ArticlePDF Available

Early Sports Specialization Is Associated With Upper Extremity Injuries in Throwers and Fewer Games Played in Major League Baseball

Article

Early Sports Specialization Is Associated With Upper Extremity Injuries in Throwers and Fewer Games Played in Major League Baseball

Abstract and Figures

Background Single-sport athletes who specialize in baseball at a young age may have a greater predisposition to overuse injury, burnout, and decreased career longevity when compared with multiple-sport athletes. The effect of sport specialization has not been studied in professional baseball players. Hypothesis Major League Baseball (MLB) players who played multiple sports in high school would experience fewer injuries, spend less time on the disabled list, play more games, and have a longer career than athletes who played only baseball in high school. Study Design Descriptive epidemiology study. Methods First- and second-round MLB draft picks from 2008 to 2016 who played in at least 1 professional game were included in this study. Athletes who participated in 1 or more sports in addition to baseball during high school were considered multisport athletes, and athletes who participated in only baseball were considered single-sport athletes. For each athlete, participation in high school sports, injuries sustained in MLB and Minor League Baseball, number of days on the disabled list for each injury, number of games played in both leagues, and whether the athlete was still active were collected from publicly available records. Results A total of 746 athletes were included in this study: 240 (32%) multisport and 506 (68%) single sport. Multisport athletes played in significantly more mean total games (362.8 vs 300.8; P < .01) as well as more mean MLB games (95.9 vs 71.6; P = .04) than single-sport athletes. There was no difference in the mean number of seasons played in the major leagues (1.8 vs 1.6; P = .15) or minor league (5.25 vs 5.20; P = .23) between multisport and single-sport athletes. Single-sport athletes had a significantly higher prevalence of upper extremity injuries compared with multisport athletes (136 [63%] vs 55 [50%]; P = .009). Single-sport pitchers also had a higher prevalence of shoulder and elbow injuries (86 vs 27; P = .008) and were more likely to have recurrent elbow injuries (33% vs 17% recurrence; P = .002) compared with multisport pitchers. Conclusion Professional baseball players who participated in multiple sports in high school played in more major league games and experienced lower rates of upper and lower extremity injuries than players who played only baseball in high school.
Content may be subject to copyright.
Original Research
Early Sports Specialization
Is Associated With Upper Extremity
Injuries in Throwers and Fewer Games
Played in Major League Baseball
Jamie Confino,* MD, James N. Irvine,* MD, Michaela O’Connor,* BA,
Christopher S. Ahmad,* MD, and T. Sean Lynch,*
MD
Investigation performed at Columbia University Irving Medical Center, New York, New York, USA
Background: Single-sport athletes who specialize in baseball at a young age may have a greater predisposition to overuse injury,
burnout, and decreased career longevity when compared with multiple-sport athletes. The effect of sport specialization has not
been studied in professional baseball players.
Hypothesis: Major League Baseball (MLB) players who played multiple sports in high school would experience fewer injuries,
spend less time on the disabled list, play more games, and have a longer career than athletes who played only baseball in high
school.
Study Design: Descriptive epidemiology study.
Methods: First- and second-round MLB draft picks from 2008 to 2016 who played in at least 1 professional game were included in
this study. Athletes who participated in 1 or more sports in addition to baseball during high school were considered multisport
athletes, and athletes who participated in only baseball were considered single-sport athletes. For each athlete, participation in
high school sports, injuries sustained in MLB and Minor League Baseball, number of days on the disabled list for each injury,
number of games played in both leagues, and whether the athlete was still active were collected from publicly available records.
Results: A total of 746 athletes were included in this study: 240 (32%) multisport and 506 (68%) single sport. Multisport athletes
played in significantly more mean total games (362.8 vs 300.8; P<.01) as well as more mean MLB games (95.9 vs 71.6; P¼.04)
than single-sport athletes. There was no difference in the mean number of seasons played in the major leagues (1.8 vs 1.6; P¼.15)
or minor league (5.25 vs 5.20; P¼.23) between multisport and single-sport athletes. Single-sport athletes had a significantly higher
prevalence of upper extremity injuries compared with multisport athletes (136 [63%] vs 55 [50%]; P¼.009). Single-sport pitchers
also had a higher prevalence of shoulder and elbow injuries (86 vs 27; P¼.008) and were more likely to have recurrent elbow
injuries (33% vs 17% recurrence; P¼.002) compared with multisport pitchers.
Conclusion: Professional baseball players who participated in multiple sports in high school played in more major league games
and experienced lower rates of upper and lower extremity injuries than players who played only baseball in high school.
Keywords: professional baseball; pitchers; MLB; sports specialization; throwers
Participation in youth sports has grown rapidly in recent
years, with an increase from 45 million athletes in 1997 to
60 million in 2008.
13,14
As this number has grown, we have
also observed a high percentage of youth athletes special-
izing in sports, with 27%of this 2008 cohort focusing on just
1sport.
13
Sport specialization is defined as year-round
training in a single sport to the exclusion of other sports.
12
At the high school level, there are 7.8 million adolescents
playing organized high school sports annually, many of
which have specialized in 1 sport before high school.
13,16
In 2016, the American Academy of Pediatrics released its
third policy statement regarding the potential sequelae of
early sport specialization and high-intensity training at a
young age, including burnout, overuse injuries, and psycho-
logical stress.
2
The American Medical Society for Sports
Medicine also released a 2014 position statement advising
athletes to avoid sport specialization before adolescence.
6
It
is believed that sport specialization leads to young athletes
not having the opportunity to develop the proper neuro-
muscular skills and general fitness that can protect against
injury.
1,5
McGuine et al
11
prospectively evaluated 1544
The Orthopaedic Journal of Sports Medicine, 7(7), 2325967119861101
DOI: 10.1177/2325967119861101
ªThe Author(s) 2019
1
This open-access article is published and distributed under the Creative Commons Attribution - NonCommercial - No Derivatives License (http://creativecommons.org/
licenses/by-nc-nd/4.0/), which permits the noncommercial use, distribution, and reproduction of the article in any medium, provided the original author and source are
credited. You may not alter, transform, or build upon this article without the permission of the Author(s). For article reuse guidelines, please visit SAGE’s website at
http://www.sagepub.com/journals-permissions.
high school athletes and reported an association between
sport specialization and lower extremity injuries. Mean-
while, Bell et al
1
showed that single-sport high school ath-
letes were more likely to experience a history of overuse
knee and hip injuries.
Baseball requires repetitive technical skills, especially
during the act of pitching. In recent years, there has been
a dramatic increase in the number of high school and col-
legiate pitchers undergoing surgery for throwing-related
injuries. One study found a 4-fold increase in the number
of elbow surgical procedures performed on collegiate base-
ball pitchers and a 6-fold increase for high school pitchers
over a 10-year period.
15
Hodgins et al
9
found a 193%
increase in ulnar collateral ligament (UCL) reconstructions
from 2002 to 2011 in the state of New York, with a signif-
icant increase in the frequency of UCL reconstructions for
individuals 17 to 20 years of age.
15
These findings coincide
with a 2017 study reporting a higher percentage of high
school athletes specializing in baseball (60%vs 45%)ata
significantly earlier age (12.3 vs 15.4 years) than they were
10 years ago.
3
Fleisig and Andrews
7
found that pitching volume is a
risk factor for elbow injuries, as an increased number of
pitches per game, innings pitched per season, months
pitched per year, and pitching for multiple teams were all
significantly associated with an increased risk for these
injuries. Throwers who pitched more than 8 months per
year had a 500%increased risk for undergoing shoulder
or elbow surgery.
15
It is speculated that sport specialization
in baseball leads to more games played, a longer season,
and playing for multiple teams. All of these factors combine
to increase the risk for overuse injuries and the potential
need for surgery.
The purpose of this study was to (1) compare the incidence
in professional baseball players of single-sport specialization
versus multisport participation during high school, (2) iden-
tify differences in length of Major League Baseball (MLB)
career and total number of MLB games played between ath-
letes with a history of single-sport specialization versus mul-
tisport athletes, and (3) distinguish differences in injury
patterns and their incidence in those with single-sport ver-
sus multisport backgrounds. We hypothesized that MLB
players who played multiple sports in high school would
experience fewer injuries, spend less time on the disabled
list (DL), play more games, and have a longer career than
athletes who played only baseball in high school.
METHODS
First- and second-round draft picks for all MLB teams from
2008 to 2016 were identified on www.MLB.com. First- and
second-round draft picks represented a higher-level baseball
player and were likely to have more public information avail-
able as well as a greater likelihood of playing professionally.
Athletes who played in at least 1 minor league game were
included in this study. A total of 751 athletes were isolated, 5
of whom never played a minor or major league game, result-
ing in 746 players being included in this study.
For each player, we collected high school sport participa-
tion, number of minor and major league games played, num-
ber of injuries sustained during minor and major league
games, number of days on the DL for each injury, and dura-
tion of career. Baseline characteristics were collected, such
as age, height, weight, and body mass index at the time of
draft, as wellas position played. Player data were obtained by
searching websites such as www.MiLB.com, www.MLB.com,
www.ESPN.com, www.FoxSports.com, www.MaxPreps.
com, and www.DraftExpress.com, as well as undergraduate
athletic websites through June 15, 2018. News articles were
used when internet data were limited.
Players were considered multisport athletes if they had
played a varsity, junior varsity, or competitive club sport in
addition to baseball during high school. Sports played before
high school or recreationally did not qualify as multisport.
We considered as injuries those that occurred during Minor
League Baseball (MiLB) and MLB games that resulted in
the athlete being on the DL for at least 7 days. Injuries
attributed to trauma, including fractures, concussions, con-
tusions, and lacerations, as well as illnesses, were excluded
from this study. Injuries were characterized by type, loca-
tion, and duration of time spent on the DL. The injury had to
occur while the athlete was employed by an MiLB or MLB
team to be included. MiLB injuries were excluded from sub-
analysis of type of injury, as there was a lack of reliable
public data for injury details. As a result, type and location
of injury were analyzed only for those sustained in MLB
games.
Based on www.MiLB.com and www.MLB.com, the total
number of games played in professional baseball were com-
piled. The percentage of possiblegames played was calculated
by dividing the number of games played by the number of
games for which the athlete was listed as available.
17
Athlete
status was characterized as active on the basis of whether the
player remained under contract with the MLB or MiLB.
Athletes were stratified by position into pitchers or posi-
tion players (nonpitchers). Analysis of injury prevalence
and number of total and possible games played was con-
ducted for pitchers only, position players only (nonpitch-
ers), and all athletes (pitchers and position players).
Statistical Analysis
The unpaired ttest, 2-tailed chi-square test, and 2-tailed
Fisher exact test were all utilized. The specific use of each
Address correspondence to T. Sean Lynch, MD, 622 West 168th Street, PH-11, New York, NY 10032, USA (email: tseanlynch@gmail.com).
*Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York, USA.
One or more of the authors has declared the following potential conflict of interest or source of funding: C.S.A. has received consulting fees from Arthrex,
royalties from Arthrex, and hospitality payments from DePuy. T.S.L. has received educational support from Smith & Nephew and Arthrex and nonconsulting
payments from Smith & Nephew. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an inde-
pendent investigation on the OPD and disclaims any liability or responsibility relating thereto.
Ethical approval was not sought for the present study.
2Confino et al The Orthopaedic Journal of Sports Medicine
test is listed in Table 1. Statistical significance in this study
was defined as a Pvalue <.05, and all statistical analyses
were performed with SPSS (v 24; IBM).
RESULTS
A total of 746 athletes were identified as first- or second-
round draft picks who played in the MLB or MiLB. Of these
athletes, 240 (32%) were multisport and 506 (68%)
were single sport. Besides baseball, the multisport
athletes played football (n ¼142), basketball (n ¼98),
soccer (n ¼15), hockey (n ¼12), track (n ¼7), golf (n ¼6),
and wrestling (n ¼2) in high school. There were no signifi-
cant differences between the multisport and single-sport
cohorts with respect to age, height, weight, or body mass
index at the time of the draft (Table 2). When player position
was compared between the cohorts, there was a significantly
higher percentage of pitchers in the single-sport cohort
(51.68%) than in the multisport cohort (41.42%,P¼.01)
(Table 3).
Of the 746 athletes drafted, 326 (43.7%) played in at least
1 major league game from 2008 to 2018. The percentage of
multisport athletes who made it to the MLB was 46%as
compared with 43%for single-sport athletes. The multi-
sport athletes played in significantly more total games on
average (363 vs 301, P¼.004) and more MLB games on
average (96 vs 72, P¼.04) than the single-sport cohort
(Table 4). However, there was no significant difference in
percentage of possible games played between multisport
and single-sport athletes (84.0%vs 82.4%,P¼.157). There
was also no significant difference in in average career
length (P¼.157), mean number of seasons played in the
major and minor leagues (P¼.15, P¼.23 respectively), or
percentage of total games spent on the DL (P¼.229).
For athletes drafted in the first 2 rounds from 2008 to
2016, the most common MLB injuries were shoulder
impingement, elbow sprain, UCL tear requiring recon-
structive surgery, lumbar strain, and oblique strain
(Table 5). In MLB, single-sport athletes had a significantly
higher number of upper extremity injuries (shoulder,
elbow, forearm, wrist, and hand) compared with multisport
athletes (136 [63%] vs 55 [50%], P¼.009) (Table 6). Single-
sport athletes also had a higher number of knee and ankle
injuries than multisport athletes (30 [14%]vs10[9%], P
.001). Within multisport athletes, there was no difference
in the type of sport played outside of baseball or the ath-
letes’ risk of subsequent injury.
When only MLB pitchers were examined, single-sport
athletes had significantly more elbow and shoulder injuries
compared with multisport athletes (86 [75.44%]vs27
[56.25%], P¼.008) (Table 7). Additionally, among pitchers
TABLE 1
Statistical Tests Used to Determine the Differences
Between the Multisport and Single-Sport Athlete Cohorts
a
Statistical Test Value Assessed
Unpaired ttest Baseline characteristics
Two-tailed
chi-square
Field position
Two-tailed
chi-square
Number of MLB games played and percentage
of total games played
Two-tailed
Fisher exact
Number of major injuries sustained, injury
type, and current MLB status
a
MLB, Major League Baseball.
TABLE 2
Mean Baseline Characteristics at Time of Draft
a
Single Sport
(n ¼506)
Multisport
(n ¼240) P
Age, y 19.80 20.01 .06
Height, in 74.45 74.13 .29
Weight, lb 198.50 198.59 .95
Body mass index 25.27 25.44 .35
a
Bold indicates P<.05.
TABLE 3
Percentage Pitchers vs Position Players
a
Single Sport
(n ¼506)
Multisport
(n ¼240) P
Pitchers, %51.68 41.42 .01
Position players, %48.32 58.58 .01
a
Bold indicates P<.05.
TABLE 4
Mean Number of Games Played per Player
a
Single Sport
(n ¼506)
Multisport
(n ¼240) P
Total games played, n 300.79 362.80 <.01
Major league games played, n 71.60 95.87 .04
Percentage of possible games
played
b
82.4 84.0 .157
a
Bold indicates P<.05.
b
Games for which the athlete was listed as available.
TABLE 5
Most Common Injuries by Type (Major League Baseball)
a
Single Sport
(n ¼216)
Multisport
(n ¼110) P
Shoulder impingement/
tendonitis
39 14 .046
Elbow sprain 23 7
UCL tear requiring Tommy
John surgery
21 11
Lumbar strain 20 11
Oblique strain 17 12
Hamstring strain 14 12
a
Data are shown as No. of injuries. Bold indicates P<.05. UCL,
ulnar collateral ligament.
The Orthopaedic Journal of Sports Medicine Sport Specialization in Major League Baseball 3
who had at least 1 elbow injury, single-sport pitchers had a
higher rate of reinjury than the multisport players (33%vs
17%,P¼.002). Furthermore, a higher percentage of mul-
tisport pitchers made it to the major leagues as compared
with single-sport pitchers; however, this result was not sig-
nificant (48.0%vs 43.7%,P¼.181). No difference was found
in the number of All-Star Game appearances between the
groups (16 [14.6%]inmultisportvs29[13.4%]insingle
sport, P¼.700).
When only position players (nonpitchers) were exam-
ined, single-sport athletes continued to have significantly
more total injuries than multisport athletes (78.4%vs
61.3%,P¼.013). However, there was no difference in the
number of shoulder and elbow injuries between the position
player groups (49%vs 45%,P¼.153).
DISCUSSION
Limited information has been published on the effects of
early sports specialization asitpertainstoprofessional
baseball athletes. Our study is the first to report on the
incidence of specific baseball injuries, career longevity, and
the impact that early specialization has on MLB and MiLB
players. Unique to our study was the finding that single-
sport pitchers were at an increased risk of upper extremity
injury with a decreased number of games played when com-
pared with multisport pitchers. We also found that single-
sport athletes experienced significantly higher rates of both
upper and lower extremity injuries, suggesting that early
sports specialization may be placing young athletes at a
higher risk of injury as they progress throughout their
careers. In addition to these higher injury rates, these early
specializers played in significantly fewer total games in
their careers, including games played at the MLB level.
However, there was no difference between the cohorts with
respect to possible games played. Therefore, young athletes
interested in a baseball career at the highest professional
level can minimize their risk of overuse injuries and have the
potential for greater future longevity by participating in
multiple sports during high school. These findings should
be reiterated to parents and coaches who might influence
young athletes to train and participate in a single sport.
About one-third of the players included in our cohort
were multisport athletes, while a 1980s study on profes-
sional baseball players found that well over half of the
included athletes in its cohort had played basketball
(68.7%) or football (59.3%) while in high school.
8
This recent
shift toward specialization has occurred because of the mis-
conception that early sport specialization provides a perfor-
mance advantage that could lead to an earlier and higher
MLB draft opportunity or highly coveted collegiate scholar-
ships. A recent study of collegiate athletes found that the
primary drivers of specialization included personal inter-
est, skill level, time constraints, and the prospect of poten-
tial scholarship opportunities.
18
This misunderstanding
leads parents and coaches to encourage young athletes to
play on multiple teams and dedicate more hours to devel-
oping their game. However, the athletes themselves seem
to believe otherwise. In a study published by Wilhelm
et al,
19
only 27%of players believed that early specializa-
tion is helpful, while nearly two-thirds (63.4%)feltthat
early specialization is not advantageous.
In an attempt to ameliorate the misconception of the
benefits of early sports specialization, the American Ortho-
paedic Society for Sports Medicine released a consensus
statement emphasizing that early specialization places
young athletes at risk for overuse injuries and burnout.
10
Our results concur, as MLB and MiLB players with early
specialization had significantly higher rates of upper
extremity injuries (shoulder, elbow, forearm, wrist and
hand) as well as lower extremity injuries (knee and ankle).
Our findings may be due to increased training and throw-
ing volume for single-sport athletes, with many single-sport
athletes playing baseball for more months per year than
their multisport counterparts. In addition, it is possible
that multisport athletes benefit from neuromuscular train-
ing through sports other than baseball, causing a protective
effect against future injury. This was further reflected in
recent data showing an increasing frequency of early sport
specialization as well as UCL reconstruction in New York
State, particularly in the adolescent thrower between the
ages of 17 and 20 years.
9
This highlights the importance for
parents and coaches to recognize the connection between
early sports specialization and the risk of overuse throwing
injuries.
This study has several limitations given our methodol-
ogy, which has been previously applied.
17
One limitation
was the use of internet data to determine if an athlete
played multiple sports in high school; however, several pub-
lished baseball studies have used internet data in their
TABLE 6
Injuries by Body Part
a
Single Sport
(n ¼216)
Multisport
(n ¼110) P
Elbow 42 (19) 17 (15)
Shoulder 53 (25) 20 (18)
Forearm 12 (6) 6 (5)
Wrist 7 (3) 2 (2)
Bicep 8 (4) 2 (2)
Hand 14 (7) 8 (7)
Knee 21 (10) 8 (7)
Ankle 9 (4) 2 (2)
Total shoulder and elbow 95 (44) 37 (34) <.01
Total upper extremity 136 (63) 55 (50) <.01
Total 166 (77) 65 (59) <.01
a
Data are shown as n (%). Bold indicates P<.05.
TABLE 7
Injuries by Body Part in Pitchers
a
Single Sport
(n ¼114)
Multisport
(n ¼48) P
Elbow 40 (35) 14 (29)
Shoulder 46 (40) 13 (27)
Total shoulder and elbow 86 (75) 27 (56) .008
a
Data are shown as n (%). Bold indicates P<.05.
4Confino et al The Orthopaedic Journal of Sports Medicine
study design. The inability to accurately determine high
school sport participation from public sources is a signifi-
cant limitation. It is possible that athletes were categorized
as single sport when they actually participated in multiple
sports during high school. Another limitation is the use of
online sources for injury data, which can be inaccurate or
incomplete as compared with the MLB Health and Injury
Tracking System.
4
Additionally, we did not investigate
injuries that occurred prior to the draft. There may have
been single-sport athletes who experienced a greater num-
ber of injuries in high school and college and were less likely
to make it to the first and second draft rounds for the MLB.
This is a potential area for injury risk assessment research.
Another limitation was the exclusion of minor league injury
specifics to include type and location, as these data were not
reliably available. Last, we looked at only the first 2 rounds
of the MLB draft, which provided us with an athlete cohort
with a skill set capable of playing at the professional level;
however, this cohort may not be representative of profes-
sional baseball as a whole.
CONCLUSION
Our findings suggest that professional baseball players
who participated in multiple sports during high school sus-
tain fewer upper extremity injuries (shoulder, elbow, fore-
arm, and hand) and lower extremity injuries (knee and
ankle) while also playing in more MLB games during their
career. In addition, pitchers who specialized early in life
had significantly higher rates of shoulder and elbow inju-
ries as well as higher reinjury rates. It is important for
parents, coaches, and players to understand that the
long-term impact of early specialization can have a delete-
rious downstream effect at the professional level.
REFERENCES
1. Bell DR, Post EG, Trigsted SM, Hetzel S, McGuine TA, Brooks MA.
Prevalence of sport specialization in high school athletics: a 1-year
observational study. Am J Sports Med. 2016;44(6):1469-1474.
2. Brenner JS; Council on Sports Medicine and Fitness. Sports special-
ization and intensive training in young athletes. Pediatrics. 2016;
138(3):e20162148.
3. Buckley PS, Bishop M, Kane P, et al. Early single-sport specialization:
a survey of 3090 high school, collegiate, and professional athletes.
Orthop J Sports Med. 2017;5(7):2325967117703944.
4. Camp CL, Dines JS, van der List JP, et al. Summative report on time
out of play for major and minor league baseball: an analysis of 49,955
injuries from 2011 through 2016. Am J Sports Med. 2018;46(7):
1727-1732.
5. Conn JM, Annest JL, Gilchrist J. Sports and recreation related
injury episodes in the US population, 1997-99. Inj Prev. 2003;
9(2):117-123.
6. DiFiori JP, Benjamin HJ, Brenner JS, et al. Overuse injuries and burn-
out in youth sports: a position statement from the American Medical
Society for Sports Medicine. Br J Sports Med. 2014;48(4):287-288.
7. Fleisig GS, Andrews JR. Prevention of elbow injuries in youth baseball
pitchers. Sports Health. 2012;4(5):419-424.
8. Hill G, Hansen G. Specialization in high school sports—the pros and
cons. Journal of Physical Education, Recreation and Dance. 1988;
59(5):76-79.
9. Hodgins JL, Vitale M, Arons RR, Ahmad CS. Epidemiology of medial
ulnar collateral ligament reconstruction: a 10-year study in New York
State. Am J Sports Med. 2016;44(3):729-734.
10. LaPrade RF, Agel J, Baker J, et al. AOSSM early sport specialization
consensus statement. Orthop J Sports Med. 2016;4(4):
2325967116644241.
11. McGuine TA, Post EG, Hetzel SJ, Brooks MA, Trigsted S, Bell DR. A
prospective study on the effect of sport specialization on lower
extremity injury rates in high school athletes. Am J Sports Med.
2017;45(12):2706-2712.
12. Myer GD, Jayanthi N, Difiori JP, et al. Sport specialization, part I: does
early sports specialization increase negative outcomes and reduce
the opportunity for success in young athletes? Sports Health. 2015;
7(5):437-442.
13. National Council of Youth Sports. 2008 NCYS market research report.
http://www.ncys.org/pdfs/2008/2008-ncys-market-research-report.
pdf. Accessed July 5, 2018.
14. National Federation of State High School Associations. High school
participation increases for 25th consecutive year. https://www
.nfhs.org/articles/high-school-participation-increases-for-25th-
consecutive-year. Published October 30, 2014.
15. Olsen SJ 2nd, Fleisig GS, Dun S, Loftice J, Andrews JR. Risk factors
for shoulder and elbow injuries in adolescent baseball pitchers. Am J
Sports Med. 2006;34(6):905-912.
16. Padaki AS, Popkin CA, Hodgins JL, Kovacevic D, Lynch TS, Ahmad
CS. Factors that drive youth specialization. Sports Health. 2017;9(6):
532-536.
17. Rugg C, Kadoor A, Feeley BT, Pandya NK. The effects of playing
multiple high school sports on National Basketball Association
players’ propensity for injury and athletic performance. Am J Sports
Med. 2018;46(2):402-408.
18. Swindell HW, Marcille ML, Trofa DP, et al. An analysis of sports spe-
cialization in NCAA Division I collegiate athletics. Orthopaedic Journal
of Sports Medicine. 2019;7(1):2325967118821179.
19. Wilhelm A, Choi C, Deitch J. Early sport specialization: effectiveness
and risk of injury in professional baseball players. Orthop J Sports
Med. 2017;5(9):2325967117728922.
The Orthopaedic Journal of Sports Medicine Sport Specialization in Major League Baseball 5
... Este conceito baseia-se numa resposta psicofisiológica de esgotamento, exibida como resultado de esforços frequentes que são incapazes de corresponder às demandas impostas pelo treino e pela competição. A discussão em torno das vantagens e desvantagens de uma especialização ou diversificação precoce pode e deve ser igualmente vista do ponto de vista do prolongamento da carreira desportiva (Confino et al., 2019;Rugg et al., 2017). De acordo com alguns estudos recentes realizados com jogadores de baseball, a especialização neste desporto no ensino secundário está associada com a participação em menos jogos na Major League Baseball e com uma maior incidência de lesões (Confino et al., 2019). ...
... A discussão em torno das vantagens e desvantagens de uma especialização ou diversificação precoce pode e deve ser igualmente vista do ponto de vista do prolongamento da carreira desportiva (Confino et al., 2019;Rugg et al., 2017). De acordo com alguns estudos recentes realizados com jogadores de baseball, a especialização neste desporto no ensino secundário está associada com a participação em menos jogos na Major League Baseball e com uma maior incidência de lesões (Confino et al., 2019). Os autores deste estudo concluíram ainda que os jogadores que se especializaram de forma precoce sofreram maior número de leões em zonas do corpo muito solicitadas por algumas ações do jogo, como sejam os ombros e os cotovelos, em comparação com aqueles que mantiveram uma prática diversificada durante mais tempo. ...
Book
Full-text available
Este libro recoge las ponencias del VI Seminario Internacional de Táctica y Técnica Deportiva organizadas por la Cátedra de Deporte y Educación Física - Centro de Estudios Olímpicos de la Universidad de Girona (antiguas Jornadas de la CEEF-CEO) dedicadas a las nuevas tendencias en el desarrollo del talento deportivo. En este libro el lector encontrará ideas y reflexiones alrededor del talento deportivo y, muy especialmente, acerca de las cuestiones relativas a su desarrollo. Dichas ideas y aportaciones han sido elaboradas por investigadores y técnicos de reconocido prestigio estatal e internacional. Es nuestro deseo que el lector pueda encontrar en estas páginas elementos de reflexión teórica y contenidos de estudios científicos que le permitan profundizar en la comprensión del desarrollo del talento deportivo, así como que le ayuden en la tarea del entrenamiento diario y cotidiano. Deseamos que los caminos, no siempre coincidentes y a veces demasiado distantes, del entrenamiento y de la investigación vayan encontrando puntos de conexión que permitan a ambos dominios retroalimentarse y mejorar en sus respectivas tareas.
... The American Journal of Sports Medicine 1-8 DOI: 10.1177/03635465211016839 Ó 2021 The Author(s) a variety of factors, such as early sport specialization, greater pitching volume, increased pitch velocity, and the use of breaking pitches (eg, curveballs and sliders). 7,18,28,32,38,49 As the prevalence of UCL injuries has increased, so too has the utilization of UCLR. 17,20,26 The rise of UCLR has also resulted from advancements in surgical technique and rehabilitation that have allowed for high rates of return to competition (RTC). ...
Article
Full-text available
Background Injury to the ulnar collateral ligament of the elbow is common among overhead throwing athletes and can result in significant functional limitations. While surgical reconstruction offers high rates of return to competition, there are no validated or universally accepted guidelines for determining when an athlete can safely resume play. Purpose To assess the existing scientific literature for return-to-competition criteria utilized after ulnar collateral ligament reconstruction. Study Design Systematic review and meta-analysis; Level of evidence, 4. Methods The PubMed database was searched for clinical investigations of ulnar collateral ligament reconstruction in overhead throwing athletes published between January 2000 and June 2020. Only studies that had a minimum follow-up of 1 year and included at least 1 specific return-to-competition criterion were considered. Results A total of 15 studies were included in the final analysis, encompassing 1156 patients with an average age of 20.7 years (SD, 2.0 years). Baseball players composed 96.3% of patients for whom sport was specified, and 92.4% of baseball players were pitchers. The most common return-to-competition criterion, identified in 87% of studies, was completion of a return-to-throwing program, which started on average 16.7 weeks (range, 12-18 weeks) after surgery. A return-to-mound program was utilized in 53% of studies, starting on average 7.4 months (range, 6-9 months) postoperatively. Minimum time from surgery was used in 73% studies, with players waiting 7 to 12 months (mean, 9.7; SD, 1.4 months) after surgery before return-to-competition consideration. The overall rate of return to competition at the preinjury level or higher was 85.7% (SD, 8.5%) at an average of 12.2 months (SD, 0.6 months). Conclusion In general, we observed a paucity of literature describing the return-to-competition process after ulnar collateral ligament reconstruction in overhead throwing athletes. Only 3 explicit return-to-competition criteria were identified across all studies: completion of a return-to-throwing program, completion of a return-to-mound program for pitchers, and minimum time from surgery. Increased transparency regarding postoperative rehabilitation protocols and further research are necessary to identify and validate sport-specific return-to-competition criteria, which will ultimately help athletes return to play in a safe and timely fashion after ulnar collateral ligament reconstruction.
Article
Objectives: : To determine (1) the proportion of National Football League (NFL) quarterbacks (QBs) who were multisport high school athletes (2) whether performance metrics in NFL QBs differed by playing multiple high school sports versus the single sport of football. Methods: : A comprehensive online search identified NFL QBs from 1995-2010, classifying them as single or multisport high school athletes. Performance data were collected for regular season and playoffs when applicable and were calculated as rates. Regular season comparisons were limited to players playing at least eight games. Accolades (Pro Bowls, MVP awards, and Super Bowl victories) were also recorded. Mann-Whitney U was utilized to compare performance metrics between multisport and single sport athletes. Results: : 403 QBs (223, 55.3% multisport) were included. In the regular season, multisport QBs played in more games (median 6.8, IQR 4-10.6 vs median 5, IQR 2.5-8.3; p=0.0001), and had higher touchdowns/game (median 0.87, IQR 0.5-1.25 vs median 0.67, IQR 0.42-1; p=0.0063), pass yards/game (median 159.4, IQR 103.9-206.7 vs median 139.4, IQR 96.3-179.6; p=0.0392), and QB rating (median 78.5, IQR 69.4-85.2 vs median 74.4, IQR 66.7-81.2; p=0.0063). There were no differences in pass completion %, interceptions/game, or rush yards/game. Multisport QBs played in more playoff games (median 0.5, IQR 0.22-0.81 vs median 0.33, IQR 0.2-0.62; p=0.027), and had more Pro Bowl appearances, MVP awards, and Super Bowl victories per athlete (p<0.05). Conclusion: : Over half of NFL QBs played multiple high school sports. Multisport involvement is associated with benefits in regular season including a higher proportion of games played, and more touchdowns/game, pass yards/game, and QB rating. Playing multiple sports was also associated with playing more playoff games and having more Pro Bowl appearances, MVP awards, and Super Bowl victories. This data supports the benefits of youth multisport training.
Article
»: There is increasing evidence in the literature regarding the important health impact of and risk factors for injury in youth sport. »: Increasing pediatric and adolescent activity intensity, such as is seen in earlier single-sport focus and specialization, may be associated with morphological changes in the growing skeleton. »: Chronic subacute injury to the developing physes in the active child can lead to stress on the growth plate and surrounding tissues that induces developmental morphological changes in the joint. »: There is evidence to suggest that frequent participation in sports that place particular stress across the physes of the proximal humerus, the proximal femur, and the distal radius can be associated with an increased risk of inducing developmental and morphological changes that could lead to future joint dysfunction and premature degeneration. »: Additional research is necessary to better define the pathoetiology of activity-mediated morphological changes, as well as to create and validate parameters for safe involvement in competitive physical activities.
Article
Background This study evaluated the status of sports participation and training frequency during school years to identify related factors for injuries in the general Japanese population. Methods A total of 1,533 adult participants (762 males, 771 females) retrospectively completed a questionnaire assessing sports participation (single/multisport), training frequency (weekly days of sports participation), and injury history (acute and overuse) at each stage of school (elementary, junior high, and high school). Results In total, 41.1% of participants reported playing multiple sports in elementary school; this rate decreased to 17.4% in junior high school and 8.9% in high school. Weekly days of sports participation were associated with almost all injuries at each age. Participants who still played multiple sports in junior high school had fewer overuse injuries in junior high school and high school (P = 0.017; odds ratio (OR) = 0.69; 95% confidence interval (CI) = 0.51–0.94; P = 0.006, OR = 0.66, 95% CI, 0.49–0.89, respectively). The ratio for sports sampling differed between elementary school and older ages. This trend was associated with the prevalence of overuse injuries. Conclusion Promoting sports sampling through junior high school ages and controlling the training frequency may decrease the occurrence of injuries in young athletes.
Chapter
Ulnar collateral ligament injuries are a high-profile injury in the media, inextricably linked to Major League Baseball. These injuries have been reported in many sports, including softball, javelin, gymnastics, and football, but they are most commonly seen in skeletally mature baseball players. A review of the literature was performed that described the epidemiology of nonbaseball sports, as well as Little League, high school, collegiate, and professional studies injury mechanisms include both acute trauma and repetitive overuse due to valgus overload of the elbow during the overhead throwing motion. The first line of treatment has included conservative management and rest, but over time surgical intervention with rehabilitation and a graduated throwing program has become increasingly common. Further study and improved injury reporting is necessary to truly understand the impact of the injury on athletes of all levels.
Chapter
Nonoperative treatment is often the first step in management of ulnar collateral ligament (UCL) injuries, though numerous patient factors and degree of UCL injury influence treatment decisions. Clinical history, injury mechanism, physical exam, and imaging guide treatment decisions. Patient education, injury prevention strategy, and creating realistic patient expectations are emphasized as important aspects of nonoperative treatment. Treatment modalities reduce elbow pain and inflammation prior to initiating active rehabilitation. Rehabilitation for UCL injury involves global conditioning of the entire kinetic chain with correction of modifiable UCL injury risk factors. When ready, athletes should undergo a supervised progressive throwing program that emphasizes proper throwing mechanics. The outcomes of nonoperative management of UCL injury are satisfactory in well-selected patients with UCL injury features optimal for healing.
Chapter
The overhead throwing motion is created by a complex series of coordinated movements involving different motor groups and the articulations of the upper extremity as well as the kinetic chain. The necessary kinematics of throwing place significant stresses across the joints of the upper extremity, which can lead to potential overload and injury. The throwing motion of the overhead pitch is divided into six segments or phases from wind-up to follow-through. In addition to these upper extremity motions, the kinetic chain increases power and ball velocity through a series of coordinated muscle activation progressing through the lower legs, pelvis, and trunk. The bony architecture of the proximal ulna and distal humerus provides the majority of the overall stability of the elbow. The remaining stability of the elbow is afforded by the radial collateral ligament complex, the ulnar collateral ligament (UCL) complex, the anterior joint capsule, and the dynamic support of the flexor–pronator muscle group. Significant valgus stress from overhead throwing activities creates tensile stresses that often predispose the UCL to injury. Another phenomena known as valgus extension overload can occur due to repetitive injury to the elbow in the setting of UCL laxity. The purpose of this chapter is to define the biomechanics in the overhead athlete with a special emphasis upon the medial elbow.
Article
Context: Sport specialization during adolescence may affect future injury risk. This association has been demonstrated in some professional sports athletes. Objective: Determine the association between adolescent sport specialization levels in high school and injuries sustained during collegiate club sports. Design: Cross-sectional study. Setting: Paper and online surveys. Patients: Collegiate club sport athletes. Intervention: An anonymous survey was administered from September 2019–May 2020. The survey included sport specialization classification via commonly used 3-point scale (Low, Moderate, High) for each high school year (9th–12th), high school sports participation, and collegiate club sport injury history. The number of years an individual was highly specialized in high school was calculated (0–4 years). Individuals who participated in the same sport in high school and college were compared to individuals who were playing a different sport in college than their high school sports. Main Outcome Measures: An injury related to sport club activities and classified as arising from a contact, non-contact, or overuse mechanism that required the individual to seek medical treatment or diagnosis. Injuries were classified into overuse and acute injury mechanisms for the upper and lower extremity, (UE and LE respectively) and head/neck. Results: Single sport participation or number of years highly specialized in high school sport were not associated with college club sport injuries (p>0.1). Individuals who played a different collegiate club sport than their high school sports were more likely to report a LE and head/neck acute injury compared to athletes who played the same collegiate and high school sport (LE=20% vs 8%, χ2=7.4 p=0.006; head/neck=16% vs 3%, χ2=19.4 p<0.001). Conclusions: Adolescent sport specialization was not associated with reported club sport injuries in collegiate club sport athletes. Collegiate club sport athletic trainers should be aware that incoming students exploring a new sport may be at risk for LE and head/neck acute injuries.
Article
Context: A single, widely accepted definition of sport specialization does not exist. A consensus definition is necessary to guide youth sport stakeholders on issues associated with sport specialization. Objective: The aim of this study was to develop a consensus definition of youth sport specialization and to identify elements that support the construct of specialization. Design: Delphi Study Setting: Directed Surveys Patients or Other Participants: A consensus panel of 17 experts was created to provide a broad multidisciplinary perspective on sport specialization in youth athletes. Data Collection and Analysis: The final definition was developed per an iterative process that involved four rounds of review. A comprehensive review of literature and expert input supported our initial proposed umbrella definition that included six additional elements. The study team reviewed the results after each round and changes were made to the definition based on panel feedback. Main Outcome Measure(s): Panel members were provided with the definition and six elements and then asked to rate each specific to importance, relevance, and clarity using a 4-point Likert scale. Results: In four Delphi consensus rounds, 17 experts reviewed the umbrella definition and six elements before consensus was reached. The umbrella definition and three of the initial six elements achieved >80% agreement for importance, relevance, and clarity after the fourth round of review. The remaining 3 components did not reach >80% agreement even after iterative edits and were removed. The process resulted in a final consensus definition: Sport specialization is intentional and focused participation in a single sport for a majority of the year that restricts opportunities for engagement in other sports and activities. Conclusions: A consensus-based conceptual definition for sport specialization has been developed using a Delphi method. This definition has important implications for clinicians and sports medicine professionals who support youth athletes.
Article
Full-text available
Background Youth sports specialization has become more prevalent despite consequences such as increased injury rates and burnout. Young athletes, coaches, and parents continue to have misconceptions about the necessity of sports specialization, giving athletes the encouragement to focus on a single sport at a younger age. Purpose To characterize the motivations for specialization and determine when elite athletes in various individual and team sports made the decision to specialize. Study Design Cross-sectional study; Level of evidence, 3. Methods A Likert-style survey was developed and distributed to athletes from two National Collegiate Athletic Association (NCAA) Division I institutions. The survey’s Flesch-Kincaid grade level was 6.3. Statistical analysis was performed via the Student t test, where a P value less than .05 was considered significant. Results A total of 303 athletes with a mean ± SD age of 19.9 ± 1.52 years across 19 sports were surveyed; 94.7% of specialized athletes had previously played another organized sport prior to college, and 45% of athletes had played multiple sports up to age 16 years. The mean age of specialization was 14.9 years, with a significant difference between athletes competing in team (15.5 years) and individual (14.0 years) sports (P = .008). Males in individual sports specialized earlier than those in team sports (P ≤ .001). Nearly one-fifth (17.4%) of athletes reported specializing at age 12 years or earlier. Personal interest, skill level, time constraints, and potential scholarships were the most important reasons for specialization overall. For individual sports, the motivations for specialization were similar, but collegiate (P < .001) or professional (P < .001) ambitions were significantly larger contributing factors. Conclusion Early sports specialization is uncommon among NCAA Division I athletes for most team sports, whereas individual sports tend to have athletes who specialize earlier and are more motivated by professional and collegiate goals. This study characterized the timing of specialization among elite athletes, providing a basis for understanding the motivations behind youth sports specialization. Physicians should be prepared to discuss the misconception that early sports specialization is necessary or common among most team-focused collegiate-level athletes. Knowing the motivations for sports specialization will guide clinicians in their discussions with youth athletes.
Article
Full-text available
Background: Specialization in young athletes has been linked to overuse injuries, burnout, and decreased satisfaction. Despite continued opposition from the medical community, epidemiological studies suggest the frequency is increasing. Hypothesis: Extrinsic pressures in addition to individual aspirations drive this national trend in sports specialization. Study design: Descriptive epidemiology study. Level of evidence: Level 3. Methods: A novel instrument assessing the driving factors behind youth specialization was generated by an interdisciplinary team of medical professionals. Surveys were administered to patients and athletes in the department's sports medicine clinic. Results: The survey was completed by 235 athletes between 7 and 18 years of age, with a mean age of 13.8 ± 3.0 years. Athletes specialized at a mean age of 8.1 years, and 31% of athletes played a single sport while 58% played multiple sports but had a preferred sport. More than 70% of athletes had collegiate or professional ambitions, and 60% played their primary sport for 9 or more months per year, with players who had an injury history more likely to play year-round ( P < 0.01). Approximately one-third of players reported being told by a coach not to participate in other sports, with specialized athletes reporting this significantly more often ( P = 0.04). Half of the athletes reported that sports interfered with their academic performance, with older players stating this more frequently ( P < 0.01). Conclusion: Young athletes are increasingly specializing in a single sport before starting high school. While intrinsic drive may identify healthy aspirations, extrinsic influences are prevalent in specialized athletes. Clinical relevance: Extrinsic factors contributing to youth specialization were identified and compounded the deleterious sequelae of youth athlete specialization.
Article
Full-text available
Background The rate of early sport specialization in professional baseball players is unknown. Purpose To report the incidence and age of sport specialization in current professional baseball players and the impact of early specialization on the frequency of serious injuries sustained during the players’ careers. We also queried participants about when serious injuries occurred, the players’ current position on the field, and their opinions regarding the need for young athletes to specialize early to play at the professional level. Study Design Descriptive epidemiological study. Methods A total of 102 current professional baseball players anonymously completed a 7-question written survey. Early sport specialization was defined as “single-sport participation prior to high school.” Injury was defined as “a serious injury or surgery that required the player to refrain from sports (baseball) for an entire year.” Chi-square tests were used to investigate the risk of injury in those who specialized early in baseball versus those who did not. Independent-sample t tests were used to compare injury rates based on current player position. Results Fifty (48%) baseball players specialized early. The mean age at initiation of sport specialization was 8.91 years (SD, 3.7 years). Those who specialized early reported more serious injuries (mean, 0.54; SD, 0.838) during their professional baseball career than those who did not (mean, 0.23; SD, 0.425) (P = .044). Finally, 63.4% of the queried players believed that early sport specialization was not required to play professional baseball. Conclusion Our study demonstrated a statistically significant higher rate of serious injury during a baseball player’s professional career in those players who specialized early. Most current professional baseball players surveyed believed that sport specialization was not required prior to high school to master the skills needed to play at the professional level. Our findings demonstrate an increased incidence of serious injuries in professional baseball players who specialized in baseball prior to high school. Youth baseball athletes should be encouraged not to participate in a single sport given the potential for an increased incidence of serious injuries later in their careers. No data are available to suggest that early specialization is needed to reach the professional level.
Article
Full-text available
Background Youth participation in organized sports in the United States is rising, with many athletes focusing on a single sport at an increasingly younger age. Purpose To retrospectively compare single-sport specialization in current high school (HS), collegiate, and professional athletes with regard to the rate and age of specialization, the number of months per year of single-sport training, and the athlete’s perception of injury related to specialization. Study Design Cross-sectional study; Level of evidence, 3. Methods A survey was distributed to HS, collegiate, and professional athletes prior to their yearly preparticipation physical examination. Athletes were asked whether they had chosen to specialize in only 1 sport, and data were then collected pertaining to this decision. Results A total of 3090 athletes completed the survey (503 HS, 856 collegiate, and 1731 professional athletes). A significantly greater percentage of current collegiate athletes specialized to play a single sport during their childhood/adolescence (45.2% of HS athletes, 67.7% of collegiate athletes, and 46.0% of professional athletes; P < .001). The age of single-sport specialization differed between groups and occurred at a mean age of 12.7 ± 2.4 (HS), 14.8 ± 2.5 (collegiate), and 14.1 ± 2.8 years (professional) (P < .001). Current HS (39.9%) and collegiate athletes (42.1%) recalled a statistically greater incidence of sport-related injury than current professional athletes (25.4%) (P < .001). The majority (61.7%) of professional athletes indicated that they believed specialization helps the athlete play at a higher level, compared with 79.7% of HS and 80.6% of collegiate athletes (P < .001). Notably, only 22.3% of professional athletes said they would want their own child to specialize to play only 1 sport during childhood/adolescence. Conclusion This study provides a foundation for understanding current trends in single-sport specialization in all athletic levels. Current HS athletes specialized, on average, 2 years earlier than current collegiate and professional athletes surveyed. These data challenge the notion that success at an elite level requires athletes to specialize in 1 sport at a very young age.
Article
Full-text available
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.
Article
Full-text available
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.
Article
Full-text available
Background: The prevalence of sport specialization in high school athletes is unknown. This information is needed to determine the scope of this issue in an active population. Purpose: To determine the prevalence of sport specialization in high school athletes and to determine if specialization is influenced by classification method, year in school, sex, and school size. A secondary purpose was to determine if highly specialized athletes would be more likely to report a history of lower extremity injuries. Study design: Cross-sectional study; Level of evidence, 3. Methods: High school athletes between the ages of 13 and 18 years from 2 local high schools completed both a sport specialization survey and an injury history survey. Athletes were classified into low, moderate, or high specialization groups using a recently developed 3-point system and were also classified using a self-classification method. Results: A total of 302 athletes completed the surveys and were classified as low specialization (n = 105, 34.8%), moderate specialization (n = 87, 28.8%), or high specialization (n = 110, 36.4%). Athletes from the small school were more likely to be classified in the low specialization group (low, 43%; moderate, 32%; high, 25%) compared with those from the large school (low, 26%; moderate, 26%; high, 48%) (P < .001). Athletes in the high specialization group were more likely to report a history of overuse knee injuries (n = 18) compared with moderate (n = 8) or low specialization (n = 7) athletes (P = .048). Athletes who trained in one sport for more than 8 months out of the year were more likely to report a history of knee injuries (odds ratio [OR], 2.32; 95% CI, 1.22-4.44; P = .009), overuse knee injuries (OR, 2.93; 95% CI, 1.16-7.36; P = .018), and hip injuries (OR, 2.74; 95% CI, 1.09-6.86; P = .026). Using the self-classification method, more participants self-classified as multisport (n = 213, 70.5%) than single sport (n = 89, 29.5%). Athletes from the small school were more likely to classify themselves as multisport (n = 128, 86%) (P < .001) than those from the large school (n = 85, 56%). There were no differences in the history of hip, knee, or ankle injuries between athletes who self-classified as single sport (hip: n = 10, 3%; knee: n = 19, 6%; ankle: n = 35, 12%) versus those who self-classified as multisport (hip: n = 45, 8%; knee: n = 23, 15%; ankle: n = 98, 33%) (P > .370). Conclusion: Classification method and school size influenced the prevalence of specialization in high school athletes. Highly specialized athletes were more likely to report a history of overuse knee or hip injuries. Participating in a single sport for more than 8 months per year appeared to be an important factor in the increased injury risk observed in highly specialized athletes.
Article
Background: Recent epidemiologic reports have demonstrated rising injury rates in Major League Baseball (MLB) and Minor League Baseball (MiLB). Although several studies have recently been published on specific injuries, the majority of injuries have not yet been formally studied. Purpose: The purpose of this study is to (1) generate a summative analysis of all injuries that occur in MLB and MiLB, (2) identify the 50 most common injuries, and (3) generate focused reports and fact sheets on the characteristics of each of those diagnoses. Study design: Case series; Level of evidence, 4. Methods: The MLB Health and Injury Tracking System was used to identify injuries occurring in MLB and MiLB players from 2011 to 2016. Injuries were defined as those that occurred during normal baseball activity and resulted in at least 1 day out of play. A multitude of player and injury characteristics were analyzed, and detailed reports of the 50 most commonly occurring injuries were generated. Results: A total of 49,955 injuries occurred during the study period; 45,123 were non-season ending, and they resulted in 722,176 days out of play. The mean (median) days missed per injury was 16 (6) days. Overall, 39.1% of all injuries occurred in pitchers. The upper extremity was involved in 39% of injuries, while 35% occurred in the hip/groin/lower extremity. Surgery was required in 6.5% of cases, and 9.7% of injuries were season ending. Hamstring strains were the most common injury (n = 3337), followed by rotator cuff strain/tear (n = 1874), paralumbar muscle strain (n = 1313), biceps tendinitis (n = 1264), oblique strain (n = 1249), and elbow ulnar collateral ligament injury (n = 1191). The diagnoses that were most likely to end a player's season were elbow ulnar collateral ligament injury (60% season ending) and superior labrum anterior and posterior tear (50.9% season ending). Conclusion: Contrary to prior reports relying on disabled list data, the annual number of injuries in professional baseball remained steady from 2011 to 2016. Similar trends were noted for the annual number of days missed and mean days missed per injury. Although the mean days missed per injury was high (16), the median was much lower at 6 days.
Article
Background: Athletes who specialize in their sport at an early age may be at risk for burnout, overuse injury, and reduced attainment of elite status. Timing of sport specialization has not been studied in elite basketball athletes. Hypothesis: National Basketball Association (NBA) players who played multiple sports during adolescence would be less likely to experience injury and would have higher participation rates in terms of games played and career length compared with single-sport athletes. Study design: Descriptive epidemiology study. Methods: First-round draft picks from 2008 to 2015 in the NBA were included in the study. From publically available records from the internet, the following data were collected for each athlete: participation in high school sports, major injuries sustained in the NBA, percentage of games played in the NBA, and whether the athlete was still active in the NBA. Athletes who participated in sports in addition to basketball during high school were defined as multisport athletes and were compared with athletes who participated only in basketball in high school. Results: Two hundred thirty-seven athletes were included in the study, of which 36 (15%) were multisport athletes and 201 (85%) were single-sport athletes in high school. The multisport cohort played in a statistically significantly greater percentage of total games (78.4% vs 72.8%; P < .001). Participants in the multisport cohort were less likely to sustain a major injury during their career (25% vs 43%, P = .03). Finally, a greater percentage of the multisport athletes were active in the league at time of data acquisition, indicating increased longevity in the NBA (94% vs 81.1%; P = .03). Conclusion: While a minority of professional basketball athletes participated in multiple sports in high school, those who were multisport athletes participated in more games, experienced fewer major injuries, and had longer careers than those who participated in a single sport. Further research is needed to determine the reasons behind these differences.
Article
Sports specialization is becoming the norm in youth sports for a variety of reasons. When sports specialization occurs too early, detrimental effects may occur, both physically and psychologically. If the timing is correct and sports specialization is performed under the correct conditions, the athlete may be successful in reaching specific goals. Young athletes who train intensively, whether specialized or not, can also be at risk of adverse effects on the mind and body. The purpose of this clinical report is to assist pediatricians in counseling their young athlete patients and their parents regarding sports specialization and intensive training. This report supports the American Academy of Pediatrics clinical report "Overuse Injuries, Overtraining, and Burnout in Child and Adolescent Athletes."