Injury Patterns in Highly Specialized Youth Athletes: Comparison of Two Different Pathways to Specialization

Sport specialization, commonly defined as intensive year-round training in a single sport at the exclusion of other sports, has been associated with increased risk for overuse injury. There are two pathways to becoming highly specialized: (1) having only ever played one sport ("exclusive highly specialized") or (2) quitting other sports to focus on a single sport ("evolved highly specialized"). Understanding injury patterns between different groups of highly specialized athletes will inform the development of injury prevention strategies.To compare distribution of injury types (acute, overuse, serious overuse) among evolved highly specialized athletes, exclusive highly specialized athletes, and low-moderate specialized athletes.Cross-sectional study.Tertiary care pediatric sports medicine clinic between January 2015 and April 2019.1171 patients (aged 13.14-17.83 years, 59.8% female) who played at least one organized sport, presented with a sports-related injury, and completed a sports participation survey.Distribution of injury types (acute, overuse, serious overuse).Percentage of injuries due to overuse was similar between exclusive and evolved highly specialized athletes (59.2% vs 53.9%; p=0.28). Compared to low-moderate specialized athletes, exclusive and evolved highly specialized athletes had higher percentage of injuries due to overuse (45.3% vs. 59.2% and 53.9, respectively; p=0.001). Multivariate analysis of the highly specialized groups revealed sport type to be a significant predictor of higher percentage of injuries due to overuse, with individual sport athletes having significantly increased odds of sustaining an overuse injury than team sport athletes (OR=1.95;CI:1.17-3.24).Distribution of injury types is similar between evolved and exclusive highly specialized youth athletes, with both groups having higher percentage of injuries due to overuse compared to low-moderate specialized athletes. Among highly specialized athletes, playing an individual sport was associated with higher proportion of overuse injuries compared to playing a team sport.