Age of Early Specialization, Competitive Volume, Injury, and Sleep Habits in Youth Sport: A Preliminary Study of US Youth Basketball

Incidence and Risk Factors for Sport-Related Concussion in Female Youth Athletes Participating in Contact and Collision Invasion Sports: A Systematic Review

BACKGROUND

The incidence and risk factors for sport-related concussion (SRC) associated with contact and collision invasion sports (CCIS) in female youth are unclear.

OBJECTIVES

This systematic review aimed to identify (i) the incidence of and (ii) risk factors for SRC in female youth athletes playing CCIS.

METHODS

A systematic search of PubMed, CINAHL, Embase, SPORTDiscus and ProQuest to 8 May, 2024 was conducted. Two reviewers independently screened articles against eligibility criteria and assessed risk of bias (Joanna Briggs Institute Critical Appraisal Tool). Aetiological or intervention studies reporting on SRC incidence or risk factors in female youth athletes (aged 13-19 years and under) participating in CCIS were included. Meta-analyses were conducted to explore SRC incidence and risk factors. For each meta-analysis of SRC incidence rate, sub-group analyses were conducted by sport. Where heterogeneity was above 60% for the meta-analysis of SRC risk/protective factors, sensitivity analyses were conducted.

RESULTS

The search yielded 4509 articles; 66 were included. Sport-related concussion incidence or risk factor data for nine CCIS were extracted. Pooled estimates revealed SRC incidence for female youth athletes in CCIS combined was 0.50/1000 match and practice hours (95% confidence interval [CI] 0.34-0.66). When examined by sport classification, SRC incidence in contact invasion sports was 0.12/1000 match and practice hours (95% CI 0.03-0.21), and in collision invasion sports was 2.08/1000 match and practice hours (95% CI 0.90-3.25). Sub-group analysis by individual sport revealed female youth soccer players had the highest overall SRC incidence rate (0.89/1000 match and practice hours, 95% CI - 0.19 to 1.97) amongst contact sports, and rugby union players had the highest overall SRC incidence rate (4.04/1000 match and practice hours, 95% CI 3.03-5.05) among collision sports. Forty-five studies (68%) reported SRC risk factor data, investigating 12 different potential risk factors. Female youth sustained over 7.5 times the rate of SRC in matches compared with practice (incidence rate ratio 7.52, 95% CI 6.32-8.95, p < 0.01) when competing in CCIS; however, considerable heterogeneity existed (I2 = 84.98%). When exploring potential risk factors, no significant difference was found in SRC rate between female youth lacrosse players wearing versus not wearing headgear (p = 0.07). No significant difference was found in SRC rates between female youth athletes competing in younger versus older age groups (incidence rate ratio 0.91, 95% CI 0.52-1.61, p = 0.48, I2 = 0.00%). Insufficient evidence was available to examine remaining risk factors.

CONCLUSIONS

This meta-analysis revealed SRC in female youth playing CCIS was higher than previously reported, with SRC rates higher in matches than practice. Soccer had the highest SRC incidence rate for female youth athletes competing in contact invasion sports, whilst rugby union demonstrated the highest SRC incidence rates for collision invasion sports. The results of this review should be interpreted with caution given the lack of representation from some common CCIS codes. Further research is required to examine SRC risk factors in female youth athletes participating in CCIS.

CLINICAL TRIAL REGISTRATION

OSF Registration: osf.io/s573v.

Amateur Athletic Union (AAU) Accessibility: An Area Deprivation Index (ADI) Analysis of National Basketball Association (NBA) Players' Profiles

PURPOSE OF REVIEW

Youth sports are increasingly shifting towards a "pay to play" model which has introduced financial barriers to participation. The Amateur Athletic Union (AAU) is the main organization for club basketball, serving as a platform where young athletes can compete beyond the recreational level. Outside the realm of athletes who have access to state-of-the-art facilities and top-tier coaching, the pathway to playing basketball at the next level may be predominantly available to those who can afford the considerable costs of AAU participation. The objective of this study is to determine the accessibility of AAU teams of active National Basketball Association (NBA) players through use of the Area Deprivation Index (ADI).

RECENT FINDINGS

We identified 114 AAU teams with physical addresses for 250 (50%) currently active domestic NBA players. The State ADI of the high schools as well as national and state ADIs of prior AAU teams of active NBA players were significantly skewed toward lower ADI rankings (higher socioeconomic status) (p < 0.05). The mean distance between high school location and AAU location was 170 miles. Prior AAU teams of currently active NBA players are more frequently located in areas of higher socioeconomic status with nearly 50% being within the top 3rd lower state decile as measured by the area deprivation index. Similarly, we found the high schools these players attended, as a proxy for areas they grew up in, were also more frequently located in areas of higher socioeconomic status.

Injury incidence among adolescent and senior basketball players: a prospective study in 19 teams across an entire season

OBJECTIVE

To quantify and compare injury incidence between national-level, adolescent and regional-level, senior, male basketball players competing in Serbia overall and according to injury mechanism (contact, non-contact, or overuse), exposure setting (training or games), and history (new or recurrent).

METHODS

A total of 218 male basketball players from 19 teams (106 senior and 112 adolescent players) volunteered to participate in the study. Descriptive data regarding game and training injury incidence were gathered across all players and reported per 10,000 athlete-exposures (AE) with 95% confidence intervals.

RESULTS

Overall, 26 injuries were reported across 52,509 AE. Ankle (n = 10, incidence rate [IR] = 1.90 [0.97, 3.40]) and knee injuries (n = 8, IR = 1.52 [0.71, 2.89]) accounted for 69% of all reported injuries, with only 1-2 injuries documented for other body regions. Ankle injuries were attributed to contact (60%, IR = 1.14 [0.46, 2.38]) or non-contact mechanisms (40%, IR = 0.76 [0.24, 1.84]). Most knee injuries occurred due to overuse (50%, IR = 0.76 [0.24, 1.84]) or non-contact mechanisms (38%, IR = 0.57 [0.15, 1.56]). Comparisons according to exposure setting revealed significantly higher knee (incidence rate ratio [IRR] = 9.95 [1.85, 53.41], p = 0.004) and ankle (IRR = 39.79 [7.94, 384.67], p < 0.001) injuries per 10,000 AE during games compared to training. Recurrent injuries were most prominent in the ankle (30% of all ankle injuries, p = 0.11). Total contact (p = 0.04), non-contact (p = 0.04), and recurrent IR (p = 0.005) were significantly higher in senior than adolescent players.

CONCLUSION

The players examined were most susceptible to ankle and knee injuries, particularly during games compared to training. Ankle injuries were mostly attributed to player contact, while knee injuries were mostly attributed to overuse and non-contact mechanisms. Senior players were at a greater risk of sustaining contact, non-contact and recurrent injuries than adolescent players.

Changes in Sports Participation, Specialization, and Burnout From 7th to 12th Grade: Final Results From a 6-Year Longitudinal Study

BACKGROUND

Previous studies show alarming rates of burnout and dropout from sports participation and physical activity in the youth population. Early sports specialization may increase the risk of injury, burnout, and eventual dropout from sports.

HYPOTHESIS

Sports participation will decrease, specialization will increase, and burnout will increase from junior high to high school.

STUDY DESIGN

Prospective longitudinal study.

LEVEL OF EVIDENCE

Level 2b.

METHODS

The graduating class of 2023 was surveyed longitudinally in the fall of each school year from 7th to 12th grade (n = 35-77 from middle to high school based on new enrollment participants and attrition). Survey questions asked about sports participation, specialization, and burnout. Responses were analyzed by grade level using mixed effects linear and logistic regression accounting for repeated measures.

RESULTS

The number of days per week in which students engaged in at least 60 minutes of strenuous exercise progressively decreased from 7th through 12th grade from 4.0 to 2.3 days per week (P < 0.01). The percentage of students participating in sports also decreased from 7th to 12th grade from 82% to 39% (P < 0.01). More students stopped participating in a sport (38% vs 22% to 29%, P = 0.04), quit a sport to focus on a single sport (60% vs 46% to 49%, P = 0.01), or reported that 1 sport was most important to them (71% vs 54% to 67%, P = 0.06) in 9th grade. Burnout in sports did not differ significantly by grade level (19% to 23%, P > 0.99). In contrast, burnout in school was significantly more common in high school (54% to 69%) compared with middle school (36%, P < 0.01). Burnout in school was higher in female students compared with male students (68% vs 38%, P < 0.01).

CONCLUSION

Organized sports participation and general physical activity decreased from middle to high school, with the entry into high school at 9th grade being a time at which a significant number of students dropped other sports to specialize in a single sport or stopped participating. Burnout in sports did not appear to increase with age; however, there was an increase in school-related burnout as students transitioned from middle to high school.

CLINICAL RELEVANCE

Our results highlight the need for continued research into sports participation, specialization, and burnout in adolescents. In addition, health professionals and the community (parents, coaches, teachers) supporting youth athletes may consider positive interventions during the periods of transition from middle to high school to include facilitating different tracks of sports participation (including a developmental or recreational model of play) to reduce dropout from sport and supportive measures to lessen burnout from sports and from school.

Sleep in marathon and ultramarathon runners: a brief narrative review

Introduction

Sleep is considered a fundamental biological function in humans necessary for recovery from daily physical activities. Considering the increasing popularity of long-distance running and participation in races such as marathons and ultramarathons, the aim of the present study was to review the relationship of such strenuous physical activities with sleep.

Methods

A search of Scopus was performed on 24/6/2023 using the syntax [ABS (sleep) AND ABS (marathon)] to identify relevant papers, the references of which were hand-searched to find additional sources.

Results

Optimal sleep has been shown to affect injury prevention and susceptibility to infection positively. In turn, participation in a marathon race may influence nocturnal autonomic modulation and disturb homeostasis. Ultramarathon races may have such a long duration that results in sleep deprivation even for several days, where sleep duration is quite below the physiological range. It seems that for ultramarathons of short duration, continuous running and sleep deprivation are beneficial for performance. In contrast, for races longer than 200 miles, it is necessary to develop sleep strategies to sustain performance.

Conclusion

In summary, the longer the distance of a running race, the greater the importance of an optimal sleep for race performance as well as the impact of a race on sleep.

The associations of early specialization, sports volume, and maturity status with musculoskeletal injury in elite youth football players

Background: Youth football in schools has experienced rapid growth in China. Despite the increase of players engaging in more frequent, intensive, and organized sports training at their early ages, the controversy over early specialization (ES) still exists. This study aims to: a) investigate the training situation of players in the Chinese School Football Programme and b) examine the associations of early specialization, sports volume, and maturity status with musculoskeletal injury. Methods: A cross-sectional survey was used. Players who participated in the National School Football Winter Camp were invited to fill out a questionnaire that included the data of maturity, ES, sports volume, and injury history (n = 88 boys and n = 90 girls). Results: The results have shown that 80.3% of the athletes were classified as ES, while 19.7% of them were classified as non-ES. Almost all athletes (96%) participated in a sport for more than 8 months in a year. Most athletes (75.8%) spent more than twice of the time on organized sports than leisure activities. 30.3% of the athletes trained on average more hours per week than the number of their ages. Binomial logistic regression models reflected the significant differences in the odds ratios (OR) of reporting a history of injury among athletes with different levels of specialization (p = 0.024) and the OR of reporting a history of leg injury among players with different weekly sports volumes (p = 0.038). Significant differences were also shown in the OR of players reporting foot injuries between players with different maturity states (p = 0.046), and the Chi-squared test showed significant differences in the OR of reporting acute injuries between players with different levels of specialization (p = 0.048) and weekly activity (p = 0.022). No significant differences were found between the remaining variables. Conclusion: Most school football elite players follow the ES pathway even though ES increases the risk of injury, especially acute injury. Pre-pubertal and early pubertal players have a higher incidence of foot injuries. Players who train more hours per week than their ages have more leg injuries and acute injuries. Therefore, priority protection and intervention should be carried out for populations with a high risk of injury.