Association between sport specialization and risk of musculoskeletal injury in high school athletes: A critically appraised topic

Context: Sport specialization is defined as intensive, year-round training in a single sport to the exclusion of other sports. The increased training and competition loads secondary to this trend have been hypothesized to contribute to psychological burnout and overuse injuries. High school athletes, in particular, are of interest due to the increased intensity and level of competition compared to youth sports. By classifying levels of sport specialization and analyzing injury history of subjects, correlations have been made to the relationship between sport specialization and the prevalence of musculoskeletal injuries in high school athletes. Thus, the question being investigated in this critically appraised topic is Is sport specialization association with an increased risk of musculoskeletal injury in high school athletes?Objective: To determine if sport specialization is associated with an increased risk of musculoskeletal injury in high school athletes.Data Sources: An electronic database search included PubMed, SPORTDiscus, and Medline. Search terms included high school athletes AND sport specialization AND musculoskeletal injury OR injury.Study Selection: Studies were included if they investigated both male and female high school athletes, were level 3 evidence or higher, in English, and published within the past 10 years (2009-2019). Studies were excluded if the participants were too young to participate in high school sports, investigate non-musculoskeletal injuries, or investigate a population from only a single sport (ex: only baseball players).Data Extraction: Three cross-sectional and one cohort study were included and appraised using the Checklist for Measuring Quality.Data Synthesis: All four studies utilized a 3-question sport participation survey in order to classify participants as either high, moderate, or low specialization and an injury history survey. Two studies included high school athletes from 29 different high schools, one included high school athletes from 2 different high schools, and one included high school athletes from only one high school. Three studies analyzed in this appraisal found positive correlations between moderate and high levels of sport specialization and musculoskeletal injuries while one did not. Additionally, two of the studies found a positive correlation between time-loss injuries and participation in club sports.Conclusions: Evidence suggests that sport specialization is associated with a higher risk of musculoskeletal injuries in high school athletes. However, other factors, such as training volume, competition volume, and club sport involvement may all also play a role in this relationship.Strength of Recommendation: