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.
Council Adopts Heat Management Policy
March 26, 2013
The adoption of a heat management policy for MHSAA tournaments and a detailed model policy to be submitted to member schools for suggested use during practice and regular-season competition was the main focus of the Representative Council of the Michigan High School Athletic Association during its annual Winter Meeting on March 22 in East Lansing.
Heat and humidity management is the next step of the MHSAA’s ongoing focus on health and safety issues in school sports. The model policy, while not setting requirements for member schools, proposes actions based on heat index – the degree of felt discomfort derived by combining temperature and humidity measurements – that are designed to minimize the risk of heat-related illness during interscholastic participation. It will be published as a recommendation for regular-season practice and competition in the 2013-14 MHSAA Handbook, and it will be mandatory for MHSAA tournaments beginning this fall.
Executive director John E. “Jack” Roberts said there are a number of member schools with solid heat management policies in place, but he hopes the adoption of this “best practice” will further raise awareness of the risks of heat-related illness while giving schools – especially those without a protocol – an opportunity to adopt a standardized policy similar to what is in place for other environmental factors such as lightning and tornadoes.
“For the past several years, we’ve used four ‘H’s’ to focus our efforts to improve the health and safety of student-athletes: Heads, Hearts, Heat and health Histories,” Roberts said. “To maintain momentum, we’ve identified several focus areas for the next four years: better acclimatization of athletes, better health and safety preparedness for coaches and modification of practice policies and contest rules to reduce head trauma and the frequency of each sport’s most injurious situations.
“Friday’s action was significant; but it’s just the next step in a continuous series of actions being taken to make school sports as healthy as possible for students.”
The heat management policy states that temperature and humidity readings should be taken at the site of the practice or competition 30 minutes prior to its start and then 60 minutes after it has begun. Recommendations for hydration and levels of activity are suggested for each of four levels of heat index readings.
Key tenets include frequency and length of water breaks, appropriate uniforms based on heat index and mandates on what time of day practices should be conducted and for how long. Practices are suggested to be postponed or moved when the heat index measures 99 to 104 degrees, and all outdoor activity (and indoor if air conditioning is unavailable) is to be stopped if the heat index rises above 104.
The Representative Council also discussed raising expectations for coaches’ education and preparedness for promoting student-athletes’ health and safety. Three proposals are under consideration for Council votes during its next three meetings:
- The first would require all assistant and sub-varsity coaches at the high school level to complete the same MHSAA rules meeting required of varsity head coaches (which includes safety information) or one of the free online sports safety courses posted on or linked to MHSAA.com. This would take effect in 2014-15 and could be voted on at the Council’s May meeting.
- The second proposal would require current CPR certification for all varsity head coaches at the high school level, with AED training a recommended component of the course. This would take effect in 2015-16 and could be voted on at the December meeting.
- The third proposal would require varsity head coaches hired to begin on or after July 1, 2016 to complete Level 1 or 2 of the MHSAA’s Coaches Advancement Program, a six-level educational regimen that aids coaches in their growth and development. This could be voted on at the Council’s March 2014 meeting.
Two sport-related actions also were taken by the Council during last week’s meeting:
- Boys lacrosse: Beginning this season, an official must be a member in good standing of an approved local boys lacrosse officials association in order to be eligible to work MHSAA tournament games. This is in addition to other existing requirements.
- Wrestling: For school years during which there are only 15 Saturdays between the first day of practice and the MHSAA Individual Finals (rather than the traditional 16 Saturdays), the number of days from the beginning of practice until the first competition shall be reduced from 23 to 19. For the 2013-14 season, the earliest day of competition is Dec. 7, instead of Dec. 11 under the previous regulation. There is no reduction in the minimum number of days when practice actually is held prior to the first competition.
The Representative Council is the 19-member legislative body of the MHSAA. All but five members are elected by member schools. Four members are appointed by the Council to facilitate representation of females and minorities, and the 19th position is occupied by the Superintendent of Public Instruction or designee.