The Effect of Single Sport Specialization in Youth Sports: Does It Increase the Risk of Injury? A Prospective Study

OBJECTIVES: Fifty-three percent of children play individual sports and 42% participate in team sports. As youth sports continue to gain popularity, sports specialization is becoming popular among young athletes. The reasons for sport specialization vary, but the most common reason offered is to gain a competitive advantage at a younger age to allow for higher level play in college and potentially at the professional level. However, there is concern that early sports specialization increases the risk of overuse injuries in youth athletes. The purpose of this investigation was to determine the prevalence of sport specialization in youth athletes, and prospectively examine whether specialization correlates with an increased incidence of athletic injury. METHODS: We prospectively enrolled 602 high school students with the intent of following them through their four years of high school. Sports specialization was defined as participating in one sport for more than 6 months of the year, while excluding other sports. Freshman and sophomore athletes completed a sports specialization and injury survey at the beginning of each sport season. Athletes’ demographic information, sport commitment, injury history and future athletic plans were collected. The same athletes were queried again at the conclusion of each season to collect injury information including but not limited to fractures, ligamentous injuries, dislocations and concussions. Athletic training records were reviewed and corroborated with covering team physician records to ensure capture of all injuries reported to health care personnel during the years of the investigation. Categorical data was analyzed via chi-squared tests. RESULTS: At the two year time point, of the 602 athletes, 255 (42.4%) reported sport specialization. Soccer (26.9%), baseball (20.6%), softball (18.3%) and swimming (15.6%) had the highest rates of specialization among participants. Ninety-five (37.3%) specialized athletes reported spending more than 10 hours a week participating in sports related activities, compared to 105 (30.3%) non-specialized athletes, p= 0.072. Of the specialized athletes, 56.5% had been injured playing their primary sport in the past, compared to 43.5% of non-specialized athletes, p= 0.046. Seventy-eight percent of the specialized athletes sustained an injury before the study period that prevented them from participating in sports for part or the whole season, whereas only 40% of the non-specialized athletes sustained these types of injuries, p= 0.055. Finally, during the study period, 9.0% of specialized athletes sustained injuries compared to 5.2% of non-specialized athletes, p= 0.065. The most common injuries were concussions (43.9% of injuries) and lateral ankle sprains (12.2% of injuries). CONCLUSION: A considerable number of high school athletes specialize in one sport during their underclass years (42.4%). Specialized student athletes spend more time participating in sports related activities than non-specialized athletes, which may account for the increased frequency of injuries, compared to non-specialized athletes. Although not statistically significant at the 2 year time point, this relationship warrants further investigation into the potential health effects of early sports specialization.