Study: Single-Sport Athletes Injured More
November 3, 2016
A study conducted by the University of Wisconsin School of Medicine and Public Health and funded by the National Federation of State High School Associations (NFHS) Foundation revealed that high school athletes who specialize in a single sport sustain lower-extremity injuries at significantly higher rates than athletes who do not specialize in one sport.
The study was conducted throughout the 2015-16 school year at 29 high schools in Wisconsin involving more than 1,500 student-athletes equally divided between male and female participants. The schools involved in the study represented a mixture of rural (14), suburban (12) and urban (3) areas, and enrollments were equally diverse with 10 small schools (less than 500 students), 10 medium schools (501-1,000 students) and nine large schools (more than 1,000 students).
Athletes who specialized in one sport were twice as likely to report previously sustaining a lower-extremity injury while participating in sports (46%) than athletes who did not specialize (24%). In addition, specialized athletes sustained 60 percent more new lower-extremity injuries during the study than athletes who did not specialize. Lower-extremity injuries were defined as any acute, gradual, recurrent or repetitive-use injury to the lower musculoskeletal system.
“While we have long believed that sport specialization by high school athletes leads to an increased risk of overuse injury, this study confirms those beliefs about the potential risks of sport specialization,” said Bob Gardner, NFHS executive director. “Coaches, parents and student-athletes need to be aware of the injury risks involved with an overemphasis in a single sport.”
Among those who reported previously sustaining a lower-extremity injury, the areas of the body injured most often were the ankle (43%) and knee (23%). The most common types of previous injuries were ligament sprains (51%) and muscle/tendon strains (20%).
New injuries during the year-long study occurred most often to the ankle (34%), knee (25%) and upper leg (13%), with the most common injuries being ligament sprains (41%), muscle/tendon strains (25%) and tendonitis (20%).
In addition, specialized athletes were twice as likely to sustain a gradual onset/repetitive-use injury than athletes who did not specialize, and those who specialized were more likely to sustain an injury even when controlling for gender, grade, previous injury status and sport.
Thirty-four (34) percent of the student-athletes involved in the Wisconsin study specialized in one sport, with females (41%) more likely to specialize than males (28%). Soccer had the highest level of specialization for both males (45%) and females (49%). After soccer, the rate of specialization for females was highest for softball (45%), volleyball (43%) and basketball (37%). The top specialization sports for males after soccer were basketball (37%), tennis (33%) and wrestling (29%).
The study, which was directed by Timothy McGuine, Ph.D., ATC, of the University of Wisconsin, also documented the effects of concurrent sport participation (participating in an interscholastic sport while simultaneously participating in an out-of-school club sport), which indicated further risk of athletes sustaining lower-extremity injuries.
Almost 50 percent of the student-athletes involved in the survey indicated they participated on a club team outside the school setting, and 15 percent of those individuals did so while simultaneously competing in a different sport within the school. Seventeen (17) percent of the student-athletes indicated that they took part in 60 or more primary sport competitions (school and club) in a single year. Among those student-athletes in this group who sustained new lower-extremity injuries during the year, 27 percent were athletes who specialized in one sport.
The student-athletes involved in the study were deemed “specialized” if they answered “yes” to at least four of the following six questions: 1) Do you train more than 75 percent of the time in your primary sport?; 2) Do you train to improve skill and miss time with friends as a result?; 3) Have you quit another sport to focus on one sport?; 4) Do you consider your primary sport more important than your other sports?; 5) Do you regularly travel out of state for your primary sport?; 6) Do you train more than eight months a year in your primary sport?
Although some sports (field hockey, lacrosse) are not offered in Wisconsin and were not included in the study, the study concluded that since specialization increased the risk of lower-extremity injuries in sports involved in the survey it would also likely increase the risk of injuries in sports that were not a part of the study.
MHSAA Provides Reopening Guidelines
May 29, 2020
By Geoff Kimmerly
Second Half editor
The Michigan High School Athletic Association today submitted to its member schools a series of updated timelines and recommendations to guide the return of sports, which have been suspended since mid-March to alleviate the potential spread of COVID-19.
The state’s current “Safer-at-Home” order runs through Friday, June 12. There can be no use of any school facilities (indoor and outdoor) and there can be no organized on-site athletic activity, including conditioning or competition, until the current stay-at-home order expires or is lifted by Governor Gretchen Whitmer. When the “Safer-at-Home” order expires or is lifted, the return-to-activity recommendations may be implemented locally by school district leadership, provided the district declares its facilities open to students and staff and the 2019-20 school year has ended for that district (based on its last originally-scheduled school day).
The “MHSAA/NFHS Guidance for Re-Opening School Sports” is based primarily on direction provided by the MHSAA and National Federation of State High School Associations’ (NFHS) Sports Medicine Advisory Committees, in addition to reopening plans provided by the Michigan and federal governments and recommendations from the Center for Disease Control and Prevention (CDC). Concepts from the United States Olympic & Paralympic Committee also were consulted.
The MHSAA/NFHS plan recommends a three-step process to returning to full athletic participation, and for each step outlines actions to be taken in five major areas: pre-workout/contest screening of athletes and coaches for sickness, limitations of the number of participants who may be involved in a gathering, proper cleaning for facilities, the use of equipment during activity and best practices for keeping participants safely hydrated. The plan also places sports into categories based on risk for transmitting the virus (low/moderate/high), with adjusted return-to-activity steps based on that level of risk.
The MHSAA serves more than 1,500 public and private schools, including 750 high schools.
“The MHSAA and its Representative Council believe restarting school sports is essential to the physical and mental well-being of students, and the guidelines outlined for schools today provide the ‘How’ for schools to return to athletics when they’ve received the go-ahead from state and county health officials,” MHSAA Executive Director Mark Uyl said. “We are thankful for our state government, state education and health departments, our medical partners and the NFHS for their guidance these last few months, and we will continue to follow and pass on their recommendations as we prepare our schools to bring back this part of student life that’s been sorely missed.”
At the present time, the only activity allowed continues to be individual, outdoor recreational activity including walking, hiking, running, etc. (as announced in Executive Order 2020-96). If this type of conditioning activity takes place with more than one person present, it must be in groups of fewer than 10 people with social distancing followed, and the activity cannot involve school coaches, be school sponsored or occur at any school facility (indoor or outdoor) until at least June 13.
Voluntary virtual (not in-person) communication and instruction from coaches to any number of students is permitted under MHSAA rules in all sports during the summer.
“The concept is that students can continue to individually condition themselves (by walking, hiking, running), but there should be no organized, group activity by any person until at least June 13. We must all continue do our part to flatten the curve in hopes of increased activity over the coming weeks,” Uyl said. “Again, it is important to note that this document addresses ‘How’ schools can return to activity; the decision on ‘When’ schools can return to activity will be done under the direction of state government and health department officials. As government actions impact this timeline, the MHSAA will continue to update all involved.”
The return-to-activity guidelines are aimed to provide direction for schools as they continue to limit potential exposure to respiratory droplets, the primary avenue for transferring COVID-19. Specifically, the MHSAA/NFHS plan addresses social distancing, use of cloth and other face coverings, event scheduling and transportation, and the possibility that schools may have to break from or completely discontinue activity including competition during the fall or winter because of recurrent outbreaks of the coronavirus.
School district administrators will determine at which step in the MHSAA/NFHS plan their schools are operating based on the number of people allowed to gather by state medical officials.
The document in full is available from the MHSAA Website. Further guidance will be provided over the weeks ahead as new information is available and the prevalence of COVID-19 changes. Updates to the MHSAA/NFHS guidelines will continue to be in accordance with those published by the Governor’s office.
The MHSAA has remained in regular contact with the Governor’s office, Michigan Department of Health & Human Services and Michigan Department of Education throughout the pandemic, in addition to leadership from the state’s superintendents, school principals, athletic administrators and school boards associations.
The MHSAA is a private, not-for-profit corporation of voluntary membership by more than 1,500 public and private senior high schools and junior high/middle schools which exists to develop common rules for athletic eligibility and competition. No government funds or tax dollars support the MHSAA, which was the first such association nationally to not accept membership dues or tournament entry fees from schools. Member schools which enforce these rules are permitted to participate in MHSAA tournaments, which attract more than 1.4 million spectators each year.