TheEffectsofEarlySportSpecializationonOveruseInjuriesinthe
PediatricPopulation:aSystematicReview
Katty Csete,SPT,MaryJackson,SPT,JoshuaMiller,SPT,ChelseaMyers,SPT,
AdamGoode,PT,DPT,PhD,andLauraCase,PT,DPT,MS,PCS,C/NDT
DoctorofPhysicalTherapyDivision,DukeUniversity,Durham,NC
Background
• Approximately60millionchildrenintheUnitedStatesfromages6-18participatein
organizedsport1
• From1997-2008therewasanincreasefrom9%to12%inthenumberofchildren
under7participatinginorganizedsport1
• Earlyspecializationinsportisontherisewiththethoughtthatthiscouldleadtoan
increasedchanceofreachinganelitelevelofplay1,2
• Severalstudieshavesuggestedthatearlydiversificationinsportmayleadtoahigher
levelofplaythanspecialization1
• Thoughnotthefocusofthisreview,otherstudieshavefoundthatearlysport
specializationincreasestheriskofsocialisolation& burnout fromincreased
psychologicalstressandcanleadtoquittingsportsearly,oppositeofwhatearly
specializationistryingtoachieve3,4
Purpose
Thepurposeofthisstudywastosystematicallyreviewtheliteratureregardingwhether
earlysportspecializationleadstoahigherrateofoveruseandchronicinjuriesinthe
pediatricpopulation.
Methods
•
•
•
•
InclusionCriteria:studiesresearchingtypicallydevelopingchildrenbetweenthe
agesof4-21participatinginsport,eitherspecializedordiversified,thathave
experiencedasportsrelatedinjury
ExclusionCriteria:participationinbaseballorAmericanfootball,non-accidental
traumaticinjuriesandconcussions
Aduplicateprocessofscreeningforeligibilityandinclusionwasperformed
Levelsofevidenceweredeterminedbystudydesign
FlowDiagram
1449titles/abstractsidentifiedafter
de-duplication
PubMed:1178
CINHAL:508
SPORTDiscus:13
1449titles/abstractsscreened
36fulltextarticlesscreened
11articlesincludedforreview
3studiesincludedfordataextraction,
synthesis,andqualityreview
Results
Analysis
Resultsofthethreearticleswereanalyzedforstatisticalandclinicalsignificance.
Consensusbetweenarticlesaswellasindividualfindingsineachstudy.Thesestudies
wereuniqueinreportingcollecteddataandnotrelyingexclusivelyonexpertopinion,
strengtheningtheabilitytodrawconclusions.
Results
StudyOverview Table
Authors
Year
BaxterJones,A;
1993
Maffulli,N;
Helms,P.
Population
N=453
231boys, 222
girls
Study
Design
Mixed
longitudinal
(prospective
study)
Malisoux,L;
N=154
Prospective
Frisch,A.;
(12-19years old)
Urhausen, 2013
cohortfollow
fromregional
A.;Seil,R.;
up
sportschools
Theisen,D.
546publicschool
Hall,R.;
Retrospective
females(>1year
Foss,B.;
cohort
2015
participation)
Hewett,T.;
epidemiology
357multiplesport
Myer,G.
study
189singlesport
Levelof
Duration
Evidence
2b
2b
2b
3years
Activity
- gymnastics
- football/
soccer
- swimming
- tennis
15sport
disciplines:
3categories:
41weeks
- team
- racket
- individual
Author
25articlesrejectedforpatient
typeandrelevanceto
specializationversus
diversification
Morespecificcriteriaappliedto
eliminateexpertopinionand
literaturereviews
BaxterJones,A.;
Maffulli,N.;
andHelms,
P.
Malisoux,L;
Frisch,A.;
Urhausen,
A.;Seil,R.;
and
Theisen,D.
Hall,R.;
Foss,B.;
Hewett,T.;
Myer,G.
Notreported
Participationin
onlyonesport
(foratleast1
year)
Outcome
Baxter-Jones,A;
Maffulli,N;Helms,P.
40%injuriesattributabletotrainingandcompetition;mostinjuries
occurredintrainingvs.competitionexceptforsoccer;Onaverage
overuseinjuriesrequiredmoremissedtrainingtime
Malisoux,L;Frisch,A.;
Urhausen,A.;Seil,R.;
Theisen,D.
Higherintensityweekpriortoinjury(significantfinding)
Sportcategoryisprime factortoconsiderwithinjuryincidence
Hall,R.;Foss,B.;
Hewett,T.;Myer,G.
SportspecializationincreasedriskofPFPinfemaleadolescents;
Apophyseal injuries4timesgreater insportspecialization
Study ComparisonTable
Consensus BetweenStudies
•
•
•
Allstudiesreporttheneedforfurther
•
research
The twostudiesthatreportedongender
foundnostatisticallysignificantgender
•
baseddifferencesintherateofsustaining
aninjury
Twostudiesconcludegreaterincidenceof
injuryinteamvs.individualorracket
sports
•
Individual StudyFindings
Halletal. reportedanassociation
betweenearlyspecializationinfemale
athletesandhigherriskforpatellarinjury
Baxter-jonesetal.reportedthatthe
majorityofacute/traumaticinjuries,
exceptinswimming,occurredin
extracurricularactivitiesratherthanfrom
overuseduringspecialization
Malisoux etal.reportedhigherintensity
trainingtheweekpriortoinjury
Conclusions
Early
Frequencyof
Specialization SportsInjury Definition
Participation
Definition
Notreported
Authors
- basketball
Not
- soccer
Reported
- volleyball
Intensity
Althoughthepoolofresearchissmall,theavailableevidence suggeststhatearlysport
specializationmayhaveanegativeeffectonyoungathletes.Thisincombinationwith
evidencethatearlyspecializationdoesnotimprovetheoddsofreachinganelitelevel
ofsportsuggeststhattheincreasedriskofinjuryassociatedwithearlyspecialization
maynotbejustified.Morestudieswithlongerfollow-upaswellasamoreuniform
definitionof“earlyspecialization”areneededtobetterunderstandtherelationship
betweenearlysportspecializationandtheriskofoveruseinjury.
Notreported
ClinicalRelevance
Study ExposureTable
1413titles/abstractsrejectedfor
notaccuratelyreflecting
specializationversus
diversificationofyouthsport
StudyOutcomesTable
“Onewhichoccurredasa
resultofparticipationin
sportwhichhadoneor
bothofthefollowing
Notreported
consequences:(1)a
reductionintheamountor
levelofsportsactivityor(2)
needfortreatmentor
advice.”
Training
intensityon4
“Physicalcomplaint
pointscale:
resultingfromamatchor 2dailytraining
light,
trainingthatforcesthe
sessions;
moderate,
athletetointerruptor
Totalvolumeof
intense,very
modifyhis/herusual
sportin
intense
trainingplanforatleast
minutes
transferredto
onetrainingunit”
RPEscalefor
validity
• PhysicalTherapistsshouldbeawareoftherisksassociatedwithearlysport
specializationandintensityoftraininginthepediatricpopulation
• Providingappropriaterecommendationstopatientsandtheirfamiliesinregardsto
earlyspecializationmaybeinstrumentalinpreventingoveruseinjury
• Thisresearchhasthepotentialtoaidindevelopingguidelinesforintensityand
quantityofparticipation inyouthathletics
Acknowledgements /References
Acknowledgments:LeilaLedbetter,MLISforaidingintheextensiveliteraturesearch
References:
¹Feeley,B.T.,Agel,J.,&LaPrade,R.F.(2015).WhenIsItTooEarlyforSingleSportSpecialization?TheAmericanJournalofSportsMedicine.http://doi.org/10.1177/0363546515576899
²Hall,R.,BarberFoss,K.,Hewett,T.E.,&Myer,G.D.(2014).SportsSpecializationisAssociatedWithanIncreasedRiskofDeveloping AnteriorKneePaininAdolescentFemaleAthletes.JournalofSport
Rehabilitation.http://doi.org/10.1123/jsr.2013-0101
³Jayanthi,N.,Pinkham,C.,Dugas,L.,Patrick,B.,&Labella,C.(2013).Sportsspecializationinyoungathletes:evidence-basedrecommendations.SportsHealth,5(3),251–257.
Notreported
Notreported
Notreported
http://doi.org/10.1177/1941738112464626
4Malina,R.M.(2010).Earlysport specialization:roots,effectiveness,risks.CurrentSportsMedicineReports,9(6),364–371. http://doi.org/10.1249/JSR.0b013e3181fe3166
5ValovichMcLeod, T.C.,Decoster, L.C.,Loud, K.J.,Micheli,L.J.,Parker,J.T.,Sandrey,M.A.,&White,C.(2011).NationalAthleticTrainers’Associationpositionstatement:prevention ofpediatricoveruse
injuries.JournalofAthleticTraining,46(2),206–220. http://doi.org/10.4085/1062-6050-46.2.206