Early sports specialization has been increasingly viewed in recent years as increasing an athlete's chances of achieving elite status, but has also raised significant concerns, both as to whether it actually accomplishes that objective, and whether early specialization carries with it an increased risk for sports-related injuries.

A quartet of research papers presented at the American Academy of Pediatrics' October 2015 National Conference and Exhibition explored various aspects of the sports specializaton issue.

In the first, researchers at Vanderbilt University reported on the development and validation of a web-based survey tool to use in investigating the characteristics of age of specialization and sports-related injuries in college athletes.   The survey, said lead investigator, Katherine H. Rizzone, MD, MPH, was able to demonstrate a potential link between age of specialization and many types of injuries.  She viewed the study as  "an important first step in understanding the characteristics of early specialization and its potential influence on risk for sport-related injuries, as it validates a measure to be used in future studies." 

The second paper reported the results of the college athletes Rizzone surveyed, most of whom had athletic scholarships.  Among Rizzone's findings were that they:

• started early but specialize late: the average age they began in their college sport, if it was an individual sport, was at around 5, and for team sports was around age 10; but most did not specialize in their sport until the beginning of high school (i.e. the average age of sport specialization high school 15.1 years); for a majority (62%), their first elite sport was the same as their college sport, but not their first organized sport (53%);
• specialized because enjoyed the sport: the most important reason for specialization was because it was the sport they wanted to play/liked the most (56%); that they were "best at this sport" came in a distant second (30%);
• were from an athletic family: a majority (57%) had a parent or sibling who was also a varsity athlete, and nearly one in ten (9%) had a parent or sibling who had participated in a sport at the Olympic or professional level (this is consistent with the findings of earlier studies at UCLA and the University of Texas at Austin);
• were relatively injury-free: the average number of injuries prior to college was only 1.55, but a quarter (25%) reported undergoing a surgical procedure for a sports injury.  The most common injury reported were ankle sprains
• no statistical link between age of specialization and sports-related injuries.  No association was found among the 65 athletes surveyed between early specialization and risk of sports-related injury. 

In the third paper, researchers at Loyola Chicago and Lurie's Children Hospital in Chicago found that young athletes participating in individual sports, such as tennis and gymnastics, report a higher degree of sports specialization, but pay a price compared to those in team sports by developing a higher rate of serious overuse injuries.

In addition, they found that girls who quit other sports to specialize in a single sport before age 12 may be more likely to report injury than those who begin specializing at age 12 or older.

The findings "suggest a potential link between age of sport specialization and subsequent injury risk," said the presenting author, Jacqueline Pasulka, "because we saw a higher proportion of injured kids among those who specialized before age 12."  

Pasulka suggested that the increased risk may be the result of increasing the intensity and volume of sports training during the child's growth spurt at the around of puberty.

She said, however, that, while there was a trend towards a correlation between age of specialization and serious overuse injury risk, "we need to be very cautious in interpreting the data." 

"Our survey suggested a potential link between age of specialization and many subsets of injuries, but the link needs to be validated by controlling for other factors and examined in a study following young athletes over a period of time. " 

In the fourth paper, a different group of researchers at Loyola Chicago reported on the results of a pilot study designed to determine if there was a difference in health status, energy expenditure, and musculoskeletal injury rate in competitive tennis-only adolescents and their parents versus competitive multi-sport (tennis plus at least one other sport) adolescents and their parents. 

They found that there was no difference in health status or injury rates, but higher levels of physical activity, in tennis-only athletes versus multi-sport competitive young athletes, but that parents of tennis-only adolescents participated in significantly more moderate to vigorous physical activity (MVPA) and more reported more weekly physical activity hours than the parents of multi-sport adolescents.  

Continued research needed 

"I think what we may see is that age of specialization is really dependent on the sport," said Dr. Neeru Jayanthi, a sports medicine physician with Emory Sports Medicine in Atlanta, and one of the country's leading experts on youth sports health, injuries, and sports training patterns and co-author of the two Loyola studies.

"For some sports, it is not a predictor of injury/overuse injury, and for others, it will make a bigger difference, particularly in individual and technical sports like gymnastics, dance, and tennis, and particularly in females, where those specialization rates and overuse injury rates are the highest.""

"Future research in sport specialization should be sport-specific," says Jayanthi, "in order to help make sport-specific recommendations regarding age of specialization."  

"We continue to believe that there is likely increased injury risk with highly specialized athletes, and we know that, while none of the data is strong it makes intuitive sense that earlier, intensified, specialized training increases the risk of burnout." 

Sources:

Schneider AM, Jayanthi N, Dugas L. Health and Fitness of Parent-Child Dyads: Specialized Young Athletes Versus Multisport Young Athletes. Presented at American Academy of Pediatrics National Conference and Exhibition, Washington, D.C. October 24, 2014.

Pasulka J, LaBella C, Jayanthi N, McCann A, Dugas L. Relationship Between Age of Sport Specialization and Injury in Young Athletes. Presented at  American Academy of Pediatrics National Conference and Exhibition, Washington, D.C. October 24, 2014.

Rizzone KH.  Characteristics of Sport Specialization in a Sample of College Athletes. American Academy of Pediatrics National Conference and Exhibition, Washington, D.C. October 24, 2014.