Socioeconomic Factors for Sports Specialization and Injury in Youth Athletes.
ABSTRACT: BACKGROUND:The effect of socioeconomic status (SES) on rates of sports specialization and injury among youth athletes has not been described previously. HYPOTHESIS:Young athletes from lower socioeconomic status will have lower rates of sports specialization and subsequently lower risk of overuse injuries. STUDY DESIGN:Cohort study. LEVEL OF EVIDENCE:Level 3. METHODS: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. RESULTS: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). CONCLUSION: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. CLINICAL RELEVANCE:As SES increases, young athletes report higher degrees of sports specialization, greater participation in individual sports, and more serious overuse injuries.
Project description:BACKGROUND:Significant evidence has emerged that sport specialization is associated with an increased risk of overuse injury in youth athletes. Several recommendations exist to reduce the risk of overuse injury in youth sports, but the risk of overuse injuries may be dependent on specific movements required by a given sport. HYPOTHESES:Associations between specialized sport participation and overuse injury will exist in volleyball athletes but not soccer or basketball athletes. Female athletes will be more likely to report an overuse injury in the previous year, regardless of sport. STUDY DESIGN:Cross-sectional study. LEVEL OF EVIDENCE:Level 3. METHODS:Youth athletes between the ages of 12 and 18 years were recruited in-person at club team tournaments, competitions, and events around the state of Wisconsin during the 2016-2017 school year. Participants were asked to complete an anonymous questionnaire that consisted of (1) participant demographics, (2) sport specialization status, (3) monthly and weekly sport volume, and (4) sport-related injury history in the previous year. RESULTS:A total of 716 youth athletes completed the questionnaire (70.8% female; mean age, 14.21 ± 1.50 years; 43.2% basketball, 19.4% soccer, 37.4% volleyball; 41.8% highly specialized; 32.3% reported overuse injury in the previous year). Sex was associated with overuse injury among basketball athletes, with female basketball athletes nearly 4 times more likely to report an overuse injury compared with male basketball athletes (odds ratio, [OR], 3.7; 95% CI, 2.1-6.6; P < 0.001). High specialization (OR, 2.3; 95% CI, 1.1-4.9; P = 0.02) and participating in a single sport for more than 8 months per year (OR, 2.0; 95% CI, 1.1-3.5; P < 0.05) were associated with overuse injury only among volleyball athletes. CONCLUSION:Specialization and exceeding 8 months per year in a single sport was associated with overuse injury in volleyball, which is one of the most popular youth sports for female athletes. Specialization was not associated with overuse injury in basketball or soccer athletes. Female basketball athletes were nearly 4 times more likely to report a history of overuse injury compared with male basketball athletes. The sex of a youth athlete and the sport that he or she plays may influence the risk of overuse injury associated with sport specialization. CLINICAL RELEVANCE:Youth athletes, parents, and clinicians should be aware that the potential risks of specialization might vary based on the athlete's sport and sex.
Project description: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.
Project description:Although early sports specialization is associated with sports-related injuries, relevant quantitative studies on young non-elite athletes, the majority of sports participants, are scarce. We described sports specialization time points and the characteristics of sports-related injuries. Undergraduate students at a university in Japan (<i>n</i> = 830) recalled their history of sports participation from elementary to high school and sports-related injuries in a self-administered questionnaire. Of 570 valid respondents, 486 (85%) engaged in sports at least once. Significantly more respondents played multiple sports in upper elementary school (30%) than in other school categories (1-23%). In junior high and high schools, 90% and 99% played only one sport, respectively. Of the 486 respondents who played sports, 263 (54%) had experienced acute or overuse injuries. The proportion of injured participants significantly differed by school category: lower elementary school (4%), upper elementary school (21%), junior high (35%), and high school (41%). The proportions of acute or overuse injuries in males were higher than those in females. In conclusion, this study clarified a slight variation in sports items, particularly in junior high and high schools, which demonstrates 13 years as the age of beginning specialization in a single sport. More than half of the non-elite athletes experienced sports-related injuries. Injuries were frequently observed in males and those in junior high and high schools.
Project description:<h4>Background</h4>Although overuse wrist injuries can have serious consequences, young athletes often do not immediately report their injury to a physician. This qualitative study aimed to identify symptoms and limitations related to overuse wrist injuries that young athletes consider important and to compare those with sports physicians' opinions, in order to improve the diagnostic process for early identification of overuse wrist injuries.<h4>Methods</h4>Twenty-one athletes aged 13-25?years in wrist-loading sports (gymnastics, tennis, judo, field hockey, volleyball and rowing) with a (previous) overuse wrist injury were included. In five focus groups, participants discussed important signals and limitations of their injury, as well as a list of relevant items previously composed by sports physicians. Data were grouped into themes and (sub)categories and subsequently coded.<h4>Results</h4>Of the resulting 224 signals and 80 limitations, respectively 81 and 20 were labelled important. Athletes considered both pain and limitations during daily life activities important indicators of overuse wrist injury, as well as long pain duration, acute onset of pain, and accompanying symptoms like swelling, cracking and discoloration. All of the sports physicians' items were also considered important by the athletes, but sport-related pain and limitations were regarded by many athletes as a natural part of their sport.<h4>Conclusions</h4>Discrepancies exist between the opinions of young athletes and sports physicians on sport-related pain reporting and competing regardless of pain or limitations. Although clinicians may be inclined to focus on these aspects, they are advised to also inquire specifically about limitations and pain during daily life activities in young athletes with overuse wrist injuries.
Project description:Over the past several decades there has been increased participation in sports by children and adolescents at earlier ages in the United States, as well as more intense participation and specialization in sports at very early ages. This trend has also partly contributed to the patterns of injuries seen in young athletes, and especially in recent years, injuries previously seen in mature athletes are being seen in young athletes. Overall, the vast majority of sport-related musculoskeletal injuries in children and adolescents are due to repetitive overuse and acute macrotrauma is less frequently seen in young athletes. Epidemiological data on sports injuries are provided by several national surveys. Investigators have used different methods to define sports injuries and the most widely used definition is based on athlete-exposure time. Certain aspects related to adolescent growth and development modulate the pattern of injuries. This article provides an overview of the epidemiology of sports-related musculoskeletal injuries seen in children and adolescents.
Project description:<h4>Background</h4>Baseball is one of the most popular boy's youth sports, and there has been a rise in the rates of certain overuse injuries among players. Specialization has been identified as a risk factor for overuse injury in high school athlete populations, but there is little understanding of the prevalence or consequences of sport specialization in Little League baseball players.<h4>Hypothesis</h4>Sport specialization will be highly prevalent among Little League baseball players and specialization will be associated with worse throwing arm health.<h4>Study design</h4>Cross-sectional study.<h4>Level of evidence</h4>Level 3.<h4>Methods</h4>A total of 246 Little League baseball players (male; N = 241; age, 9.5 ± 1.6 years) between 7 and 12 years old completed an anonymous, online questionnaire with their parent's assistance. The questionnaire consisted of participant demographics and baseball participation information, including sport specialization status and the Youth Throwing Score (YTS), a valid and reliable patient-reported outcome measure for youth baseball players.<h4>Results</h4>Only 29 (11.8%) players met the criteria for high specialization. Approximately one-third of all players (n = 77; 31.3%) reported participating in baseball year-round or receiving private coaching outside of their league (n = 81; 32.9%). Highly specialized athletes demonstrated worse scores on the YTS on average compared with low-specialization athletes (mean [SE]: 56.9 [1.6] vs 61.1 [1.2]; <i>P</i> = 0.01). Similarly, pitching in the previous year (<i>P</i> < 0.01) or traveling overnight regularly for showcases (<i>P</i> = 0.01) were associated with a worse score on the YTS.<h4>Conclusion</h4>While the prevalence of high sport specialization was low among Little League baseball players, other behaviors associated with specialization such as year-round play and the receiving of private coaching were more common. Highly specialized Little League players demonstrated worse throwing arm health compared with low-specialization players.<h4>Clinical relevance</h4>Little League players and their parents may represent a potential target audience for dissemination campaigns regarding sport specialization.
Project description:<h4>Objectives</h4>To investigate the prevalence of shoulder-related acute and overuse injuries in triathletes and examine the role of possible risk factors, in order to identify potential preventive measures.<h4>Methods</h4>We performed a retrospective epidemiologic study of 193 amateur triathletes between June and August 2013 and evaluated their competition and training habits, as well as the presence of acute and overuse injuries of the shoulder sustained during the past 12 months. Contingency tables were analyzed using Pearson's chi-squared test. Normally distributed data were compared with the independent samples t-test, while non-parametric analyses were performed with the Mann-Whitney U test. Binary logistic regression was used to identify important predictors of injuries.<h4>Results</h4>12 participants (6%) sustained acute injuries and 36 athletes experienced an overuse injury. The acute injury rate amounted to 0.11 per 1000 hours of training and the overuse injury rate to 0.33 per 1000 hours of training. There was no association between athletes' age, height, weight, BMI, a history of shoulder complaints or triathlon experience in years and acute or overuse injuries. Male athletes had a trend for sustaining more acute injuries then female athletes (8% vs. 2%, p = 0.079). Athletes with acute injuries spent a significantly higher amount of time per week doing weight training (p = 0.007) and had a trend for a higher weekly duration of cycling training (p = 0.088). Athletes with overuse injuries participated in a significantly higher number of races compared to athletes without overuse injuries (p = 0.005). The regular use of paddles was associated with a significantly higher rate of overuse injuries (24% vs. 10%, p = 0.014).<h4>Conclusion</h4>The regular use of paddles during swimming training appears to be a risk factor for the development of overuse injuries, while an increased duration of weight and cycling training seems to be associated with a higher rate of acute injuries.
Project description:<h4>Background</h4>Not all anterior cruciate ligament (ACL) injuries are preventable. While some ACL injuries are unavoidable such as those resulting from a tackle, others that occur in non-contact situations like twisting and turning in the absence of external contact might be more preventable. Because ACL injuries commonly occur in team ball-sports that involve jumping, landing and cutting manoeuvres, accurate information about the epidemiology of non-contact ACL injuries in these sports is needed to quantify their extent and burden to guide resource allocation for risk-reduction efforts.<h4>Objective</h4>To synthesize the evidence on the incidence and proportion of non-contact to total ACL injuries by sex, age, sport, participation level and exposure type in team ball-sports.<h4>Methods</h4>Six databases (MEDLINE, EMBASE, Web of Science, CINAHL, Scopus and SPORTDiscus) were searched from inception to July 2021. Cohort studies of team ball-sports reporting number of knee injuries as a function of exposure and injury mechanism were included.<h4>Results</h4>Forty-five studies covering 13 team ball-sports were included. The overall proportion of non-contact to total ACL injuries was 55% (95% CI 48-62, I<sup>2</sup> = 82%; females: 63%, 95% CI 53-71, I<sup>2</sup> = 84%; males: 50%, 95% CI 42-58, I<sup>2</sup> = 86%). The overall incidence of non-contact ACL injuries was 0.07 per 1000 player-hours (95% CI 0.05-0.10, I<sup>2</sup> = 77%), and 0.05 per 1000 player-exposures (95% CI 0.03-0.07, I<sup>2</sup> = 97%). Injury incidence was higher in female athletes (0.14 per 1000 player-hours, 95% CI 0.10-0.19, I<sup>2</sup> = 40%) than male athletes (0.05 per 1000 player-hours, 95% CI 0.03-0.07, I<sup>2</sup> = 48%), and this difference was significant. Injury incidence during competition was higher (0.48 per 1000 player-hours, 95% CI 0.32-0.72, I<sup>2</sup> = 77%; 0.32 per 1000 player-exposures, 95% CI 0.15-0.70, I<sup>2</sup> = 96%) than during training (0.04 per 1000 player-hours, 95% CI 0.02-0.07, I<sup>2</sup> = 63%; 0.02 per 1000 player-exposures, 95% CI 0.01-0.05, I<sup>2</sup> = 86%) and these differences were significant. Heterogeneity across studies was generally high.<h4>Conclusion</h4>This study quantifies several key epidemiological findings for ACL injuries in team ball-sports. Non-contact ACL injuries represented over half of all ACL injuries sustained. The proportion of non-contact to total ACL injuries and injury incidence were higher in female than in male athletes. Injuries mostly occurred in competition settings.
Project description:When paired together, manual therapy and exercise have been effective for regaining range of motion (ROM) in multiple conditions across varied populations. Although exercise in an aquatic environment is common, research investigating manual therapy in this environment is limited. There is little evidence on AquaStretchTM an aquatic manual therapy technique, but anecdotal clinical evidence suggests its effectiveness.To investigate the effects of AquaStretch™ on ROM and function in recreational athletes with self-reported lower extremity injury and pain.Quasi-experimental design.Injured recreational athletes participated in a 30-minute intervention session of AquaStretch.™ Injuries ranged from ankle (sprains and overuse), knee (contusions, sprains, and overuse), and hip conditions (contusions, overuse, and pain). Before a single intervention (preintervention) and within 24 hours after the intervention (postintervention), participants completed the following patient-reported outcome instruments: the Lower Extremity Functional Scale (LEFS) and the Foot and Ankle Ability Measure (FAAM) Sports subscale. AROM measurements of the ankle, knee, and hip and the following muscle length tests were measured: Ober's test, measurement of the popliteal angle, and the modified Thomas test. Finally, the overhead deep squat test was performed as a test of function.Twenty-six recreational athletes with lower extremity injuries of the ankle, knee, and hip, aged 18-60 years (18 males, 8 females, mean age 27.4 years) completed the study. The overall group by time interaction for the mixed-model Generalized Estimating Equations analysis was statistically significant for the LEFS (all p<.002) and for the FAAM Sports subscale (p<.01). There were no statistically significant time (pre vs post) by group interactions for range of motion and other measures, including the Ober's test, the overhead deep squat test, popliteal angle, and the modified Thomas test for injured athletes.One session of AquaStretch™ in recreational athletes improved the patient-rated outcome measures of function specifically the LEFS and FAAM Sports subscale. These results suggest that AquaStretch™ may be an effective form of manual therapy to improve lower extremity function in injured athletes.2b, Individual Cohort Study.
Project description:<h4>Introduction</h4>Annually, 2 million sports-related injuries are reported in Germany of which athletes contribute to a large proportion. Multiple sport injury prevention programs designed to decrease acute and overuse injuries in athletes have been proven effective. Yet, the programs' components, general or sports-specific, that led to these positive effects are uncertain. Despite not knowing about the superiority of sports-specific injury prevention programs, coaches and athletes alike prefer more specialized rather than generalized exercise programs. Therefore, this systematic review aimed to present the available evidence on how general and sports-specific prevention programs affect injury rates in athletes.<h4>Methods</h4>PubMed and Web of Science were electronically searched throughout April 2018. The inclusion criteria were publication dates Jan 2006-Dec 2017, athletes (11-45 years), exercise-based injury prevention programs and injury incidence. The methodological quality was assessed with the Cochrane Collaboration assessment tools.<h4>Results</h4>Of the initial 6619 findings, 15 studies met the inclusion criteria. In addition, 13 studies were added from reference lists and external sources making a total of 28 studies. Of which, one used sports-specific, seven general and 20 mixed prevention strategies. Twenty-four studies revealed reduced injury rates. Of the four ineffective programs, one was general and three mixed.<h4>Conclusion</h4>The general and mixed programs positively affect injury rates. Sports-specific programs are uninvestigated and despite wide discussion regarding the definition, no consensus was reached. Defining such terminology and investigating the true effectiveness of such IPPs is a potential avenue for future research.