• Sports specialization, the intense training in one particular sport with the exclusion of other sports,1 occurs naturally as young athletes mature. In individual sports, specialization occurs earlier than in team sports. 2

• Overuse injury, burnout, and attrition from sport have all been associated with early sports specialization.3,4 Success drives participation in one sport year round, often in youth leagues modeled after adult leagues, which may be detrimental to the young athlete’s health and safety. 5,6

• Most of the current literature1-13 about specialization is expert recommendation, but the body of evidence examining when specialization should occur is still growing.

• How does early sports specialization affect youth and adolescent athletes?

• Articles examining the effects of early sport specialization were identified from the following databases from January 1990 through September 2014:1. PubMed (www.pubmed.gov)2. Cumulative Index to Nursing and Allied Health Literature 3. Physical Therapy & Sports Medicine Collection4. MEDLINE

• Key terms included:• “child and child development and youth sports

specialization or sport specialization”• “adolescent and adolescent development and youth sports

specialization or sport specialization”• Studies could be either full reports or abstracts meeting the

inclusion criteria in table 1.

The Effects of Early Sports Specialization on Youth and Adolescent Athletes: A Systematic Review

Nicole R. Miela, Adam J. Gutierrez, & David C. Berry, PhD, AT, ATC

Saginaw Valley State University, University Center, MI

• Two reviewers independently assessed (Table 2) studies according to the Strengthening in the Reporting of Observational Studies in Epidemiology (STROBE) checklist when applicable.

Table 3. Included Articles with Reported Data

• An association exists between early sports specialization and increased risk of injury14,15 and sport attrition.16,17

• Focus may be better placed on the quality of instruction and training than when an athlete specialized.10 There are many benefits to gain from youth sport, 11 but sport specialization may limit the development of fundamental motor skills, narrowing the base upon which to build and develop further skills.12

• The young athlete should participate in sports for personal enjoyment13 and needs emotional and instructional support from coaches to maximize a positive overall sport experience.10

• Athletic trainers often work with adolescent athletes who suffer from overuse injuries due to early specialization, intense training, and inadequate rest periods.

• In order to reduce further risk of overuse injury and attrition from activity, athletic trainers should educate athletes, parents, and coaches about the inherent risks associated with early sports specialization and encourage adequate rest and sport diversification.

• Early sports specialization contributes to increased risk of overuse injuries in young athletes and greater rates of attrition from activity in young adulthood. Training and rest should be balanced to diminish incidence of fatigue, and specialization should be delayed to decrease sport attrition.

1. Jayanthi N, Pinkham C, Dugas L, Patrick B, Labella C. Sports specialization in young athletes: evidence-based recommendations. Sports Health. 2013;5(3):251-257.

2. Wiersma LD. Risks and benefits of youth sport specialization: perspectives and recommendations. Pediatr Exerc Sci. 2000;12:13-22.3. McLeod TCV, et al. National Athletic Trainers’ Association position statement: prevention of pediatric overuse injuries. J Athl Train. 2011;46(2):206-

220. 4. Callendar SS. The early specialization of youth in sports. Athl Train Sports Health Care. 2010;2(6):255-257.5. Malina RM. Early sport specialization: roots, effectiveness, risks. Curr Sports Med Rep. 2010;9(2):364-371.6. FIMS/WHO Ad Hoc Committee on Sports and Children. Sports and children: consensus statement on organized sports for children. Bull World Health

Organ. 1998;76(5):445-447. 7. American Academy of Pediatrics’ Committee on Sports Medicine and Fitness. Intensive training and sports specialization in young athletes. Pediatrics.

2000;106(1):154-157.8. Johnson JH. Overuse injuries in young athletes: Cause and prevention. Strength Cond J. 2008;30(2):27-31.9. DiFiori JP. Evaluation of overuse injuries in children and adolescents. Curr Sports Med Rep. 2010;9(6):372-378.10. Brylinksy J. Practice makes perfect and other curricular myths in the sport specialization debate. J Phys Educ Recreat Dance. 2010;81(8):22-25.11. Nyland J. Coming to terms with early sports specialization and athletic injuries. J Orthop Sports Phys Ther. 2014;44(6):389-390.12. Branta CF. Sport specialization: Developmental and learning issues. J Phys Educ Recreat Dance. 2010;81(8):19-21,28.13. Kaleth AS, Mikesky AE. Impact of early sport specialization: A physiological perspective. J Phys Educ Recreat Dance. 2010;81(8):29-32,37.14. Jayanthi N, Dugas L, Fischer D, Pasulka J, LaBella C. Risks of intense, specialized training and growth for injury in young athletes: A clinical

evaluation. Br J Sports Med. 2014;48:611.15. Hall R, Barber Foss K, Hewett TE, Myer GD. Sports specialization is associated with an increased risk of developing anterior knee pain in adolescent

female athletes [published online ahead of print March 12 2014]. J Sport Rehabil. 2014.16. Russell WD, Limle AN. The relationship between youth sport specialization and involvement in sport and physical activity in young adulthood. J Sport

Behav. 2013; 36(1):82-98.17. Russell WD. The relationship between youth sport specialization, reasons for participation, and youth sport participation motivations: A retrospective

study. J Sport Behav. 2014;37(3):286-305.

Crystal M. Lange College of Health and

Human Services

Introduction

Clinical Question/Objective

Discussion

Clinical Application

Conclusion

References

Data Sources

Data Extraction Data Synthesis

Table 1. Inclusion Criteria.1. Peer-reviewed level 1-5 research/reports/abstracts following

Oxford’s Centre for Evidence-Based Medicine (CEBM)

2. Written in English

3. Involved children and adolescents ages 4-204. Available abstract5. Outcomes or expert/association recommendations effected by

early sports specialization

Table 2. Data of Interest

1. Subjects and methods of observation

2. Descriptive, univariate, and/or multivariate data

3. Odds ratios, relative risk, and 95% confidence intervals where applicable

4. Expert/association recommendations

Lyman et al.5

Author(s) Subjects Groups Methods Outcome Measures Results

Jayanthi et al.14 1,206 young athletes ages 7-18 yo (50.7% male) recruited from sports medicine and primary care clinics.

Injured young athletes, recruited from the sports medicine clinic; healthy controls, recruited from two primary care clinics presenting for sports physicals.

Baseline evaluation collecting injury data and assessing risk factors; longitudinal follow up data collection is ongoing.

Independent variables were hours per week of organized sport, gym, free play, sports specialization, and growth rate; dependent variables were total injuries, overuse injuries, serious overuse injuries, and acute injuries.

Injured athletes were older (14.1±2.1 yo) and spent more time in organized sport (11.3±6.9 hr) than uninjured athletes (12.9±2.6 yo; 9.4±8.2 hr; p<.001). After adjustments, specialization remained an independent risk factor for injury (OR 1.48, p<.05). Athletes who spent more hours per week in sport than their age (p<.05) and in >2 times more organized sports than free play (p=.001) were more likely to sustain serious overuse injury.

Hall et al.15 546 female basketball, soccer, and volleyball players with diagnoses of patellofemoral pain (PFP) recruited from 5 middle schools and 4 high schools in one county public school district in Kentucky.

357 multisport athletes; 189 single sport athletes - 66 basketball, 57 soccer, and 66 volleyball.

Completion of standardized history and physician-administered physical examination for presence of PFP; Normalization of sports participation data by sport season, with each sport accounting as one season of exposure.

Incidence rate ratios (IRR) and 95% confidence intervals (CI).

Specialization increased the relative risk of PFP 1.5 times (95% CI: 1.0-2.2; p=.038). Specific diagnoses of Sindig-Larsen-Johansson/patellar tendionopathy and Osgood-Schlatter Disease increased 4-fold in specialized athletes than in multisport athletes.

Russell and Limle16 153 participants ages 18-22 yo in general education wellness courses at a mid-size Midwestern university (71 male, 82 female).

87 self-reported specialized athletes (56.9%); 66 self-reported multisport athletes.

Survey; included questions related to sports specialization and past and present sports participation, a 17-item examination of general retrospective perceptions of youth sport, and the Physical Activity Enjoyment Scale, (PACES).

Descriptive statistics, independent t-tests, chi-square procedures, and multiple regression analyses.

The most frequent specialized sports reported were basketball and soccer. 32 of the 87 specialized participants reported specializing at or before age 8. Of all 153 participants, 53 (35.3%) reported attrition. Independent t-tests were nonsignificant for specialization’s effect on activity enjoyment, current aerobic exercise, current strength training, and overall retrospective perceptions of youth sport participation (p>.05). Chi square testing revealed a significant negative relationship between specialization and current sport participation (χ2(2)=8.77, p<.05).

Russell17 200 participants ages 17-22 yo in general education wellness courses at a mid-size Midwestern university ( 93 male, 107 female).

113 self-reported specialized athletes (56%); 87 self-reported multisport athletes.

Survey; included questions related to sports specialization and past and present sports participation, a 9-item examination of reasons for youth sports participation and withdrawal, the PACES, and the Sport Motivation Scale (SMS).

Descriptive statistics, independent t-tests, chi-square procedures, and one-way MANOVAs.

In the specialized group, 101 (89%) specialized before adolescence, 72 (71%) before age 10, and 21% before age 6.103 of 200 participants (51.5%) reported attrition from sport as young adults. Specializers’ reasons for attrition were lack of time (n=17), lost interest (n=12), and lack of fun (n=10); nonspecializers’ reasons were lost interest (n=10) and lack of time (n=8).Chi-square testing found participants who specialized were less likely to participate in sport as a young adult (χ2(2)=6.43, p<.05).

• Eight of sixteen articles met the inclusion criteria. Four articles reported data (Table 3) while four provided recommendations (Table 4).

Table 4. Expert/Association Recommendations

Jayanthi et al.1 Specialization should be delayed until late adolescence to optimize sports success and reduce injury risk.

AAP Committee on Sports Medicine and Fitness7

Sports participation should be at the child’s desire and specialization delayed until adolescence. The child’s health should be monitored for developmental growth and abnormalities. Physicians, coaches, and parents should recognize the signs and symptoms of overuse injury.

Johnson8 Youth sports should involve gradual skill progression, random practice, rest, and age-appropriate activities. Change of activity should occur every 2-3 months and diversification embraced.

DiFiori9 Regardless of specialization or diversification, the amount of time spent in sport and the number of teams a child belongs to should be limited. Training should focus on skill acquisition, general fitness, and should follow a progression.