Original Research

High Sport Specialization Is Associated With More Musculoskeletal Injuries in Canadian High School Students

Whatman, Chris PT, PhD^*; van den Berg, Carla MSc^†; Black, Amanda M. CAT(C), PhD^†; West, Stephen PhD^†; Hagel, Brent PhD^‡,§; Eliason, Paul PhD^†; Emery, Carolyn PT, PhD^{†,‡,§,¶,‖}

Author Information

^*Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand;

^†Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada;

^‡Departments of Pediatrics; and

^§Community Health Sciences, Cumming School of Medicine, University of Calgary, AB, Canada;

^¶Alberta Children's Hospital Research Institute, Canada Health, University of Calgary, Calgary, AB, Canada; and

^‖McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada.

Corresponding Author: Chris Whatman, PT, PhD School of Sport and Recreation, Faculty of Health and Environmental Sciences, Auckland University of Technology, Private Bag 92006, Auckland, New Zealand ([email protected]).

The authors report no conflicts of interest.

Clinical Journal of Sport Medicine 33(3):p 233-238, May 2023. | DOI: 10.1097/JSM.0000000000001100

Abstract

Objective:

To describe levels of sport specialization in Canadian high school students and investigate whether sport specialization and/or sport participation volume is associated with the history of musculoskeletal injury and/or concussion.

Design:

Cross-sectional study.

Setting:

High schools, Alberta, Canada.

Participants:

High school students (14-19 years) participating in various sports.

Independent Variables:

Level of sport specialization (high, moderate, low) and sport participation volume (hours per week and months per year).

Main Outcome Measures:

Twelve-month injury history (musculoskeletal and concussion).

Results:

Of the 1504 students who completed the survey, 31% were categorized as highly specialized (7.5% before the age of 12 years). Using multivariable, negative, binomial regression (adjusted for sex, age, total yearly training hours, and clustering by school), highly specialized students had a significantly higher musculoskeletal injury rate [incidence rate ratio (IRR) = 1.36, 95% confidence interval (CI), 1.07-1.73] but not lower extremity injury or concussion rate, compared with low specialization students. Participating in one sport for more than 8 months of the year significantly increased the musculoskeletal injury rate (IRR = 1.27, 95% CI, 1.02-1.58). Increased training hours significantly increased the musculoskeletal injury rate (IRR = 1.18, 95% CI, 1.13-1.25), lower extremity injury rate (IRR = 1.16, 95% CI, 1.09-1.24), and concussion rate (IRR = 1.31, 95% CI, 1.24-1.39).

Conclusions:

Approximately one-third of Canadian high school students playing sports were categorized as highly specialized. The musculoskeletal injury rate was higher for high sport specialization students compared with low sport specialization students. Musculoskeletal injuries and concussion were also more common in students who train more and spend greater than 8 months per year in one sport.

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High Sport Specialization Is Associated With More Musculoskeletal Injuries in Canadian High School Students