Highly Specialized Young Athletes At Risk for Knee, Hip Injuries

    There is a sense among those who pay attention to youth and high school athletics that more and more young athletes today are focusing on excelling at a single sport instead of playing a variety of sports.

    Perhaps surprisingly, little research has been conducted on the prevalence of sports specialization in high school athletes — and what that might mean for these competitors’ health.

    “Sport specialization is a hot topic in sports medicine, yet there is a severe lack of empirical data that exists about the topic,” said University of Wisconsin-Madison’s David Bell, PhD, an assistant professor with the Department of Kinesiology’s Athletic Training Program and the director of the Wisconsin Injury in Sport Laboratory (WISL). 

    “Physicians are way ahead of the research in this area and, anecdotally, they report that they are seeing more kids in their clinics that have injuries that used to be only found in older athletes.”

    Small School = Less Specialization

    In an effort to contribute some much-needed data on the topic, Dr. Bell and colleagues at UW-Madison recently published a groundbreaking study in The American Journal of Sports Medicine.

    Their 1-year observational study found that high school athletes from a smaller school were less likely to specialize in a sport than those attending a large school. They also found that highly specialized athletes were more likely to report a history of overuse knee or hip injuries.

    If there is a key takeaway for young athletes and their parents, Dr. Bell said simply, “Make sure your children are getting breaks in competition.”

    More Specialization = More Injuries

    To conduct their study, the researchers asked 302 high school athletes at 2 schools to complete 2 different surveys — 1 examining sport specialization and 1asking about injury history. The athletes were then classified into low-, moderate-, or high-specialization groups.

    Of those who completed the survey, 34.8% were classified as low specialization, 28.8% as moderate specialization, and 36.4% as high specialization. The surveys found that athletes from the small school were more likely to be classified in the low-specialization group (low, 43%; moderate, 32%; high, 25%) compared with those from the large school (low, 26%; moderate, 26%; high, 48%).

    The researchers also found that athletes in the high-specialization group were more likely to report a history of overuse knee injuries compared with those in the moderate- or low-specialization groups.

    Similarly, athletes who trained in 1 sport for more than 8 months out of the year were more likely to report a history of knee injuries, overuse knee injuries, and hip injuries.

    “Participating in a single sport for more than 8 months per year appeared to be an important factor in the increased injury risk observed in highly specialized athletes,” the authors concluded.

    Spreading the Word

    Moving forward, Dr. Bell said he would like to build on these findings and put this important information into the hands of young athletes, parents, and coaches.

    “Recommendations already exist to try and limit athletes’ year-round exposure to sports,” Dr. Bell said. “Yet we don’t know how well these recommendations are known to the average person.

    “Our next step is to survey parents and athletes regarding their knowledge of sport participation recommendations, and also their attitudes toward sport specialization. Do they think it is important to achieve their athletic goals, and why?

    “There are so many great aspects to sports participation and we don’t want this information to scare athletes or parents — we just want them to be wise consumers and to participate as safely as possible.”


    Bell DR, Post EG, Trigsted SM, et al. Prevalence of sport specialization in high school athletics: a 1-year observational study. Am J Sports Med. 2016 Feb 26. pii: 0363546516629943. [Epub ahead of print]