporation of
preventive training may potentially
reduce the number of sports-related in-
juries, while further maximizing young
athletes’ future performance.
Conflicts of Interest and Source of Funding:
W. P. Meehan receives royalties from
ABC-Clio publishing for the sale of his
book, Kids, Sports, and Concussion: A
guide for coaches and parents; Springer
International for the book Head and Neck
Injuries in Young Athlete; and Wolters
Kluwer for working as an author for
UpToDate. He is under contract with
ABC-Clio publishing for a future book
entitled, Concussions. His research is
funded, in part, by a grant from the
National Football League Players
Association and by philanthropic support
from the National Hockey League Alumni
Association through the Corey C. Griffin
Pro-Am Tournament. The remaining
authors report no conflicts of interest and
no source of funding.
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... Several risks related to sport specialization have been identified, including increased prevalence of physical injury and athlete burnout [2][3][4][5], poor mental health [6], and decreased adult participation in physical activity in later years due to either a lack of skills in different sports [7], or an aversion to sport based on their specialized past [7,8]. However, despite consensus statements from both the American Orthopaedic Society for Sport Medicine and the International Olympic Committee recommending against early sport specialization [9,10] solutions to this issue, in youth sport contexts that are becoming more specialized and professionalized, are not clear. ...
... As echoed above there is little attention outside of performance, with no articles reflecting on how the multisport pathway could aid in mental health and personal development in children as implied by the work by Côté and colleagues [12]. In addition, most articles have considered the topic of multisport engagement as a broad topic of discussion focusing on reviewing the positives and negatives of the multisport versus single sport pathway from a country wide perspective [35], or age group perspective [5]. There were three articles [4,25,36] that were more narrowly focused and provided discussion on one specific sport (tennis and soccer respectively), while two articles specifically focused on the DMSP [13,37]. ...
Full-text available
Multisport engagement is positioned as the antithesis to specialization within youth development pathways. However, different terms are used to describe the multisport pathway, which may create confusion regarding what the pathway should look like. This review investigated all published research examining the multisport pathway, with a focus on terminology, and how different terms have led to varying interpretations of this research. Four databases were searched for all peer reviewed studies published up until December 2021. All included papers were full text, in English, and focusing on multisport athlete engagement. In total, 1974 abstracts were screened for inclusion eligibility, resulting in 82 articles included within this review. General results showed most studies are empirical (71%, n = 58) and looked at athlete development pathways using retrospective questionnaires aimed at investigating the specific pathway to sporting excellence. However, despite the consensus that multisport athletes play many sports in their lifetime, there is little investigation into when and the level of intensity (play versus practice) at which these sports are being played. Further, inconsistencies in the terminology used to describe this pathway have made it difficult to understand potential mechanisms that lead to any positive or negative effects. It is recommended that differences between the key terms of diversification and sampling are clarified and should not be regarded as synonymous as they may represent different paths within multisport development based on varying levels of intensity of play and practice.
... This pressure may stem from their internal pressures, for example, players' inherent desire to excel and their desire to be recognized as talented by coaches, social media, the sports industry, and society (Malina, 2010;Mostafavifar et al., 2013). This pressure can also be extrinsic, such as parental and coaching support, in the hope that young players can gain competitive advantages at an early age (Feeley et al., 2016;Padaki et al., 2017); the incentive of potential college scholarships and future career contracts with lucrative financial rewards (Malina, 2010;Mostafavifar et al., 2013;Padaki et al., 2017); and pressures for early talent identification and selection driven by national elite player development programs Sugimoto et al., 2017). This stressful environment has resulted in an increasing number of young players choosing to specialize at an early age, with preteens, seventh graders, and/or children younger than 12 years participating in intensive training in organized sports on an annual or approximately year-round basis and/or competed for more than 8 months and played only one sport and no other or limited free play . ...
Full-text available
Background: Youth football in schools has experienced rapid growth in China. Despite the increase of players engaging in more frequent, intensive, and organized sports training at their early ages, the controversy over early specialization (ES) still exists. This study aims to: a) investigate the training situation of players in the Chinese School Football Programme and b) examine the associations of early specialization, sports volume, and maturity status with musculoskeletal injury. Methods: A cross-sectional survey was used. Players who participated in the National School Football Winter Camp were invited to fill out a questionnaire that included the data of maturity, ES, sports volume, and injury history (n = 88 boys and n = 90 girls). Results: The results have shown that 80.3% of the athletes were classified as ES, while 19.7% of them were classified as non-ES. Almost all athletes (96%) participated in a sport for more than 8 months in a year. Most athletes (75.8%) spent more than twice of the time on organized sports than leisure activities. 30.3% of the athletes trained on average more hours per week than the number of their ages. Binomial logistic regression models reflected the significant differences in the odds ratios (OR) of reporting a history of injury among athletes with different levels of specialization (p = 0.024) and the OR of reporting a history of leg injury among players with different weekly sports volumes (p = 0.038). Significant differences were also shown in the OR of players reporting foot injuries between players with different maturity states (p = 0.046), and the Chi-squared test showed significant differences in the OR of reporting acute injuries between players with different levels of specialization (p = 0.048) and weekly activity (p = 0.022). No significant differences were found between the remaining variables. Conclusion: Most school football elite players follow the ES pathway even though ES increases the risk of injury, especially acute injury. Pre-pubertal and early pubertal players have a higher incidence of foot injuries. Players who train more hours per week than their ages have more leg injuries and acute injuries. Therefore, priority protection and intervention should be carried out for populations with a high risk of injury.
... Talent identification is not utterly reliable until puberty is completed (Gu¨llich, 2014;H€ oner et al., 2017). However, there is yet evidence that early specialization might be harmful for talent development (Sugimoto et al., 2017). In line with these arguments, we still think that multidimensional research in the youngest players may provide the basis for promising, long-term, soccer development model, irrespective of the actual performance level. ...
Talent identification in sports is a heavily debated topic. Previous studies have separately explored either executive functions or gross motor skills to predict the success of top-level soccer players or, more generally, to characterize elite performance in soccer. However, at mid-childhood, the possibility to scope sport-specific requirements remains elusive. We aimed in this study to investigate a valid and simple method of testing for a unique combination of cognitive and speed abilities for identifying promising soccer players at mid-childhood. We measured cognitive functions by means of a Stroop smartphone application and agility with a T-Drill Ball-success test, in two groups of (a) elite-(n ¼ 31) and (b) low-division (n ¼ 37) Italian 7-year-old male soccer players. We administered the tests in a randomized order to both groups. We found better inhibitory control, cognitive flexibility and soccer-specific agility in high-division versus low-division players (p < .001). Inhibitory
... Furthermore Pattinson (2016), and Baxter- Jones and Mundt (2007) suggest there is a common belief amongst youth coaches in sport that intensive training at an early age is a necessity to achieve senior success. However, less than 1% of current elite athletes came through a typical early specialisation pathway (Sugimoto, 2017). ...
... Furthermore Pattinson (2016), and Baxter- Jones and Mundt (2007) suggest there is a common belief amongst youth coaches in sport that intensive training at an early age is a necessity to achieve senior success. However, less than 1% of current elite athletes came through a typical early specialisation pathway (Sugimoto, 2017). ...
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Football specialisation is a relatively recent subject for debate in Norway. As specialisation has only now become a possibility with new technology and better facilities, offering protection from the long winter. Despite being a topic for extensive research, there is much controversy associated with early specialisation amongst researchers and practitioners alike. The study aimed to investigate and compare an early specialisation approach with that of a late specialiser. This was done by investigating the effects of early and late specialisation, and place this into the context of Norwegian sporting culture, the characteristics of football, and finally reviewed the pathways of elite and sub-elite players. Furthermore, the knowledge was applied to investigate the pathways of current players at level 1-4 of Norwegian football (n=37). The participants answered a questionnaire investigating their playing pathways. The study reached the following conclusions; on average, elite performers had engaged in more football training, in more unorganised play, and in more other sports but at a lower volume than sub-elite performers. Ultimately the study suggests better players had engaged in higher volumes of football trainings and unorganised play, but fewer practise hours in other sports. While a majority of the participants participated in other sports, the trend is that better player specialise in football between the ages of 13 and 15. Future studies should review early specialisation in the context of age appropriate stimuli during a player’s pathway; which other sports are more beneficial for young players; and through the lens of positional requirements. Future researchers should also consider a longitudinal study, as it will contribute valuable data.
The Internet of Things (IoT) technology is an information technology developed in recent years with the development of electronic sensors, intelligence, network transmission and control technologies. This is the third revolution in the development of information technology. This article aims to study the algorithm of the Internet of Things technology, through the investigation of the hazards of athletes’ sports training, scientifically and rationally use the Internet of Things technology to collect data on safety accidents in athletes’ sports training, thereby reducing the risk of athletes’ sports training and making athletes better. In this article, the methods of literature research, analysis and condensing, questionnaire survey, theory and experiment combination, etc., investigate the safety accident data collection of the Internet of Things technology in athletes’ sports training, and provide certain theories and methods for future in-depth research practice basis. The experimental results in this article show that 82% of athletes who are surveyed under the Internet of Things technology will have partial injuries during training, reducing the risk of safety accidents in athletes’ sports training, and better enabling Chinese athletes to achieve a consistent level of competition and performance through a virtuous cycle of development.
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Introduction: While practitioners and organizations advise against early specialization, the lack of a consistent and clear definition of early specialization reduces the impact of recommendations and policies in youth sport. An important first step in understanding the consequences of early specialization is establishing what early specialization is. Objectives: This PRISMA-guided systematic review aimed to determine the types, characteristics, and general content of early specialization papers within the literature, and examine how early specialization has been defined and measured in order to advance knowledge toward a clear and consistent definition of early specialization. Data sources: Four different electronic databases were searched (SPORTDiscus, Web of Science, Sports Medicine and Education Index, and Scopus). Both non data-driven and data-driven studies were included to ensure a comprehensive understanding of the literature. Eligibility Criteria: In order to be included in the review, the paper must: (a) Focus on specialization and explicitly use the term “specialization” (b) Focus on sport and athletes (c) Be papers from a peer-reviewed (d) Be in English. And finally, (e) be available in full text. Results: One thousand three hundred and seventy one articles were screened resulting in 129 articles included in the review after applying inclusion/exclusion criteria. Results indicated a clear discrepancy between key components of early specialization and the approaches used to classify early specializers. Conclusion: Future research should work toward developing a valid and reliable approach to classifying early specializers and establishing a consistent definition across studies.
Objective: To investigate associations of early specialisation (highly specialised before age 13 years) and sport participation volume with injury history in New Zealand children. Design: Cross-sectional survey study. Methods: Children attending a national sports competition were invited to complete a questionnaire capturing specialisation level (high, moderate or low), participation volume and injury history. Multiple logistic regression was used to investigate associations between variables. Results: Nine hundred and fourteen children (538 female) completed the questionnaire. After adjusting for age, sex and hours of weekly sport participation, the odds of reporting an injury history were not significantly higher for early specialised children compared to children categorised as low specialisation (OR=0.88; CI=0.59-1.31; p=0.53). Participating in more hours of sport per week than age in years (OR=2.42; CI=1.27-4.62; p=0.02), playing one sport for more than 8 months of the year (OR=1.60; CI=1.07-2.36; p=0.02), or exceeding a 2:1 weekly ratio of organised sport to recreational free-play hours (OR=1.52; CI=1.08-2.15; p=0.02), increased the odds of reporting a 'gradual onset injury'. Conclusion: Early specialisation in one sport did not increase the odds of reporting a history of injury. Exceeding currently recommended sport participation volumes was associated with increased odds of reporting a history of gradual onset injury.
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Background: Early sport specialization is not a requirement for success at the highest levels of competition and is believed to be unhealthy physically and mentally for young athletes. It also discourages unstructured free play, which has many benefits. Purpose: To review the available evidence on early sports specialization and identify areas where scientific data are lacking. Study design: Think tank, roundtable discussion. Results: The primary outcome of this think tank was that there is no evidence that young children will benefit from early sport specialization in the majority of sports. They are subject to overuse injury and burnout from concentrated activity. Early multisport participation will not deter young athletes from long-term competitive athletic success. Conclusion: Youth advocates, parents, clinicians, and coaches need to work together with the sport governing bodies to ensure healthy environments for play and competition that do not create long-term health issues yet support athletic competition at the highest level desired.
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Context: Many coaches, parents, and children believe that the best way to develop elite athletes is for them to participate in only 1 sport from an early age and to play it year-round. However, emerging evidence to the contrary indicates that efforts to specialize in 1 sport may reduce opportunities for all children to participate in a diverse year-round sports season and can lead to lost development of lifetime sports skills. Early sports specialization may also reduce motor skill development and ongoing participation in games and sports as a lifestyle choice. The purpose of this review is to employ the current literature to provide evidence-based alternative strategies that may help to optimize opportunities for all aspiring young athletes to maximize their health, fitness, and sports performance. Evidence acquisition: Nonsystematic review with critical appraisal of existing literature. Study design: Clinical review. Level of evidence: Level 4. Conclusion: Based on the current evidence, parents and educators should help provide opportunities for free unstructured play to improve motor skill development and youth should be encouraged to participate in a variety of sports during their growing years to influence the development of diverse motor skills. For those children who do choose to specialize in a single sport, periods of intense training and specialized sport activities should be closely monitored for indicators of burnout, overuse injury, or potential decrements in performance due to overtraining. Last, the evidence indicates that all youth should be involved in periodized strength and conditioning (eg, integrative neuromuscular training) to help them prepare for the demands of competitive sport participation, and youth who specialize in a single sport should plan periods of isolated and focused integrative neuromuscular training to enhance diverse motor skill development and reduce injury risk factors. Strength of recommendation taxonomy sort: B.
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Context: There is increased growth in sports participation across the globe. Sports specialization patterns, which include year-round training, participation on multiple teams of the same sport, and focused participation in a single sport at a young age, are at high levels. The need for this type of early specialized training in young athletes is currently under debate. Evidence acquisition: Nonsystematic review. Study design: Clinical review. Level of evidence: Level 4. Conclusion: Sports specialization is defined as year-round training (greater than 8 months per year), choosing a single main sport, and/or quitting all other sports to focus on 1 sport. Specialized training in young athletes has risks of injury and burnout, while the degree of specialization is positively correlated with increased serious overuse injury risk. Risk factors for injury in young athletes who specialize in a single sport include year-round single-sport training, participation in more competition, decreased age-appropriate play, and involvement in individual sports that require the early development of technical skills. Adults involved in instruction of youth sports may also put young athletes at risk for injury by encouraging increased intensity in organized practices and competition rather than self-directed unstructured free play. Strength-of-recommendation taxonomy sort: C.
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Objectives: With rising participation in youth sports such as baseball, proximal humeral epiphysiolysis (“Little league Shoulder,” LLS), is being seen with increasing frequency. However, there remains a paucity of literature regarding the causes or outcomes of LLS. This study’s purpose was to analyze the demographics, symptoms, diagnosis, and treatment of LLS, with an emphasis on identifying underlying risk factors for development and recurrence of LLS. Methods: A departmental database at a single pediatric referral center was queried to identify cases of LLS between 1999 and 2013, which were reviewed to analyze age, sex, physical examination and radiologic findings, treatment details, and rates of recurrence. Results: 95 patients (93 males; mean age 13.1 years, range 8-17 years) were diagnosed with LLS, with volumes increasing over the study period (Figure 1). In addition to the primary complaint of shoulder pain with overhead athletics seen in all patients, 13% reported elbow pain, 10% reported shoulder fatigue or weakness, and 8% reported mechanical symptoms. While the vast majority of patients (97%) were baseball players (86% pitchers, 8% catchers, 7% other positions), 3% were tennis players. On physical exam, 30% were reported to have glenohumeral internal rotation deficit (GIRD). Treatment recommendations included rest in 98% of cases, physical therapy in 79% (100% of patients with GIRD), and position change upon return to play in 25%. Average time to resolution of symptoms was 2.6 months, while average time to return to competition was 4.2 months. Recurrent symptoms were reported in 7.4% in the overall population at a mean of 8 months following symptom resolution. The odds ratio of recurrence between the group with diagnosed GIRD (14.3%) and those without GIRD (4.5%) was approximately 3:1. Conclusion: Little league shoulder is being diagnosed with increasing frequency. While most common in male baseball pitchers, the condition can occur in females, youth catchers, other baseball positions players, and tennis players. Concomitant elbow pain may be seen in up to 13%. After rest and physical therapy, recurrent symptoms can occur, generally 6-12 months after return to sports. Almost one-third of LLS patients with had GIRD, and this group had three times higher probability of recurrence compared to those without GIRD.
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Over the past 15 years, there has been an increase in youth sports participation with a concomitant increase in early year-round training in a single sport. Many factors contribute to the desire of parents and coaches to encourage early single sport specialization, including the desire to give the young athlete an edge in competition, pursuit of scholarships, and potential professional status, and the ability to label a young athlete as elite at an early age. Despite these perceived advantages, some data suggest that early sport specialization does not lead to a competitive advantage over athletes who participate in multiple sports. Although the data are limited, there is some evidence that early sport specialization may put the young athlete at risk for overuse injuries. The focus of this review is to highlight the evidence regarding early sport specialization and risk for injury; discuss the risk factors for overuse injury in high-risk sports including ice hockey, swimming, gymnastics, and baseball; and discuss future potential research that would help define the risk of injury for young athletes who participate in early sport specialization. © 2015 The Author(s).
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Data are lacking regarding the independent risk of injury related to intense single-sport training or growth rate in young athletes. To determine whether sports specialization, weekly training volumes, and growth rates are associated with increased risk for injury and serious overuse injury in young athletes. Case-control study; Level of evidence, 3. Injured athletes aged 7 to 18 years were recruited from 2 hospital-based sports medicine clinics and compared with healthy controls from affiliated primary care clinics undergoing sports physicals (2010-2013). Participants completed surveys reporting hours per week spent in organized sports, physical education class, and free play, as well as degree of sports specialization and Tanner stage. Heights and weights were measured. Injury details were obtained from athlete surveys and electronic medical records. Of 1214 athletes enrolled, 1190 (50.7% male) had data satisfactory for analysis. There were 822 injured participants (49.5% male; unique injuries, n = 846) and 368 uninjured participants (55% male). Injured athletes were older than uninjured athletes (14.1 ± 2.1 vs 12.9 ± 2.6 years; P < .001) and reported more total hours of physical activity (19.6 ± 9.2 vs 17.6 ± 8.9 h/wk; P < .001) and organized sports activity (11.2 ± 2.6 vs 9.1 ± 6.3 h/wk; P < .01). After accounting for age and hours in sports activity spent per week, sports-specialized training was an independent risk for injury (odds ratio [OR], 1.27; 95% CI, 1.07-1.52; P < .01) and serious overuse injury (OR, 1.36; 95% CI, 1.08-1.72; P < .01). Young athletes participating in more hours of sports per week than number of age in years (OR, 2.07; 95% CI, 1.40-3.05; P < .001) or whose ratio of organized sports to free play time was >2:1 hours/week had increased odds of having a serious overuse injury (OR, 1.87; 95% CI, 1.26-2.76; P < .01). Growth rates were similar between injured and uninjured athletes (4.8 cm/y for both groups; P = .96). Injured young athletes were older and spent more hours per week in organized sports. There is an independent risk of injury and serious overuse injury in young athletes who specialize in a single sport. Growth rate was not related to injury risk. The study data provide guidance for clinicians counseling young athletes and their parents regarding injury risks associated with sports specialization. © 2015 The Author(s).
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Anterior cruciate ligament (ACL) injury is a major concern in physically active females. Although ACL reconstruction techniques have seen significant advances in recent years, risk associated with re-injury and future osteoarthritis remains a major concern. Thus, prevention of ACL injury is a logical step to protect and preserve healthy knee joints in young athletes. The current report aims to summarize a list of evidence-based prevention strategies to reduce ACL injury in female athletes. A list of six critical principles, which come from documented, large-scale clinical trial studies and further analyses, were presented with ABC format including age, biomechanics, compliance, dosage, exercise, and feedback. Also, a grade for evidence and implications of future research are noted. Finally, in the conclusion section, importance of collaborative efforts from healthcare practitioners, researchers, and personnel associated with athletics is addressed.
Background: With rising participation in youth sports such as baseball, proximal humeral epiphysiolysis, or Little League shoulder (LLS), is being seen with increasing frequency. However, there remains a paucity of literature regarding the causes, natural history, or treatment outcomes of LLS. Purpose: To analyze the demographic, clinical, and diagnostic features of a population of LLS patients, with an emphasis on identifying underlying risk factors for the development and recurrence of LLS after nonoperative treatment. Study Design: Case series; Level of evidence, 4. Methods: A departmental database at a high-volume regional children's hospital was queried to identify cases of LLS between 1999 and 2013. Medical records were reviewed to allow for analysis of age, sex, athletic information, physical examination and radiologic findings, treatment details, clinical course, and rates of recurrence. Results: Ninety-five patients (93 males, 2 females; mean age, 13.1 years; range, 8-16 years) were diagnosed with LLS. The number of diagnosed cases increased annually over the study period. All patients had shoulder pain with overhead athletics; secondary symptoms included elbow pain in 13%, shoulder fatigue or weakness in 10%, and mechanical symptoms in 8%. While the majority of patients (97%) were baseball players (86% pitchers, 8% catchers, 7% other positions), a small subset (3%) were tennis players. On physical examination, 30% were reported to have glenohumeral internal rotation deficit (GIRD), defined as a decreased arc of rotational range of motion of the shoulder. Treatment recommendations included rest in 99% of cases, physical therapy in 79% (including 100% of patients with GIRD), and position change upon return to play in 26%. Average time to full resolution of symptoms was 2.6 months, while average time to return to competition was 4.2 months. Recurrent symptoms were reported in 7% of the overall cohort at a mean of 7.6 months after initial diagnosis. The odds of recurrence in the group with diagnosed GIRD (14%) were 3.6 times greater than those without GIRD (5%; 95% CI: 0.7-17.1), but this difference was not statistically significant (P =.11). Conclusion: Little League shoulder is being diagnosed with increasing frequency. While most common in male baseball pitchers, the condition can occur in females, youth catchers, other baseball positions players, and tennis players. Concomitant elbow pain may be seen in up to 13%. After rest and physical therapy, recurrent symptoms may occur in a small subset of patients (7%), generally 3 to 6 months after return to sports. Almost one-third of LLS patients had GIRD, and this group had approximately three times higher probability of recurrence compared with those without GIRD.
Pediatric and adolescent sports participation has increased with a concomitant increase in injuries. Sports have transitioned from recreational to deliberate, structured activities wherein success is determined by achievement of 'elite' status. This has led to specialization in a single sport with intensive, repetitive activity at younger ages causing physical and emotional consequences, particularly true for the growing athlete who is particularly susceptible to injury. Clinicians caring for this population must understand the epidemiology of youth sports specialization, the unique physiology/structure of this age group, and the potential physical and emotional consequences. Copyright © 2015 Elsevier Inc. All rights reserved.