The Effect of Sport Specialization on Lower Extremity Injury Rates in High School Athletes

Background: High school athletes are increasingly encouraged to participate in 1 sport year-round to increase their sport skills. However, no study has examined the association of competition volume, club sport participation, and sport specialization with sex and lower extremity injury (LEI) in a large sample of high school athletes. Hypothesis: Increased competition volume, participating on a club team outside of school sports, and high levels of specialization will all be associated with a history of LEI. Girls will be more likely to engage in higher competition volume, participate on a club team, and be classified as highly specialized. Study Design: Cross-sectional study. Level of Evidence: Level 3. Methods: High school athletes completed a questionnaire prior to the start of their competitive season regarding their sport participation and previous injury history. Multivariable logistic regression analyses were used to investigate associations of competition volume, club sport participation, and sport specialization with history of LEI, adjusting for sex. Results: A cohort of 1544 high school athletes (780 girls; grades 9-12) from 29 high schools completed the questionnaire. Girls were more likely to participate at high competition volume (23.2% vs 11.0%, χ2 = 84.7, P < 0.001), participate on a club team (61.2% vs 37.2%, χ2 = 88.3, P < 0.001), and be highly specialized (16.4% vs 10.4%, χ2 = 19.7, P < 0.001). Athletes with high competition volume, who participated in a club sport, or who were highly specialized had greater odds of reporting a previous LEI than those with low competition volume (odds ratio [OR], 2.08; 95% CI, 1.55-2.80; P < 0.001), no club sport participation (OR, 1.50; 95% CI, 1.20-1.88; P < 0.001), or low specialization (OR, 2.58; 95% CI, 1.88-3.54; P < 0.001), even after adjusting for sex. Conclusion: Participating in high sport volume, on a club team, or being highly specialized was associated with history of LEI. Girls were more likely to participate at high volumes, be active on club teams, or be highly specialized, potentially placing them at increased risk of injury. Clinical Relevance: Youth athletes, parents, and clinicians should be aware of the potential risks of intense, year-round participation in organized sports.

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Use of Discretionary Protective Equipment and Rate of Lower Extremity Injury in High School Athletes

American Journal of Epidemiology ◽

10.1093/aje/kwi077 ◽

2005 ◽

Vol 161 (6) ◽

pp. 511-519 ◽

Cited By ~ 34

Author(s):

J. Yang ◽

S. W. Marshall ◽

J. M. Bowling ◽

C. W. Runyan ◽

F. O. Mueller ◽

...

Keyword(s):

High School ◽

Lower Extremity ◽

Lower Extremity Injury ◽

Protective Equipment ◽

Extremity Injury ◽

High School Athletes

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Physical Exam Risk Factors for Lower Extremity Injury in High School Athletes

Clinical Journal of Sport Medicine ◽

10.1097/jsm.0000000000000284 ◽

2016 ◽

Vol 26 (6) ◽

pp. 435-444 ◽

Cited By ~ 10

Author(s):

James A. Onate ◽

Joshua S. Everhart ◽

Daniel R. Clifton ◽

Thomas M. Best ◽

James R. Borchers ◽

...

Keyword(s):

Risk Factors ◽

High School ◽

Lower Extremity ◽

Physical Exam ◽

Lower Extremity Injury ◽

Extremity Injury ◽

High School Athletes

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Lower Extremity Musculoskeletal Injury Risk After Concussion Recovery in High School Athletes

Journal of Athletic Training ◽

10.4085/1062-6050-52.11.22 ◽

2017 ◽

Vol 52 (11) ◽

pp. 1028-1034 ◽

Cited By ~ 21

Author(s):

Robert C. Lynall ◽

Timothy C. Mauntel ◽

Ryan T. Pohlig ◽

Zachary Y. Kerr ◽

Thomas P. Dompier ◽

...

Keyword(s):

High School ◽

Lower Extremity ◽

Musculoskeletal Injury ◽

Lower Extremity Injury ◽

Extremity Injury ◽

High School Athletes ◽

Time Loss ◽

Lower Extremity Injuries ◽

Subsequent Time ◽

Extremity Injuries

Context: Although an association between concussion and musculoskeletal injury has been described in collegiate and professional athletes, no researchers have investigated an association in younger athletes. Objective: To determine if concussion in high school athletes increased the risk for lower extremity musculoskeletal injury after return to activity. Design: Observational cohort study. Setting: One hundred ninety-six high schools across 26 states. Patients or Other Participants: We used data from the National Athletic Treatment, Injury and Outcomes Network surveillance system. Athletic trainers provided information about sport-related concussions and musculoskeletal injuries in athletes in 27 sports, along with missed activity time due to these injuries. Main Outcome Measure(s): Three general estimating equations were modeled to predict the odds of sustaining (1) any lower extremity injury, (2) a time-loss lower extremity injury, or (3) a non–time-loss lower extremity injury after concussion. Predictors were the total number of previous injuries, number of previous concussions, number of previous lower extremity injuries, number of previous upper extremity injuries, and sport contact classification. Results: The initial dataset contained data from 18 216 athletes (females = 39%, n = 6887) and 46 217 injuries. Lower extremity injuries accounted for most injuries (56.3%), and concussions for 4.3% of total injuries. For every previous concussion, the odds of sustaining a subsequent time-loss lower extremity injury increased 34% (odds ratio [OR] = 1.34; 95% confidence interval [CI] = 1.13, 1.60). The number of previous concussions had no effect on the odds of sustaining any subsequent lower extremity injury (OR = 0.97; 95% CI = 0.89, 1.05) or a non–time-loss injury (OR = 1.01; 95% CI = 0.92, 1.10). Conclusions: Among high school athletes, concussion increased the odds of sustaining subsequent time-loss lower extremity injuries but not non–time-loss injuries. By definition, time-loss injuries may be considered more severe than non–time-loss injuries. The exact mechanism underlying the increased risk of lower extremity injury after concussion remains elusive and should be further explored in future research.

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Musculoskeletal Injuries and Their Association With Previous Concussion History: A Prospective Study of High School Volleyball and Soccer Players

The American Journal of Sports Medicine ◽

10.1177/0363546521997116 ◽

2021 ◽

pp. 036354652199711

Author(s):

Kevin M. Biese ◽

Stephanie A. Kliethermes ◽

Andrew M. Watson ◽

Timothy A. McGuine ◽

Pamela J. Lang ◽

...

Keyword(s):

High School ◽

Lower Extremity ◽

Female Athletes ◽

Musculoskeletal Injury ◽

Musculoskeletal Injuries ◽

Lower Extremity Injury ◽

Extremity Injury ◽

Adolescent Athletes ◽

Injury Rates ◽

The Past

Background: Sports-related concussions may have a neurobiological recovery period that exceeds the period of clinical recovery, and one consequence of an extended neurobiological recovery may be the risk of subsequent musculoskeletal injuries. Most literature citing an increased risk of musculoskeletal injury after a sports-related concussion has been reported in populations other than adolescent athletes. Purpose/Hypothesis: The purpose was to prospectively determine if incidence rates of musculoskeletal injury differ between adolescent athletes with and without a previous sports-related concussion, while controlling for sex, sport, and age. A secondary aim was to determine if this relationship differs between male and female athletes of the same sport. Our hypotheses were that acute-noncontact injury rates would be higher in athletes with a previous sports-related concussion when compared with athletes without a previous sports-related concussion, and that this relationship would exist only in female athletes and not male athletes. Study Design: Cohort study; Level of evidence, 2. Methods: High school soccer and volleyball players were recruited in 2 prospective cohort studies that observed 4837 athletes during their sporting season (females, 80%; soccer, 57%; mean [SD] age, 15.6 [1.1] years). At preseason, all participants self-reported demographics and previous sports-related concussion within the past 12 months. During the sport season, team athletic trainers electronically recorded athlete exposures and injury data, including injury characteristics. Injury rates per 1000 athlete exposures and injury rate ratios (IRRs) with 95% confidence intervals were calculated. All injury rates and IRRs were adjusted for sex, age, and sport. Results: The rate of acute-noncontact lower extremity injury was 87% greater (IRR, 1.87; 95% CI, 1.29-2.74) in participants with a previous sports-related concussion versus those without one. The acute-noncontact lower extremity injury rates (IRRs) for females and males with a previous sports-related concussion were 1.76 (95% CI, 1.19-2.59) and 2.83 (95% CI, 0.85-9.50), respectively. No difference was detected in acute-contact (IRR, 0.98; 95% CI, 0.56-1.73) or overuse (IRR, 1.09; 95% CI, 0.51-2.37) lower extremity injury rates by previous sports-related concussion. Conclusion: Female adolescent athletes who reported a sports-related concussion within the past 12 months were more likely to sustain an acute-noncontact lower extremity injury during their high school sports season when compared with female athletes without a previous sport-related concussion.

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Impact of Routine Gastrocnemius Stretching on Ankle Dorsiflexion Flexibility and Injury Rates in High School Basketball Athletes

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119836774 ◽

2019 ◽

Vol 7 (4) ◽

pp. 232596711983677 ◽

Cited By ~ 1

Author(s):

Derrick M. Knapik ◽

Scott LaTulip ◽

Michael J. Salata ◽

James E. Voos ◽

Raymond W. Liu

Keyword(s):

High School ◽

Cohort Study ◽

Lower Extremity ◽

Ankle Dorsiflexion ◽

Lower Extremity Injury ◽

Extremity Injury ◽

Control Groups ◽

Injury Rates ◽

Time Points ◽

And Control

Background: Achilles tightness exacerbates a variety of foot and ankle conditions while increasing the risk of lower extremity injuries. The correlation between Achilles tightness and lower extremity injury rates in a young, athletic population is unknown. Purpose: To evaluate the impact of routine gastrocnemius stretching on ankle flexibility and lower extremity injury rates in youth basketball athletes. Study Design: Cohort study; Level of evidence, 3. Methods: A prospective cohort study enrolling 8 high school basketball teams (4 male teams, 4 female teams) was conducted over a 3-month sporting season. Two schools (2 male teams, 2 female teams) were assigned to a daily gastrocnemius stretching protocol. Two control schools (2 male teams, 2 female teams) followed no protocol. Passive ankle dorsiflexion was measured bilaterally in both groups at 4 time points: preseason, 1 month and 2 months after the start of the season, and postseason (3 months from the start of the season). The number of injuries sustained during the season and the number of games missed because of a lower extremity injury were recorded. Differences in dorsiflexion flexibility measurements and injury rates were analyzed between the protocol and control groups. Results: A total of 106 athletes (46 male, 60 female) were included in the study. The protocol group included 51 athletes (mean age, 15.7 ± 1.2 years) versus 55 athletes (mean age, 16.2 ± 1.0 years) in the control group. Athletes undergoing routine gastrocnemius stretching had significantly higher ankle dorsiflexion flexibility measurements compared with control athletes at all time points ( P < .05 for each time point) while also demonstrating a significant increase in dorsiflexion between the preseason and postseason time points ( P = .04). No significant difference in injury rates was appreciated between the protocol and control groups, and no difference in dorsiflexion flexibility measurements was appreciated between injured and uninjured athletes. Conclusion: The implementation of a gastrocnemius stretching protocol in youth basketball athletes increased ankle dorsiflexion over a single season without decreasing the injury incidence relative to controls in our study. Because the size of our study limited statistical power, a confirmation of the results in a larger study is required.

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