O1016: Sport Specialization Classification and Injury Risk in Female Athletes

Background: Literature regarding sport specialization has drawn consistent conclusions about its possible detrimental effects. However, description of risks specific to adolescent female athletes is limited. The definition of sport specialization has also evolved, and currently there is no consensus for objective classification. We hypothesized that specialized female athletes would have higher rates of injury, body image issues, and menstrual dysfunction, regardless of the specialization classification utilized.

Methods: Retrospective data related to sport participation and injury were obtained from questionnaires from female athletes in local high schools (n=229; 13–18 years of age). The widely-utilized 3-point specialization scale was used to analyze differences in injury rates, body image issues, and menstrual dysfunction between low, moderate, and highly specialized athletes. When comparing accuracy of specialization scales in identifying high risk athletes, three peer-reviewed specialization classification scales were utilized—a 3-point scale, a 6-point scale, and a binary self-selection scale—to determine an athlete’s specialization level. Odds ratios (OR), 95% confidence intervals (CI), and effect size were calculated for studied variables (a priori p ≤0.05).

Results: Of 229 athletes surveyed, 219 (95.6%) completed the 3-point specialization classification questions and were included in the study. Using the 3-point scale, 91 athletes (41.6%) were categorized as low specialization (LS), 59 (26.9%) were moderately specialized (ModS), and 69 (31.5%) were highly specialized (HS). ModS athletes were more likely to have a history of stress fractures (SFx) 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 injury history (p=0.01; OR 2.93; 95% CI 1.38–6.24) and to have a history of concussion (p < 0.01; OR 5.00; 95% CI 1.86–13.42).

Conclusion: Among female high school athletes, this study demonstrates that higher levels of specialization are associated with greater risk of injuries overall, and greater risk for concussion and SFx. This study did not demonstrate significant associations between specialization and body image issues or menstrual dysfunction. This study further corroborates the association between injury and sport specialization. Strengthening the description of this association better allows members of an athlete’s multidisciplinary team to prevent injury. Our finding that combining specialization scales may improve accuracy of risk stratification also contributes toward this goal.