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 ¼ 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 ¼ .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 ¼ .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 ¼ 1.95; 95% CI ¼ 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.