Early sport specialisation (ESS) is often considered to be a risk factor for injury, despite a lack of good evidence to support this relationship. This FastFact highlights a paper that attempts to determine whether ESS is indeed associated with an increased risk of injury by evaluating a group of American Collegiate athletes1.
It has been demonstrated that school-aged athletes are increasingly opting to focus on a single sport at a relatively young age. This has become known as ‘early specialisation’. There is concern among many coaches and clinicians that this ESS may have negative effects on athletes. Athletes that specialise in a single sport early have been shown to have an increased risk of burnout, be more likely to retire from sport early and to be less likely to reach the elite level. The evidence relating to injury risk is less well established. The primary aim of this study was to evaluate whether NCAA athletes who reported specialising early were more likely to be injured (than those who did not).
A cross sectional study involving a total of 232 athletes, with a mean age of 20.1 years, was completed. The athletes were asked to complete a short survey detailing demographics, scholarship status, reasons for sport specialisation, age of specialisation, training volume, and injury/surgical history. The age at which an athlete ‘specialised’ was defined as being the age when they began to train greater than 8 months out of the year for their primary sport.
The study had several interesting findings. Firstly there was an association between both early specialisation (before the age of 14 years) and high training loads with an increased risk of injury and of having had surgery. The association was greatest for participants that trained for more than 28 hours per week in their eventual sport before they started high school. Participants with a history of ESS were more likely to be recruited or receive a scholarship that those who did not, which may indicate that they were better athletes.
A clear limitation of this study is recall bias. Participants were asked to estimate their training and injury history based on their recall. A prospective study design would have been more robust. The inclusion of athletes from multiple sports also makes it hard to generalise the study’s findings to other athlete groups, for example elite academy football players. Another consideration is that the study sample does not include athletes who did not reach the collegiate level, potentially due to injury or burnout.
While this study does have some clear limitations, it does support the impression that athletes who specialise in a single sport may be more likely to be injured.
1. Ahlquist S, Cash BM, Hame SL. Associations of Early Sport Specialization and High Training Volume With Injury Rates in National Collegiate Athletic Association Division I Athletes. Orthop J Sports Med. 2020 Mar; 8(3): 2325967120906825.