Lower Extremity Biomechanics Are Altered Across Maturation in Sport-Specialized Female Adolescent Athletes

Sport specialization is a growing trend in youth athletes and may contribute to increased injury risk. The neuromuscular deficits that often manifest during maturation in young, female athletes may be exacerbated in athletes who specialize in a single sport. The purpose of this study was to investigate if sport specialization is associated with increased lower extremity biomechanical deficits pre- to post-puberty in adolescent female athletes. Seventy-nine sport-specialized female adolescent (Mean ± SD age = 13.4 ± 1.8 years) basketball, soccer, and volleyball athletes were identified and matched with seventy-nine multi-sport (soccer, basketball, and volleyball) female athletes from a database of 1,116 female adolescent basketball, soccer, and volleyball athletes who were enrolled in one of two large prospective, longitudinal studies. The athletes were assessed over two visits (Mean ± SD time = 724.5 ± 388.7 days) in which they were classified as pre-pubertal and post-pubertal, respectively. Separate 2 × 2 analyses of covariance were used to compare sport-specialized and multi-sport groups and dominant/non-dominant limbs with respect to pubertal changes in peak knee sagittal, frontal, and transverse plane joint angular measures and moments of force recorded while performing a drop vertical jump task. The sport-specialized group were found to exhibit significantly larger post-pubertal increases in peak knee abduction angle (p = 0.005) and knee abduction moment (p = 0.006), as well as a smaller increase in peak knee extensor moment (p = 0.032) during landing when compared to the multi-sport group. These biomechanical changes are indicative of potentially compromised neuromuscular control that may increase injury risk pre- to post-puberty in sport-specialized female athletes. Consideration of maturation status may be an important factor in assessing the injury risk profiles of adolescent athletes who specialize in sport

Socioeconomic Factors for Sports Specialization and Injury in Youth Athletes.

The effect of socioeconomic status (SES) on rates of sports specialization and injury among youth athletes has not been described previously. Young athletes from lower socioeconomic status will have lower rates of sports specialization and subsequently lower risk of overuse injuries. Cohort study. Level 3. Injured athletes aged 7 to 18 years were recruited from 2 hospital-based sports medicine clinics and compared with uninjured athletes presenting for sports physicals at primary care clinics between 2010 and 2013. Participants completed surveys on training patterns. Electronic medical records provided injury details as well as patient zip code, race, and health insurance type. SES was estimated from zip codes. The sample was divided into SES tertiles. Analysis of variance and multivariate regression were used for continuous variables, and multivariate logistic regression analyses were conducted to explore relationships between risk factors and injury. Of 1190 athletes surveyed, 1139 (96%) had satisfactory SES data. Compared with low-SES athletes, high-SES athletes reported more hours per week spent playing organized sports (11.2 ? 6.0 vs 10.0 ? 6.5; P = 0.02), trained more months per year in their main sport (9.7 ? 3.1 vs 7.6 ? 3.7; P < 0.01), were more often highly specialized (38.9% vs 16.6%; P < 0.01), and had increased participation in individual sports (64.8% vs 40.0%; P < 0.01). The proportion of athletes with a greater than 2:1 ratio of weekly hours in organized sports to free play increased with SES. Accounting for age and weekly organized sports hours, the odds of reporting a serious overuse injury increased with SES (odds ratio, 1.5; P < 0.01). High-SES athletes reported more serious overuse injuries than low-SES athletes, potentially due to higher rates of sports specialization, more hours per week playing organized sports, higher ratio of weekly hours in organized sports to free play, and greater participation in individual sports. As SES increases, young athletes report higher degrees of sports specialization, greater participation in individual sports, and more serious overuse injuries

Specialization patterns across various youth sports and relationship to injury risk

<p><b>Objectives</b>: Current trends among young athletes towards earlier specialization age and year-round training on multiple teams has raised concern for increased injury risk. Our previous analyses showed higher risk for injury in highly specialized young athletes. The goal of this research was to determine whether sports specialization and injury patterns vary by sports type.</p> <p><b>Methods</b>: In this clinical case-control study, injured athletes (aged 7–18 years) were recruited from sports medicine clinics and compared to similarly aged uninjured athletes recruited from primary care clinics. Participants completed a survey reporting age, gender, sport type, specialization patterns, and details regarding sports-related injuries in the previous 6 months. Clinical diagnoses were collected from patients’ medical records. Injuries were classified as acute, overuse, or serious overuse.</p> <p><b>Results</b>: Of 1,190 athletes enrolled, 26% (313) were single-sport specialized (reported participation in one sport and trained >8 months/year). Sports with the highest proportion of single-sport specialized athletes were tennis (46.7%), gymnastics (30.1%), and dance (26.3%). Single-sport specialized athletes in individual sports started specializing at a younger age (11.2 ± 2.4 vs. 12.0 ± 2.7, p = 0.05) and reported higher training volumes (11.8 vs. 10.3 h/week, p = 0.04) than those in team sports. Sports with the youngest specialization age were gymnastics (8.9 ± 1.7), dance (10.8 ± 3.0), and soccer (10.9 ± 2.4). Single-sport specialized athletes in individual sports accounted for a higher proportion of overuse injuries (44.3% vs 32.2%, OR = 1.67, p = 0.037) and serious overuse injuries (23.4% vs 11.6%, OR = 2.38, p = 0.011), but a lower proportion of acute injuries (28.8% vs 13.8%, OR = 0.37, p = 0.001) compared to single-sport specialized athletes involved in team sports.</p> <p><b>Conclusions</b>: Athletes in individual sports may be more likely to specialize in a single sport than team sport athletes. Single-sport specialized athletes in individual sports also reported higher training volumes and greater rates of overuse injuries than single-sport specialized athletes in team sports.</p

Age and Gender Differences in Injuries and Risk Factors in Elite Junior and Professional Tennis Players

Background: Elite tennis athletes experience injuries throughout the entire body. impairments in trunk stability, lower limb flexibility, and hip range of motion (ROM) are modifiable risk factors that can impact injuries and performance. Information on nonmodifiable risk factors such as age and gender is limited. The purpose of this investigation was to provide information on risk factors to direct clinical decision-making and injury prevention and rehab programming in this population. Hypothesis: Prevalence and location of injuries will differ by age group and gender. Trunk stability, lower limb flexibility, and hip ROM will differ by age group and gender. Study Design: Cross-sectional study. Level of Evidence: Level 3. Methods: A de-identified database (n = 237; females = 126) from the United States Tennis Association High Performance Profile (HPP) 201.4-2015 was used for the analysis. Subjects were elite junior and professional tennis players (mean age 14.6 [range, 9-27] years). The HPP is a tennis-specific assessment and questionnaire that includes retrospective information on injury history. Subjects were categorized by injury, gender, and age. Injury locations were dassified by region. Trunk stability measures included drop vertical jump (DVJ), single-leg squat, and prone and side planks. Lower limb measures included hamstring, quadriceps and hip flexor flexibility, and hip rotation ROM. Results: A total of 46% of athletes reported an injury. Significant differences were found for injury prevalence and location by age group. Adolescent athletes (age 13-17 years) had more trunk injuries, while adult athletes (age >= 18 years) had more lower limb injuries. Adolescent athletes performed worse on DVJ, dominant side plank, and hamstring flexibility compared with young (age <= 12 years) and adult athletes. Significant gender differences in hip ROM included internal rotation on both the dominant and nondominant sides. Conclusion: impairments in trunk stability, lower limb flexibility, and hip rotation ROM may affect both health and performance outcomes in this population. Elite tennis athletes may benefit from additional off court programming to address trunk and lower limb impairments

Developmental Training Model for the Sport Specialized Youth Athlete: A Dynamic Strategy for Individualizing Load-Response During Maturation

Context: Most available data on athletic development training models focus on adult or professional athletes, where increasing workload capacity and performance is a primary goal. Development pathways in youth athletes generally emphasize multisport participation rather than sport specialization to optimize motor skill acquisition and to minimize injury risk. Other models emphasize the need for accumulation of sport- and skill-specific hours to develop elite-level status. Despite recommendations against sport specialization, many youth athletes still specialize and need guidance on training and competition. Medical and sport professionals also recommend progressive, gradual increases in workloads to enhance resilience to the demands of high-level competition. There is no accepted model of risk stratification and return to play for training a specialized youth athlete through periods of injury and maturation. In this review, we present individualized training models for specialized youth athletes that (1) prioritize performance for healthy, resilient youth athletes and (2) are adaptable through vulnerable maturational periods and injury. Evidence Acquisition: Non-systematic review with critical appraisal of existing literature. Study Design: Clinical review. Level of Evidence: Level 4. Results: A number of factors must be considered when developing training programs for young athletes: (1) the effect of sport specialization on athlete development and injury, (2) biological maturation, (3) motor and coordination deficits in specialized youth athletes, and (4) workload progressions and response to load. Conclusion: Load-sensitive athletes with multiple risk factors may need medical evaluation, frequent monitoring, and a program designed to restore local tissue and sport-specific capacity. Load-niave athletes, who are often skeletally immature, will likely benefit from serial monitoring and should train and compete with caution, while load-tolerant athletes may only need occasional monitoring and progress to optimum loads

Sport Specialization, Part I: Does Early Sports Specialization Increase Negative Outcomes and Reduce the Opportunity for Success in Young Athletes?

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

National Trends in American Youth Sport during the COVID-19 Pandemic: Understanding Parents’ Perspectives and Experiences

American children participate relatively ubiquitously in youth sport and parents are intimately engaged in their participation. However, the onset of the novel coronavirus 2019 (COVID-19) has dramatically changed how families consume youth sport. Given this, it is important to explore the new and still-changing landscape of youth sport in the United States. The purpose of the present study was to better understand parent perceptions of the current state of youth sport in the United States amidst the backdrop of the COVID-19 pandemic. To address this purpose, a large and statistically representativesubset of youth sport parents in the United States (N= 2603; Mage= 38.72) was recruited via Qualtrics panel to complete a study-designed instrument assessing their perceptions prior to and during COVID-19-related restrictions. Results highlight parents’ experiences in youth sport in the United States amidst the backdrop of the COVID-19 pandemic, as well as thier expectations for return-to-play protocols in various organizational, community, and sociodemographic contexts. The present work has the potential to shape the ways families engage with youth sport when COVID-19-related restrictions are ultimately lifted