Sport specialization and risk of overuse injuries: A systematic review with meta-Analysis

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CONTEXT: Sport specialization is theorized to increase the risk of sustaining overuse musculoskeletal injuries. OBJECTIVE: To complete a systematic review and meta-Analysis of the literature to determine if sport specialization is associated with overuse musculoskeletal injuries. DATA SOURCES: An electronic search was conducted using the search terms "specialization, " "year-round, " "overuse, " "repetitive stress, " "injury, " "young, " "pediatric, " and "sports." STUDY SELECTION: Studies were included if their population was ≤18 years of age, if they compared athletes with high or single-sport specialization with athletes with low or multisport specialization, and focused on overuse injuries. DATA EXTRACTION: Of the 12 articles that were identified for full-Text review, 5 studies met all the inclusion criteria. Four studies provided adequate data for the meta-Analysis. Quality scores on the modified Downs and Black scale ranged from 69% to 81%. RESULTS: Athletes with high specialization were at an increased risk of sustaining an overuse injury compared with athletes with low (pooled relative risk [RR] ratio: 1.81; 95% confidence interval [CI]: 1.26-2.60) and moderate (pooled RR: 1.18; 95% CI: 1.05-1.33) specialization. Athletes with moderate specialization were at a higher risk of injury compared with athletes with low specialization (RR: 1.39 [95% CI: 1.04-1.87]). LIMITATIONS: Four of the 5 studies included in this systematic review were included in the metaanalysis because of the lack of access to the original data set for 1 article. CONCLUSIONS: Sport specialization is associated with an increased risk of overuse musculoskeletal injuries (Strength of Recommendation Taxonomy grade: B).



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