Injury Patterns in Highly Specialized Youth Athletes: A Comparison of 2 Pathways to Specialization

Context Sport specialization, commonly defined as intensive year-round training in a single sport to the exclusion of other sports, has been associated with an increased risk for overuse injury. Two pathways to becoming highly specialized are recognized: (1) having only ever played 1 sport (exclusive highly specialized) and (2) quitting other sports to focus on a single sport (evolved highly specialized). Understanding the differences in injury patterns between these groups of highly specialized athletes will inform the development of injury-prevention strategies. Objective To compare the distribution of injury types (acute, overuse, serious overuse) among evolved highly specialized athletes, exclusive highly specialized athletes, and low-moderately specialized athletes. Design Cross-sectional study. Setting Tertiary care pediatric sports medicine clinic between January 2015 and April 2019. Patients or Other Participants A total of 1171 patients (age = 12.01–17.83 years, 59.8% female) who played ≥1 organized sports, presented with a sport-related injury, and completed a sports participation survey. Main Outcome Measure(s) Distribution of injury types (acute, overuse, serious overuse). Results The percentage of injuries due to overuse was similar between the exclusive and evolved highly specialized athletes (59.2% versus 53.9%; P = .28). Compared with low-moderately specialized athletes, exclusive and evolved highly specialized athletes had a higher percentage of overuse injuries (45.3% versus 59.2% and 53.9%, respectively; P = .001). Multivariate analysis of the highly specialized groups revealed sport type to be a significant predictor of a higher percentage of injuries due to overuse, with individual-sport athletes having increased odds of sustaining an overuse injury compared with team-sport athletes (odds ratio = 1.95; 95% CI = 1.17, 3.24). Conclusions The distribution of injury types was similar between evolved and exclusive highly specialized youth athletes, with both groups having a higher percentage of injuries due to overuse compared with low-moderately specialized athletes. Among highly specialized athletes, playing an individual sport was associated with a higher proportion of overuse injuries compared with playing a team sport.