Introduction

Youth sport specialization has been under increased scrutiny in recent years due to reports of increasing sport-related injuries, overuse injuries, and early burnout in young athletes. However, literature on potentially negative consequences of specialization in young female athletes is limited. Additionally, the definition of specialization has changed over the years, with no current consensus on the best way to measure specialization. Though the 3-point specialization scale is used in some literature, it has not been measured against the 6-point specialization test and the single vs multi-sport classification, which is still used in some literature. The purpose of this study was to determine the associations between sport specialization, injury risk, menstrual dysfunction, and body image dysphoria while comparing three different specialization scale measurements.

Methods

Retrospective data was collected from a pre-participation physical questionnaire distributed to female athletes from local high schools (n=229; 13-18 years of age). Information regarding sport participation and injury was collected. Athletes self-classified as single or multisport, and answered questions based on the 3- and 6-point specialization scales. Odds ratios, 95% confidence intervals (CI), and effect size were calculated to investigate the association between specialization and injuries, irregular menses, and body image concerns (a priori p =0.05).

Results

Of the 229 athletes surveyed, 219 (95.6%) completed the specialization portion and were included in the study. Of those, per the 3-point specialization scale, 91(41.6%) were low specialized (LS), 59 (26.9%) were moderately specialized (ModS), and 69 (31.5%) were highly specialized (HS). Among the 69 HS athletes, 22 (31.9%) self-classified as multi-sport athletes and therefore “not specialized,” while 6 (8.7%) did not qualify as specialized per the 6-point scale. Among the 91 LS athletes, 64 (70.3%) self-classified as single-sport specialized athletes and 3 (3.3%) were specialized according to the 6-point scale.
When comparing injuries using the 3-point specialization scale, ModS athletes were more likely to have a history of stress fractures compared to LS athletes (p=0.02; OR,3.62; 95% CI, 1.27-10.26). Compared to LS athletes, HS athletes were more likely to have a history of injury and a history of concussion, (p=0.01; OR,2.93; 95% CI, 1.38-6.24) and (p<0.01; OR,5.00; 95% CI, 1.86-13.42) respectively. Further results are provided in Table 1.

Conclusions

Higher levels of specialization are associated with higher risk of injuries including concussions and stress fractures in female high school athletes. The 3-point specialization scale is an effective tool to classify sport specialization, however, combination with another scale, such as the 6-point scale, would likely facilitate more accurate stratification of risks associated with specialization.