Sport specialization and sport participation opportunities and their association with injury history in female high school volleyball athletes

Development and validation of the Wisconsin Sport Specialization Questionnaire (WISSQ) for older adolescent athletes

OBJECTIVE

The proliferation of youth sport specialisation may be concerning for the overall health of adolescent athletes, but no validated tool to measure specialisation exists. We aimed to assess the measurement properties and validate the Wisconsin Sport Specialization Questionnaire (WISSQ) in older adolescent athletes.

METHODS

Using previously developed sport specialisation items with established content validity, questionnaires were administered to 14-18-year-old athletes residing in both regional and national settings, who were participating in organised sport. Confirmatory factor analyses and Rasch partial credit modelling independently assessed structural and concurrent validity and reliability in both datasets. The best-fitting national model was then fit onto the regional data to further assess the stability of the measurement properties.

RESULTS

The regional and national data included 474 (77% female, 86% non-Hispanic White) and 564 (38% female, 63% non-Hispanic White) athletes, respectively. Twelve of 25 items were retained in three domains (n=4 social, n=5 motivation, n=3 physical). One item cross-loaded on both the motivation and physical domains. The adapted regional (comparative fit index (CFI), 0.97; Tucker-Lewis index (TLI), 0.97; root mean square error of approximation (RMSEA), 0.04) and national (CFI, 0.99; TLI, 0.99; RMSEA, 0.05) datasets achieved good model fit. Internal consistency among the three subdomains ranged from Ω=0.78-0.88 (national) to Ω=0.73-0.83 (regional). All items contributed appropriately to measuring the construct of sport specialisation in the regional (infit/outfit: 0.77-1.16) and national (infit/outfit: 0.74-1.16) datasets.

CONCLUSIONS

We present the first validated tool to measure youth sport specialisation while considering physical, motivational and social characteristics of sport participation. The WISSQ is a valid, reliable assessment of sport specialisation in older adolescent athletes.

Prevalence and associated factors of non-traumatic knee pain in high school volleyball players: a cross-sectional study

OBJECTIVES

This study aimed to determine the prevalence of knee pain among high school volleyball attackers, identify associated factors, and explore the relationship between knee pain and lower back pain (LBP).

METHODS

A cross-sectional study involving 82 high school volleyball attackers (15-17 years) used questionnaires, interviews, and field-based assessments to collect data on demographics, volleyball-specific factors, flexibility, and jumping ability. Logistic regression analysis was used to identify factors associated with knee pain.

RESULTS

The prevalence of knee pain was 19.5%. Factors significantly associated with knee pain were a history of LBP (OR, 4.64; 95% CI, 1.28 to 16.8; p = 0.019) and flexibility determined by the absolute difference in heel-buttock distance (OR, 1.37; 95% CI, 1.02 to 1.83; p = 0.037). Participants with knee pain had more volleyball experience and a higher proportion of players who competed as starters in the previous year. Both groups reported approximately 18 hours of practice per week during the school year and around 27 hours during school holidays, with no significant difference observed.

CONCLUSION

Factors associated with knee pain include a history of LBP and reduced flexibility on the heel-buttock distance test. The study highlights the need for a comprehensive approach, considering the coexistence of LBP and focusing on improving anterior thigh flexibility.

Injury Risk Factors Related to Sport Specialization in High School Basketball: A Prospective Study

CONTEXT

Research that has examined the association between specialization and injury in basketball has been limited to cross-sectional or retrospective studies.

OBJECTIVE

To determine whether specialization is a risk factor for injury among high school basketball athletes.

DESIGN

Prospective cohort study.

SETTING

Basketball players from 12 high schools participating in the National Athletic Treatment, Injury, and Outcomes Network Surveillance Program (NATION-SP) were recruited before the 2022-2023 interscholastic basketball season.

PATIENTS OR OTHER PARTICIPANTS

One-hundred thirty athletes (mean age ± SD = 15.6 ± 1.3; girls' basketball: n = 68 [52.3%]).

MAIN OUTCOME MEASURE(S)

Before the start of the school basketball season, participants completed a questionnaire that had questions regarding participation in various specialized sport behaviors. During the basketball season, the school's athletic trainer reported all athlete-exposures and injuries (regardless of time loss) for participating athletes into NATION-SP. Injury incidence and incidence rate ratios (IRRs) with 95% CIs were calculated for the specialized sport behaviors previously described.

RESULTS

No difference in injury risk between highly specialized and low specialized athletes was found (IRR [95% CI] = 1.9 [0.9, 3.7]). Players who participated in basketball year round were twice as likely to sustain an injury than those who did not play year round (IRR [95% CI] = 2.1 [1.1, 3.6]). Similarly, players who reported participating in basketball skills camps were at increased risk of injury compared with athletes who did not participate in basketball skill camps (IRR [95% CI] = 2.5 [1.2, 5.7]).

CONCLUSIONS

Injury risk related to sport specialization in basketball may be specific to certain behaviors such as year-round play and participation in skills camps. Validated measures of comprehensive sport activity are needed to better measure specialization in youth sports to better determine injury risk related to sport specialization and develop injury prevention programs for basketball athletes.

High School Girls' Volleyball Athletes' Self-Reported Management of Pain, Intentions to Report Overuse Injuries, and Intentions to Adhere to Medical Advice for Treating Overuse Injuries

CONTEXT

Girls' high school volleyball is a popular sport with a high rate of overuse injuries and sport specialization. Health professionals perceive that high school athletes are reluctant to follow treatment plans involving sport activity reduction. This study's purpose was to describe high school girls' volleyball athletes' self-reported shoulder and knee pain, the likelihood of adhering to medical advice, and the association of factors that influence the likelihood of reporting overuse injuries and sport specialization.

STUDY DESIGN

Cross-sectional.

METHODS

Participants completed an online survey (demographics, sport participation measures, shoulder and knee pain information, medical adherence likelihood [4-point Likert: not at all likely to extremely likely], and factors influencing overuse injury reporting intentions). A 2 × 2 chi-square analysis compared factors that influence athletes' intentions to "not report an overuse injury" (eg, I thought my coach would get mad; yes/no) and sport specialization (nonhighly specialized/highly specialized athletes).

RESULTS

There were 150 participants (highly specialized = 56%, grade: ninth = 33%, 10th = 28%, 11th = 22%, 12th = 17%). At least 60% reported shoulder and knee pain related to an overuse mechanism. Most reportedly did not seek rehabilitation led by a medical provider (shoulder pain = 66%, knee pain = 60%). Only 11% of athletes reported they were "extremely likely" to rest from sporting activity during the regular season if advised by a medical professional. Highly specialized athletes were more likely to report the pursuit of a college scholarship as a factor that influences their intention to report an overuse injury compared to nonhighly specialized athletes (13% vs 3%, respectively, P = .04).

CONCLUSIONS

Most girls' volleyball athletes did not treat their pain with guided rehabilitation, which may increase their risk of a worse overuse injury or even acute injury. Clinicians, athletes, parents, and coaches need to work together to create a sport culture that empowers athletes to discuss their pain and overuse injuries with medical professionals.

The Association of Sport Specialization With Youth Ice Hockey Position and Youth Ice Hockey Parents’ Perceptions of Sport Specialization

Attitudes and beliefs of parents about sport specialization may indicate why youth athletes decide to specialize. The purpose of this study was to determine the association between sport specialization level, ice hockey position, and the parent/guardians’ attitudes and beliefs on sport specialization. Our results demonstrate that goalies were the most likely to specialize, and parents of specialized ice hockey players tend to believe that sport specialization helps their child achieve future sporting aspirations. Increased sport specialization may put ice hockey goalies at an increased risk for overuse injuries, and parents’ beliefs about sport specialization may impact their child’s sporting behaviors.

High School Sport Specialization and Injury in Collegiate Club-Sport Athletes

CONTEXT

Sport specialization during adolescence may affect future injury risk. This association has been demonstrated in some professional sport athletes.

OBJECTIVE

To determine the association between adolescent sport specialization levels in high school and injuries sustained during collegiate club sports.

DESIGN

Cross-sectional study.

SETTING

Paper and online surveys.

PATIENTS OR OTHER PARTICIPANTS

Collegiate club-sport athletes.

MAIN OUTCOME MEASURES(S)

An anonymous survey was administered from September 2019 to May 2020. The survey included sport specialization classification via a commonly used 3-point scale (low, moderate, high) for each high school year (9th-12th), high school sports participation, and collegiate club-sport injury history. The number of years (0-4) an individual was highly specialized in high school was calculated. Individuals who participated in the same sport in high school and college were compared with individuals who played a different sport in college than in high school. An injury related to sport club activities was classified as arising from a contact, noncontact, or overuse mechanism required and the individual to seek medical treatment or diagnosis. Injuries were classified into overuse and acute mechanisms for the upper extremity, lower extremity (LE), and head/neck.

RESULTS

Single-sport participation and the number of years highly specialized in high school sport were not associated with college club-sport injuries (P > .1). Individuals who played a different collegiate club sport than their high school sport were more likely to report an LE or head/neck acute injury compared with athletes who played the same collegiate and high school sport (LE = 20% versus 8%, χ2 = 7.4, P = .006; head/neck = 16% versus 3%, χ2 = 19.4, P < .001).

CONCLUSIONS

Adolescent sport specialization was not associated with reported injuries in collegiate club-sport athletes. Collegiate club-sport athletic trainers should be aware that incoming students exploring a new sport may be at risk for LE and head/neck acute injuries.

Epidemiology of Injuries in National Collegiate Athletic Association Women's Volleyball: 2014-2015 Through 2018-2019

CONTEXT

Women's volleyball is a globally popular sport with widespread participation at the National Collegiate Athletic Association (NCAA) level.

BACKGROUND

Routine examinations of NCAA women's volleyball injuries are important for recognizing emerging injury-related patterns in this population.

METHODS

Exposure and injury data collected in the NCAA Injury Surveillance Program during the 2014-2015 through 2018-2019 athletic years were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics, and injury rate ratios were used to examine differences in injury rates.

RESULTS

The overall injury rate was 6.73 per 1000 athlete-exposures. Knee (14.6%) and ankle (13.8%) injuries accounted for the largest proportion of all reported injuries, and most injuries were attributed to overuse (26.1%) or noncontact (22.7%) mechanisms. Lateral ankle ligament complex tears (11.1%) and concussions (7.3%) were the most commonly reported specific injury.

SUMMARY

Results indicate an increasing burden of practice-related injuries and the need to further examine overuse injuries. Lower-extremity injury prevention strategies and mechanisms of concussion also warrant further attention.