Developmental Training Model for the Sport Specialized Youth Athlete: A Dynamic Strategy for Individualizing Load-Response During Maturation

Effect of neuromuscular injury prevention strategies on injury rates in adolescent males playing sport: a systematic review protocol

OBJECTIVE

This review will assess the effectiveness of neuromuscular injury prevention strategies on injury rates among adolescent males playing sports.

INTRODUCTION

Adolescent athletes are predisposed to injuries during this period of growth. Growth-related injury risk factors can be mitigated by implementing appropriate neuromuscular injury prevention strategies. This review will include all sporting disciplines in summarizing the components and assessing the effectiveness of injury prevention strategies in the adolescent male population.

INCLUSION CRITERIA

Randomized controlled trials investigating adolescent males, between the ages of 13 and 18 years, participating in organized sports, in any setting and level of participation, will be included. Studies that evaluate neuromuscular injury prevention strategies (eg, balance, proprioceptive, plyometric, agility, strength, weight, conditioning and sport-specific exercises and training, warm up, cool down, stretches, neuromuscular control) vs no intervention or standard training and competition exposure will be included. The outcomes of interest are injury incidence and prevalence rates.

METHODS

Databases searched will include MEDLINE (PubMed), CINAHL Complete (EBSCOhost), ClinicalKey, SPORTDiscus (EBSCOhost), Physiotherapy Evidence Database (PEDro), Scopus, ScienceDirect, MasterFILE Premier (EBSCOhost), Academic Search Complete (EBSCOhost), Cochrane Central Register of Controlled Trials (CENTRAL) and ClinicalTrials.gov. Gray literature and unpublished studies will be searched via Health and Medical Complete (ProQuest Dissertations & Theses). Study screening and selection against inclusion criteria will be performed. Data extraction and critical appraisal will be performed using the standardized JBI templates and checklists for qualitative research. All stages will be performed by 2 independent reviewers, with conflicts resolved by a third reviewer.

REVIEW REGISTRATION

PROSPERO CRD42022327047.

Sleep, Nutrition, and Injury Risk in Adolescent Athletes: A Narrative Review

This narrative review explores the impact of sleep and nutrition on injury risk in adolescent athletes. Sleep is viewed as essential to the recuperation process and is distinguished as an active participant in recovery through its involvement in growth, repair, regeneration, and immunity. Furthermore, the literature has shown that the sleep of athletes impacts elements of athletic performance including both physical and cognitive performance, recovery, injury risk, and mental well-being. For sleep to have a restorative effect on the body, it must meet an individual's sleep needs whilst also lasting for an adequate duration and being of adequate quality, which is age-dependent. The literature has suggested that athletes have increased sleep needs compared to those of the general population and thus the standard recommendations may not be sufficient for athletic populations. Therefore, a more individualised approach accounting for overall sleep health may be more appropriate for addressing sleep needs in individuals including athletes. The literature has demonstrated that adolescent athletes achieve, on average, ~6.3 h of sleep, demonstrating a discrepancy between sleep recommendations (8-10 h) and actual sleep achieved. Sleep-wake cycles undergo development during adolescence whereby adaptation occurs in sleep regulation during this phase. These adaptations increase sleep pressure tolerance and are driven by the maturation of physiological, psychological, and cognitive functioning along with delays in circadian rhythmicity, thus creating an environment for inadequate sleep during adolescence. As such, the adolescent period is a phase of rapid growth and maturation that presents multiple challenges to both sleep and nutrition; consequently, this places a significant burden on an adolescent athletes' ability to recover, thus increasing the likelihood of injury. Therefore, this article aims to provide a comprehensive review of the available literature on the importance of sleep and nutrition interactions in injury risk in adolescent athletes. Furthermore, it provides foundations for informing further investigations exploring the relation of sleep and nutrition interactions to recovery during adolescence.

S.P.O.R.R.T.-A Comprehensive Approach to the Assessment and Non-Operative Management of Overuse Knee Conditions in Youth Athletes

PURPOSE OF REVIEW

The evaluation of a young athlete with an overuse injury to the knee involves a comprehensive approach. There are a number of elements to consider including assessments of skeletal maturity (biologic maturation), workload (training load + competition load), sport specialization status, and biomechanics. The type of injury and treatment, as well as future prognosis, may be influenced by these and other factors.

RECENT FINDINGS

Calculating the percentage of predicted adult height (PPAH) is a valuable tool in assessing overuse injury patterns and diagnoses in youth athletes. Modifiable and non-modifiable overuse injury risk factors require monitoring from clinicians as young athletes mature and develop over time. Training and rehabilitation programs should be adapted to account for these. In this manuscript, we seek to introduce a novel, comprehensive approach: S.P.O.R.R.T. (Skeletal Maturity, Prior Injury Risk, One Sport Specialization, Rehabilitation, Return to Play, Training Recommendations) (Fig. 1). Overuse, non-traumatic injuries to the knee in youth athletes will be presented in a case-based and evidence-based model to provide a framework for a comprehensive approach to the assessment and treatment of youth athletes with overuse injuries.

Epidemiology of injuries in elite Women's Artistic Gymnastics: a retrospective analysis of six seasons

Background

Women's Artistic Gymnastics (WAG) is a sport well known for requiring a heavy and difficult training load from a younger age to reach a high level of performance. This also is associated with an injury risk. Epidemiological studies are thus needed to improve injury prevention strategies.

Objective

We aimed to determine the injury epidemiology in French high-level WAG.

Methods

We conducted a retrospective analysis of injury data collected prospectively over six seasons from the 2014-2015 season to the 2019-2020 season among French high-level Women's Artistic Gymnasts from the France Gymnastics National Centre of Saint-Etienne. We performed descriptive analyses, including the calculation of the 1-year injury prevalence.

Results

43 gymnasts were included in this study, representing 111 gymnast-seasons. A total of 285 injuries were collected over the study period, that was, an average of 2.6 injuries per gymnast per season. On average, 91.4% of gymnasts had at least one injury per season. The estimated injury incidence rate was 1.8 injuries per 1000 hours of gymnastics practice. The knee was the most affected joint (16%), followed by the elbow (12%) and the ankle (12%). The most frequent injury type was physis pathologies (16%) and bone injuries (15%). Eighty-eight per cent of injuries required a modification of the gymnastics practice.

Conclusions

The results of this study allowed a description of the epidemiology of injuries in this population of young and elite gymnasts. This very high injury prevalence supports the need to improve injury risk reduction strategies in WAG.

Survey of the current practices of German football academies towards biological maturation assessment

OBJECTIVES

This study aimed to examine the importance assigned to assessing and considering biological maturation in thematic areas of player development and provide an overview of current practices in German football academies regarding its consideration in training and competition.

METHODS

An online survey was sent to 56 elite German football academies. A total of 46 responded to the questionnaire (82% response rate). Six participants provided incomplete information resulting in a total of 40 completed surveys in the period from March to May 2022.

RESULTS

Only 20 of participants regularly carried out maturation assessments, despite 95% recognizing its importance for load management, 90% for player development, and 85% for injury prevention. There was no consistent approach to modifying training and competition formats based on maturity status, with a primary focus on gym-based sessions for load management.

CONCLUSION

The survey results highlight limited implementation of maturation assessment and training modification based on maturity status in German elite youth football academies. Despite recognizing the importance of load monitoring, reporting to parents, and long-term player development in considering biological maturation, practices are not widespread. The predominant use of the maturity offset method suggests an opportunity to improve accuracy by exploring alternative measurement methods and increasing assessment frequency. Moreover, a lack of established procedures for incorporating maturity status into training and competition exists, hindering comprehensive consideration of biological maturation and injury risk prevention. Further research is needed to understand the reasons for inconsistent approaches in maturation assessment and load modification during training and competition.

School's out for summer-Differences in training characteristics between adolescent biathletes of different performance levels

The purpose of this study was to retrospectively describe the longitudinal changes of training variables in adolescent biathletes based on performance level. Thirty biathletes (15 men and 15 women) were included in the study and categorized as either national level biathletes (NLB, n = 21) or national team biathletes (NTB, n = 9). Retrospective training data was collected from training diary covering the biathletes' four years (Y1-Y4) as student-athletes at upper secondary school. Training data was divided into physical and shooting training variables. A linear mixed-effect model was used for comparing the difference of the performance group and year of upper secondary school on training characteristics. The NTB group achieved a greater annual training volume than the NLB group, especially during Y4 (594±71 h·y-1 vs 461±127 h·y-1, p < 0.001), through an increase in duration of each session and by completing more weekly training volume during the general phase (13.7±4.6 vs 10.0±4.9 h·w-1, p = 0.004). No difference was observed in relative training intensity distribution between the groups. The total number of shots fired was also greater for the NTB (9971±4716 vs 7355±2812 shots·y-1, p = 0.003). There was an equal frequency in illness and injury for both the NLB and NTB. Accordingly, the results of the present study describe longitudinal changes of biathlon training in adolescent biathletes that also may affect performance development.

Sport activities for children and adolescents: the Position of the European Academy of Paediatrics and the European Confederation of Primary Care Paediatricians 2023-Part 1. Pre-participation physical evaluation in young athletes

The European Academy of Paediatrics (EAP) and the European Confederation of Primary Care Paediatricians (ECPCP) emphasize the importance of promoting healthy lifestyles within the pediatric population. Many health professionals have questions concerning adequate levels of physical activity for both the healthy pediatric population and for those who may have specific complications. Unfortunately, the academic literature that provides recommendations for participation in sport activities within the pediatric population that have been published during the last decade in Europe is limited and is mainly dedicated to specific illnesses or advanced athletes and not toward the general population. The aim of part 1 of the EAP and ECPCP position statement is to assist healthcare professionals in implementing the best management strategies for a pre-participation evaluation (PPE) for participation in sports for individual children and adolescents. In the absence of a uniform protocol, it is necessary to respect physician autonomy for choosing and implementing the most appropriate and familiar PPE screening strategy and to discuss the decisions made with young athletes and their families. This first part of the Position Statement concerning Sport Activities for Children and Adolescents is dedicated to healthy young athletes.

Effects of Age and Popularity of Sport on Differences among Wrestlers' Parental Support: An Exploratory Study

No research was previously performed on wrestling related to parental support. It is not known whether there are differences in support between younger and older children. The popularity of a sport can be reflected in parental support, and parents may be more inclined towards popular sports. The aim of this research was to examine differences in parental support among wrestlers of different age categories and between those coming from communities in which wrestling is a popular sport versus communities in which it is less popular. The sample of participants consisted of 172 wrestlers. The Parental Support Scale for Children in Sports was applied. Parental willingness to set an example was lower. As far as age is concerned, the period of entry into specialisation is sensitive. At this age, children perceive less parental support (p = 0.04) and lower parental belief in the benefits of sports (p = 0.01). The popularity of the sport is related to parental support. In environments in which wrestling is popular, parents know the sport better and can participate; therefore, children perceive more parental support. The findings of this study may help coaches to better understand athlete-parent relationships.

Plyometric-Jump Training Effects on Physical Fitness and Sport-Specific Performance According to Maturity: A Systematic Review with Meta-analysis

BACKGROUND

Among youth, plyometric-jump training (PJT) may provide a safe, accessible, and time-efficient training method. Less is known on PJT effectiveness according to the maturity status.

OBJECTIVE

This systematic review with meta-analysis set out to analyse the body of peer-reviewed articles assessing the effects of PJT on measures of physical fitness [i.e., maximal dynamic strength; change of direction (COD) speed; linear sprint speed; horizontal and vertical jump performance; reactive strength index] and sport-specific performance (i.e., soccer ball kicking and dribbling velocity) according to the participants' maturity status.

METHODS

Systematic searches were conducted in three electronic databases using the following inclusion criteria: (i) Population: healthy participants aged < 18 years; (ii) Intervention: PJT program including unilateral and/or bilateral jumps; (iii) Comparator: groups of different maturity status with control groups; (iv) Outcomes: at least one measure of physical fitness and/or sport-specific performance before and after PJT; (v) experimental design with an active or passive control group, and two or more maturity groups exposed to the same PJT. The DerSimonian and Laird random-effects models were used to compute the meta-analysis. The methodological quality of the studies was assessed using the PEDro checklist. GRADE was applied to assess certainty of evidence.

RESULTS

From 11,028 initially identified studies across three electronic databases, 11 studies were finally eligible to be meta-analysed (n total = 744; seven studies recruited males; four studies recruited females). Three studies were rated as high quality (6 points), and eight studies were of moderate quality (5 points). Seven studies reported the maturity status using age at peak height velocity (PHV; pre-PHV values up to - 2.3; post-PHV up to 2.5). Another four studies used Tanner staging (from Tanner I to V). The training programmes ranged from 4 to 36 weeks, using 1-3 weekly training sessions. When compared to controls, pre-PHV and post-PHV participants obtained small-to-moderate improvements (ES = 0.35 - 0.80, all p < 0.05) in most outcomes (i.e., sport-specific performance; maximal dynamic strength; linear sprint; horizontal jump; reactive strength index) after PJT. The contrast of pre-PHV with post-PHV youth revealed that PJT was similarly effective in both maturity groups, in most outcome measures except for COD speed (in favour of pre-PHV). PJT induces similar physical fitness and sport-specific performance benefits in males and females, with a minimal exercise dosage of 4 weeks (8 intervention sessions), and 92 weekly jumps. Results of this meta-analysis are based on low study heterogeneity, and low to very low certainty of evidence (GRADE analysis) for all outcomes.

CONCLUSION

Compared to control participants, PJT resulted in improved maximal dynamic strength, linear sprint speed, horizontal jump performance, reactive strength index, and sport-specific performance (i.e., soccer ball kicking and dribbling velocity). These effects seem to occur independently of the maturity status, as both pre-PHV and post-PHV participants achieved similar improvements after PJT interventions for most outcomes. However, several methodological issues (e.g., low sample sizes and the pooling of maturity categories) preclude the attainment of more robust recommendations at the current time. To address this issue, consistency in maturity status reporting strategies must be improved in future studies with the general youth population and youth athletes.

Weekly cumulative extracurricular core training time predicts cadet physical performance: A descriptive epidemiological study

Background

Core training can enhance athletic performance by enhancing core strength and stability. To achieve this outcome, however, a tailored training program is required; the normal military training curriculum is inadequate. The connection between cumulative weekly extracurricular training time, cumulative weekly extracurricular core training time and cadet performance is unknown.

Methods

The association between cumulative weekly extracurricular training time, cumulative weekly extracurricular core training time and performance has been discovered using a descriptive epidemiological study methodology. Questionnaires were used to collect information on personal characteristics and weekly cumulative extracurricular (core) training time, as well as the results of the Chinese Army Physical Fitness Test (C-APFT), which included 100-m dash, 5000-m run, 3000-m armed training run, 400-m steeplechase, 800 m breaststroke, horizontal bar pull-ups, 2-min sit-ups, 2-min push-ups, and hand grenade throwing. This study recruited two hundred and twenty male cadets (aged 18 to 23 years, 19.68 ± 0.91) from a military medical university.

Results

(a) The correlation between cumulative weekly extracurricular training time and C-APFT score is significant. The 100-m dash, 5000-m run, 3000-m armed training run, 400-m steeplechase, and 2-min push-ups performed the best when participants exercised for 5 to 10 h per week. (b) The number of cadets scoring good or excellent on the C-APFT improves with cumulative weekly extracurricular core training time. The recommended amount of core training for cadets per week is 120 min. (c) The average cumulative weekly extracurricular core training time was a effective predictor of performance on the 400-m steeplechase (R2 = 0.470, F = 10.641, P＜0.01), horizontal bar pull-ups (R2 = 0.238, F = 68.191, P＜0.01), 2-min sit-ups (R2 = 0.280, F = 84.710, P＜0.01), 100-m run (R2 = 0.031, F = 6.920, P＜0.01), 3000-m armed training run (R2 = 0.025, F = 5.603, P＜0.05), 2-min push-ups (R2 = 0.019, F = 4.295, P＜0.05), and hand grenade tossing (R2 = 0.025, F = 5.603, P＜0.05).

Conclusions

Active participation in extracurricular core training can improve cadets' C-APFT scores. An average cumulative weekly extracurricular training duration of 5-10 h showed the most progress, and more than 120 min per week was ideal for extracurricular core training. The amount of extracurricular time spent on core training exercises each week can be used as a predictor of the C-APFT.

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.

First Rib Stress Fracture in an Adolescent Elite Tennis Player: A Case Report

CASE

A 16-year-old, right-hand-dominant, Asian male, elite tennis player presented to the clinic with a 1-month history of left shoulder pain. Originally, the pathology was believed to be shoulder-based, but lack of improvement after several weeks of therapy warranted further imaging, which ultimately revealed a nondisplaced fracture of the posterior left first rib.

CONCLUSION

Stress injuries are not uncommon in the sport of tennis, but atraumatic rib fractures are rare. Given the increase in youth sports specialization and overtraining and other risk factors such as adolescent age and race, it is important to keep rib stress fracture on the differential.

Youth athletes at Swedish sports high schools with an athletics specialism emphasise environmental support for injury risk management: a focus group study

In this study, we examined knowledge and understanding of sport-related injuries among youth athletics (track and field) athletes and assessed their needs in managing any health problems. Qualitative data were collected via 12 focus groups with youth athletes (16-19 years) studying at Swedish sports high schools with an athletics specialism. All focus group discussions were audiorecorded and transcribed before being analysed using a thematic analysis approach. Four researchers independently reviewed the transcripts, generated codes and developed themes. Three overarching themes related to the athletes' knowledge and understanding of sport-related injury were developed: (1) awareness of injuries, (2) perception of injuries, and (3) factors contributing to injuries. The youth athletes were typically uncertain about how to acknowledge a sport-related injury. They expressed that knowledge about injuries was obtained in part by reflecting on the lived experiences of their peers. It was also demonstrated that there appears to be a 'culture of acceptance' regarding injury occurrence. In contrast, causes of injuries were viewed as dependent on multiple factors (eg, lack of context-specific knowledge about training practices). Regarding athletes' needs in managing injuries, an additional three themes were developed: (1) creating functioning elite sports environments, (2) application of knowledge and (3) fostering athletes. An apparent lack of structure and organisation related to the school environment was identified as an important issue to review to create opportunities for sustainable athletic development. The study identified areas that can be improved in Swedish sports high schools with an athletic specialism and could be applied in other youth sports contexts. The results of this study guide school stakeholders, alongside the sport governing bodies who have the mandate to influence activities in youth sports contexts, whereby special attention should be directed towards improving the social environment for youth athletes.

Is Cumulative Load Associated with Injuries in Youth Team Sport? A Systematic Review

Background

High cumulative external and internal load may predispose athletes to increased risk for injury across a variety of sports, competition levels, and age groups. However, evidence of an association between cumulative load and injury in youth sport remains inconclusive. The objective of this study was to determine the current evidence for cumulative load and injury risk relationships in youth team sport through a systematic review of the existing literature.

Methods

A systematic review of the literature was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Literature searches were conducted in PubMed, Web of Science, SCOPUS, and CINAHL for relevant articles published between January 2010 and April 2021. The authors conducted independent review and quality assessment of the eligible studies. Eleven articles evaluating youth (less than 18 years old) team sport were included for qualitative synthesis.

Results

Fifty-nine percent (n = 39/66) of the relationships assessed revealed an association between cumulative load and injury across the team sports studied, including the presence of load–injury associations in 84% (n = 16/19) of assessments in youth soccer. Of those relationships where an association was present, 79% (n = 31/39) were positive associations between cumulative load and injury. Risk of bias assessment scores ranged from three to six out of seven possible (median = 5) for cohort studies and from four to seven out of 10 possible (median = 5.5) for cross-sectional studies.

Conclusions

There is some evidence for a positive association between load and injury in youth team sport. Youth soccer was the most studied team sport, and a substantial number of positive load–injury associations were reported. Current evidence lacks consistency in the measures and metrics used in defining load–injury relationships.

Trial Registration PRISMA ID - CRD42020203622.

Physical activity and sport-specific training patterns in Swedish sporting and working trial dogs-A questionnaire survey

OBJECTIVE

To explore physical activity patterns, including conditioning exercise and sport-specific training, and management routines utilized by handlers of Swedish sporting and working dogs participating in agility, obedience, rally obedience and working trial disciplines.

PROCEDURES

Dog handlers provided information on competition-level dogs through an internet-based cross-sectional and descriptive survey on physical activity, sport-specific training and management. Results are reported overall and stratified by participation in specific disciplines.

RESULTS

We received 1615 replies to the questionnaire. After data cleaning, 1582 dogs (98%) remained for the analysis. Of these, 430 participated in agility, 790 in obedience, 596 in rally obedience, and 847 dogs had competed in a working trial, i.e., messenger, protection, search or tracking. Number of disciplines performed by each dog varied between one and five. Most common was participation in one (n = 767, 48%) or two (n = 541, 34%) disciplines. Out of the dogs competing in one discipline, 38% (n = 294) were considered to be specialized as they actively trained only that discipline for ≥10 months per year. The vast majority of the dogs (n = 1129, 71%) received more than 1 h of daily physical activity, e.g., walks, and only n = 51 (3%) were never exercised off-leash. Preferred self-selected gait was trot (n = 907, 57%) and gallop (n = 499, 32%). A fifth (n = 319, 20%) never played with other dogs. The majority (n = 1328, 84%) received more than 1 h of vigorous physical conditioning exercise per week. Almost three quarters (n = 1119, 71%) participated in physical conditioning exercise. Two thirds (n = 953, 60%) participated in at least 3 h of sport-specific training per week and only a very small portion (n = 35, 2%) trained their specific discipline less than once per week. Median total work load, i.e., all daily physical activity, vigorous physical conditioning exercise and sport-specific training, was 16.5 h per week.

CONCLUSION AND CLINICAL RELEVANCE

We observe physical activity at moderate to high durations and moderate to vigorous intensities among Swedish sporting and working trial dogs. Most dogs received physical conditioning exercise, but not all dogs were warmed up before training and competition. Our study provides veterinary professionals and dog trainers with valuable insights on the physical exposures and management routines of sporting and working trial dogs.

Differential Repeated Sprinting Training in Youth Basketball Players: An Analysis of Effects According to Maturity Status

The differential learning approach, which includes fluctuations that occur without movement repetitions and without corrections has received growing interest in the skill acquisition field. This study aimed to determine the effects of a 9-week training intervention involving differential repeated sprint training on a series of physical tests in youth basketball players. A total of 29 participants with different maturity statuses (pre-peak height velocity (PHV), n = 7; mid-PHV, n = 6; post-PHV, n = 16) completed 2 sessions per week of differential repeated sprint training for a period of 9 weeks. Sessions consisted of 2 × 10 repetitions sprints of 20-m whereby participants were instructed to perform various additional fluctuations for each repetition. Before and after the training intervention, participants completed jumping tests (countermovement jump (CMJ), single-leg CMJs, the modified 505 agility test, and straight sprinting tests (0-10 splits time), and maturity status was evaluated as well. Within-group analysis showed improvement in CMJ asymmetries and changes in direction asymmetries and 10-m sprint performance for the pre-, mid-, and post-PHV groups, respectively (p < 0.05), with large to very large effects. Analysis of covariance demonstrated that changes in sprint time in post-PHV players were greater than in the pre- and mid-PHV groups (p < 0.05), with moderate effect. Adding random fluctuations during repeated sprint training appear to be a suitable and feasible training strategy for maintaining and enhancing physical performance in youth basketball players, irrespective of maturity status. Furthermore, the present findings encourage practitioners to implement the present approach in youth athletes to improve their physical performance, but they should be aware that training response can vary according to maturity status.

Training, Wellbeing and Recovery Load Monitoring in Female Youth Athletes

Participation in youth sports is ever-increasing, along with training and competition demands placed upon youth athletes. Young athletes may experience high training loads due to playing several sports, as well as participating in school physical education. Therefore, monitoring youth athlete load is an emerging area of research that may help limit non-functional overreaching, injury, or illness and assist with long-term athlete development. This narrative review highlights that multiple measures have been explored to monitor both internal and external load. However, the validity, reliability and practicality of these measures are often not fully understood in female youth populations. The most commonly used external monitoring methods are GPS tracking and TRIMP whereas common internal monitoring tools are questionnaires, perceived exertion rating and heart rate measures. The reporting of injuries and menstrual cycles is also crucial for providing completeness when monitoring an athlete. It has been suggested that the combination of training load, recovery and wellbeing monitoring variables is the optimal way to monitor an athlete's fatigue levels. Whichever monitoring method is applied, in a youth population it is important that the protocol can be individualised, is inexpensive and can be easily implemented and reported so that the monitoring is sustainable.

Specialization and Injury Risk in Different Youth Sports: A Bio-Emotional Social Approach

Aims

Sport specialization is an actual trend in youth athletes, but it can increase injury risk. The aim was to determine the eventual correlation between sports specialization and injury risk in various sports, using a biopsychosocial approach.

Methods

169 sport-specialized athletes completed [(38 female, 131 male); overall (11.2 ± 2.7 years), (56.28 ± 15.72 kg), (161.3 ± 15.52 cm)] a self-reported questionnaire regarding sociodemographic (age, gender, educational level), physical-attitudinal, injuries and psychological-attitudinal To analyze data univariate and correlate analyses were used.

Results

Of 169 athletes enrolled, 53% were single-sport specialized (reported participation in one sport and trained > 8 months/year). In team sports (100%, OR = 0.75; p = 0.022) a high risk of having to remain at rest for up to 1 month because of overuse was observed. Males who suffered direct trauma (70%; OR = 1.03; p = 0.006) in the team group (95%, OR = 0.09; p = 0.008) were more exposed to that type of injury, and also the type of specialization figured significantly (p = 0.047). In addition, interoceptive awareness correlates with injury (95%, 1.04, p = 0.01). This study shows that, even though young athletes seem to be at a high risk of becoming injured, early team sport specialization and a high performance level cannot be considered to be the only risk factors.

Early Sport Specialization in College Athletes and the Impact on Health-Related Quality of Life: A Critically Appraised Topic

Clinical Scenario: Youth athletes may specialize in a sport of their choosing, or based on external pressures, to pursue elite status in that sport. Current evidence shows an association between highly specialized athletes and an increase in injuries as well as a connection between injury and lower health-related quality of life (HRQOL). Clinical Question: In college athletes, do early sport specialization characteristics (ie, age at specialization and degree of specialization) impact current HRQOL? Summary of Key Findings: The literature was searched for studies that investigated the age of specialization (early vs late) or degree of specialization (high, moderate, and low) and the impact on HRQOL. (1) The search returned 6 possible studies related to the clinical question. Three of the studies met the inclusion criteria and were used for this appraisal. (2) Two of the 3 included studies reported that highly specialized athletes noted lower HRQOL. (3) One study found there to be no significant difference in HRQOL between athletes who specialized early versus late but did find those who specialized early to have a greater incidence of injuries that required surgery. Clinical Bottom Line: There is moderate evidence that early sport specialization is associated with lower HRQOL compared with late sport specialization. It is important to educate athletes, parents, and coaches on the potential detriments that are associated with early sport specialization to allow stakeholders to make informed decisions regarding participation. Strength of Recommendation: Grade B evidence exists to support the idea that early, intensive sport specialization may be associated with decreased HRQOL in current college athletes.

Training Load, Maturity Timing and Future National Team Selection in National Youth Basketball Players

Despite its importance to the management of training stress, monotony and recovery from exercise, training load has not been quantified during periods of intensity training in youths. This study aimed to (1) examine and quantify the training load (TL) in youth national team basketball players during a 2-week training camp according to maturity timing and (2) determine which parameters were related to under-18 (U18) national team selection. Twenty-nine U-16 national team basketball players underwent an anthropometric assessment to determine maturity timing. Players were categorised by maturity timing (early vs. average), whilst TL parameters during a 2-week training camp (i.e., 21 sessions) prior to FIBA U16 European Championship were used for group comparison and to predict future U-18 national team selection. The early-maturing players, who were taller and heavier (p &lt; 0.05), experienced greater training strain in week 1 (p &lt; 0.05) only. Irrespective of maturity timing, training loads in week 2 were predictive of onward selection for the U-18 national team. Conclusion: Based on present findings, practitioners are encouraged to develop their athletes' ability to tolerate high weekly loads, but also to be mindful that athletes' perceived exertion during national team training may be influenced by maturity timing.