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.

Cohen Champions Treatment, Technology

By Geoff Kimmerly
MHSAA.com senior editor

March 10, 2014

By Geoff Kimmerly
Second Half editor

Abby Cohen was looking for a problem to solve.

Two years later, she’s potentially only one more year from helping relieve a medical dilemma faced by 25 million Americans.

And the most impressive part might be that she graduated from high school a mere five years ago and is 23 years old.  

Cohen, a 2009 MHSAA Scholar-Athlete Award winner as a senior at Bloomfield Hills Cranbrook-Kingswood, certainly could be called proactive, going back to her days as a volleyball, basketball and soccer standout for the Cranes. Less than a year after graduating from Washington University in St. Louis, Mo., she’s co-founder and co-CEO of Sparo Labs, which seeks to provide asthma sufferers with a proactive way of monitoring their symptoms and improving their treatments.

“Everyone has a different perspective on how to go about doing things,” Cohen said. “For me, growing up trying to improve in sports, I’d write down a list of things to do every day and actually do them, follow through. That aspect of always wanting to get better, and improve, is something that’s carried through to the rest of what we do at Sparo and in general how I approach things.”

On March 22, the MHSAA and Farm Bureau Insurance will recognize a 25th class of Scholar-Athlete Award winners. In advance of the celebration, Second Half has caught up with some of the hundreds who have been recognized (see additional links at the bottom of this page).

Cohen, who also served on the MHSAA Student Advisory Council from 2007-09, chose Washington based on its strong engineering problem and successful women’s basketball program. She studied bio-medical engineering and was a freshman on the Bears team that defeated Hope College for the Division III national championship in 2010.

But that first season was followed by a series of ankle injuries that required reconstructive surgery – and, effectively, ended her collegiate sports career. She still can play pick-up games, but four-hour daily practices and the other commitments of a varsity program would've been too much.

She missed basketball. But the end of her competitive career on the court, as it turned out, allowed more time to dive into a new pursuit – and, in her words, “work with another kind of team.”   

“I’m a big believer in everything happens for a reason,” Cohen said. “It was disappointing having to have surgery to make everything feel better, for the long term, not just basketball. For me at that time, I didn't appreciate that with the extra time I could have, I could take the time to try new things, make the world a better place.”

Cohen planned at first to eventually become a physician. She shadowed a number of doctors, but decided that in the long run she could have a greater impact as an engineer designing products physicians could use.

In addition to her classwork, she helped form an extracurricular entrepreneurial group – and set out for an issue in need of repair. She and her now-business partner Andrew Brimer didn't realize how many Americans are affected by asthma, “that respiratory diseases are the only ones getting worse over time rather than getting better. That although technology is improving, why it’s not making a dent.”

They set out find out and make that dent themselves.

Through a series of interviews with patients, doctors, respiratory therapists and others in the field, Cohen and Brimer got an idea what could help – an affordable, easy-to-use device to allow patients to monitor on their own their symptoms so they can better manage them and the treatments to help. Cohen and Brimer designed a device that plugs into a smart phone and allows patients to blow into it like a whistle and register lung function readings – while also collecting data on medications, pollen counts, and other variables that affect lung function. Their device also should dent the health care costs that go with current testing, which generally requires an office visit.

Sparo will work over the next six months to improve its app interface and user experience, and then submit for Food and Drug Administration approval at the end of this year or the beginning of 2015 – with the hope it will then become available to patients later next spring.

Cohen is based in St. Louis, where she and Brimer have been able to work with three large local hospitals and within a nurturing entrepreneurial community. Brimer's brother owns a tech education company in New York which has provided additional support as she and Brimer discussed what was possible. “We were talking to patients and physicians, and it just seemed like the right thing to do,” Cohen said. “If we weren’t going to do this, who was?”

Cohen and Brimer have won 9 of 11 entrepreneurship grant competitions they've entered, netting more than $300,000 to get their lab rolling and allow them to hire two more engineers. Long-term, today’s work could just be the start of what Cohen hopes eventually will reach into developing countries as well.

She remains in touch with a number of teachers at Cranbrook-Kingswood – also, her mother Sheila Cohen teaches sixth-grade math at the school – and she spoke there at the end of 2013 as part of a TEDx event.   

As she continues to build her team, Cohen is reminded of additional lessons she learned on the courts and soccer field – including a major one that will continue to pay as Sparo expands. 

“Learning how to work on a team, with really different personalities, different people who all play different roles,” Cohen said. “That really came from sports – the ability to work with people and reach one common goal.” 

Click to read the series' first installments: 

PHOTO: Abby Cohen (10) helps her teammates hoist a trophy while a player at Bloomfield Hills Cranbrook-Kingswood in 2009. (Photo courtesy of Cranbrook-Kingswood.)