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Specialized Training in Young Athletes Linked to Serious Overuse Injuries

Discussion in 'Biomechanics, Sports and Foot orthoses' started by NewsBot, Apr 19, 2013.

  1. NewsBot

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    Press Release:
    Intense, Specialized Training in Young Athletes Linked to Serious Overuse Injuries
     
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    OVERUSE AND TRAUMATIC MUSCULOSKELETAL EXTREMITY INJURIES IN SCHOOL CHILDREN
    E Jespersen, R Holst, C Franz, C Rexen, H Klakk, N Wedderkopp
    Br J Sports Med 2014;48:611-612 doi:10.1136/bjsports-2014-093494.140
    Abstracts from the IOC World Conference on Prevention of Injury & Illness in Sport, Monaco 2014

     
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    Association between sports type and overuse injuries of extremities in children and adolescents: a systematic review.
    Chéron C, Le Scanff C, Leboeuf-Yde C
    Chiropr Man Therap. 2016 Nov 15;24:41. eCollection 2016.
     
  4. NewsBot

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    Press Release:
    Overuse Injuries More Common in Kids Who Specialize in Individual Sport
    4/12/2017 12:00 AM
     
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    A Prospective Study on the Effect of Sport Specialization on Lower Extremity Injury Rates in High School Athletes
    Timothy A. McGuine, PhD, ATC, Eric G. Post, MS, Scott J. Hetzel, MS, ...
    The American Journal of Sports Medicine; July 23, 2017
     
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    Press Release:
    Sports Specialization May Lead to More Lower Extremity Injuries
    Better education to coaches and parents about the effects of single sport specialization is critical, say researchers presenting their work today at the American Orthopaedic Society for Sports Medicine’s Annual Meeting in Toronto, Canada. Research Wins AOSSM/STOP Sports Injuries Annual Award
    TORONTO, ONTARIO, CANADA (PRWEB) JULY 23, 2017
    Better education to coaches and parents about the effects of single sport specialization is critical, say researchers presenting their work today at the American Orthopaedic Society for Sports Medicine’ s Annual Meeting in Toronto, Canada.
    “Our study is the first one to prospectively document the association between sports specialization and lower extremity injuries in a large, diverse, group of high school athletes,” said lead researcher, Timothy A. McGuine, PhD, ATC from the University of Wisconsin.
    McGuine and his colleagues enrolled 1,544 individuals into the study during the 2015-2016 school year with 50% being female and an average age of 16 years. Participants completed a questionnaire which identified their sports participation, history of injury and level of specialization (low, moderate, high) based on a 3-item scale previously published. They were asked to report all interscholastic and club sports participation during the previous 12 months and any activity that they planned to participate in during the upcoming school year. The questionnaires were also reviewed by an athletic trainer before being placed into the study.
    The participants competed in 167,349 athletic exposures. A total of 490 (31.7%) reported sustaining a previous loss of practice/playing time due to a lower extremity injury (LEI) while 759 (49.2%) participated in their primary sport in a league outside of their high school. During the study time-period, 15% or 235 individuals sustained 276 lower extremity injuries causing them to miss an average of seven days of participation. Injuries occurred most often in the ankle (34%), knee (25%) and upper leg (13%) and included ligament sprains (41%), muscle/tendon strains (25%) and tendonitis/tenosynovitis (20%). Soccer was the sport with the highest percentage of athletes being highly specialized with 265 subjects reporting that they had competed in more than 60 competitions within the last year in their primary sport. Players whose primary sports were basketball, football and soccer sustained more lower extremity injuries than their peers who were in baseball, tennis, track, volleyball or wrestling.
    “Our results demonstrated that athletes who classified themselves as moderately specialized had a 50% higher incidence of LEI and athletes who had a high specialization classification had an 85% higher incidence of LEI,” said McGuine. “Sport specialization appears to be an independent risk factor for injury, as opposed to simply being a function of increased sport exposure. Athletic associations, school administrators, coaches and sports medicine providers need to better educate parents and their athletes on the increased chances of injury risk and provide more opportunities for diversified athletic play.”
     
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    Press Release:
    High risk of injury in young elite athletes
    Published 2017-10-18 08:00.

    Every week, an average of three in every ten adolescent elite athletes suffer an injury. Worst affected are young women, and the risk of injury increases with low self-esteem, especially in combination with less sleep and higher training volume and intensity, a doctoral thesis from Karolinska Institutet shows.
    Even though thousands of young elite athletes participate in organised sporting events every year, knowledge of injury and its consequences is limited. A thesis by Philip von Rosen, researcher at the Department of Neurobiology, Care Sciences and Society, can help to address this problem.
    Some 1,200 young people in Sweden attend a national sports high school, where they combine their regular studies with elite sports in order to attain an international standard in their particular activity. Philip von Rosen’s studies include 680 elite athletes representing 16 different sports at 24 such schools around the country who have completed a series of surveys on injury occurrence and the volume and intensity of their training programmes.
    75 per cent were seriously injured over a year
    “Our studies show that the incidence of injury is high in adolescent elite athletes,” says Mr Philip von Rosen. “During the average week, one in three of them was injured. Over a year, almost all of them had been injured at least once and around 75 per cent reported that they had been seriously injured at least once during the year.”
    Girls had highest rate of injury and remained injured for longer.
    To ascertain the possible risk factors behind the injuries, the participants were also asked every term about their self-esteem, nutrient intake and self-rated stress and sleep. The ones who increased the volume and intensity of their training while reducing the duration of their sleep showed a 100 per cent rise in risk of injury. Low self-esteem also increased the risk. An athlete with low self-esteem who increased the volume and intensity of his or her training while cutting back on sleep had three times the risk of injury compared to an athlete with average self-esteem who had not changed his or her training or sleeping habit.
    Negative psychological consequences
    In smaller research groups, students also talked about negative psychological consequences of injury, such as guilt, frustration and anger, and how injuries made them consider quitting elite sport altogether.
    “The high risk of injury in adolescent elite athletes shows that early-intervention injury-prevention strategies are needed in order to avoid long-term consequences of injury and to encourage continuing engagement in sport,” says Mr von Rosen. “We therefore recommend that medical teams are made available for all athletes at every national sports high school to reduce the unhealthy behaviour associated with being injured, to prevent new injuries and to help injured athletes return to sport.”
    Mr von Rosen will be defending his thesis “Injuries, risk factors, consequences and injury perceptions in adolescent elite athletes” at Karolinska Institutet on 20
     
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    Prevalence and incidence of musculoskeletal extremity complaints in children and adolescents. A systematic review.
    Fuglkjær S et al
    BMC Musculoskelet Disord. 2017 Oct 18;18(1):418. doi: 10.1186/s12891-017-1771-2.
     
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    The prevalence and severity of health problems in youth elite sports: a 6-month prospective cohort study of 320 athletes
    C H Moseid, et al
    Scandinavian Journal of Medicine & Science in Sports
     
  12. AtomAnt

    AtomAnt Active Member

    This is an important concept for us as parents and as clinicians. I see too many kids specializing too soon.
     
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    PUBLIC RELEASE: 31-JAN-2018
    Kids born later in the year can still excel in sport
    New study supports delaying talent identification in sport

    A child's birth month shouldn't affect their long-term prospects in high-level sport and those who hold off on specialising until later years may be the most successful, according to new research from the University of Sydney.

    The study, conducted in collaboration with Swimming Australia and published in the Journal of Science and Sports Medicine, examined the representation of over 6000 athletes at the National Swimming Championships between 2000 and 2014.

    It found those born earlier in the age category cut-offs were much more likely to be involved at 12-14 years, however by 17-18 years this had completely reversed with an over-representation of relatively younger swimmers.

    Lead author and sports and exercise psychologist Dr Stephen Cobley said sports scientists have long been interested in the 'relative age effect', whereby older athletes within a sports age grouping typically have selection advantages, and greater access to development programs likely due to early growth and maturity.

    "However our research shows there are a lot more relatively younger athletes making the qualification times and competing at national level swimming at the time of transition to adult competition, so if you just wait the influence of early physical differences will slowly disappear," said Dr Stephen Cobley from the Faculty of Health Sciences at the University of Sydney.

    Interestingly, in female participants the relative age effect dropped off earlier than male participants further supporting the link between relative age and maturation.

    "We also found athletes who started competing in the earlier years tended to drop off and not return annually, compared to those who didn't compete until the older age brackets. This could be due to several things, including intensive training loads, burn out and loss of interest related to earlier specialisation," said Dr Cobley.

    These findings, and other recent work by Cobley and colleagues in rugby league and ice hockey, show how relatively younger and later maturing athletes may be more likely to go on to attain adult career success.

    "From a sports development perspective our research suggests you are more likely to pick the genuinely promising athletes if you delay talent identification, athlete selection and specialisation until 15, 16 or even later to account for the later development trajectories of some athletes."

    Swimming Australia's High Performance Pathway Manager Jamie Salter said the research is in line with the organisation's athlete development ethos and further changes had already been made as part of the four year strategy in the lead up to Tokyo 2020 Olympics.

    "We've been aware of relative age effects in swimming for a number of years and in 2013 Swimming Australia brought in a relative age effect criterion to our talent identification."

    "The new criterion focussed on swimmers aged 15 years and above as the evidence shows we can be even more deliberate and precise with our pathway programs once relative age effects are known."

    Mr Salter said based on the research Swimming Australia has also reviewed and changed competition structures, with the aim of improving the pathway from entry, into national level competition, up to the elite stage.

    "For many young swimmers, their age and the difference in physical size and strength can have a big impact on swimming times which often results in some swimmers gaining an advantage and at the same time, discouraging others, purely based on the month of the year that they were born," said Mr Salter.

    "As such we have changed the minimum age for swimmers to compete, and this will be different for boys and girls due to girls maturing earlier. We are also implementing events and strategies to help maintain involvement in later post-maturation years."
     
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    Knowledge, Attitudes, and Beliefs of Youth Sports Coaches Regarding Sport Volume Recommendations and Sport Specialization
    Post, Eric et al
    The Journal of Strength & Conditioning Research: February 22, 2018 - Volume Publish Ahead of Print - Issue - p
     
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    PUBLIC RELEASE: 6-MAR-2018
    The growing trend of youth sports specialization
    Data finds focus on single sport, largely driven by parents, leads to injury and burnout


    NEW ORLEANS, La. (March 6, 2018)-Youth sports has experienced a paradigm shift over the past 15 to 20 years. Gone are the days filled with pick-up basketball games and free play. Kids are increasingly specializing in sports.

    New research from two studies presented at the 2018 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS) demonstrated the substantial psychosocial impact parents can have on their children's sports experience, as 54.7 percent of parents encouraged their children to specialize in a single sport. Additionally, the number of hours of vigorous activity was found to be a bigger risk factor for injury than specialization. For girls, the number of hours per week of activity is a stronger predictor of injury than sports specialization. For boys, both specialization and the number of hours per week were predictive of injury.

    Sports specialization in youth is defined as engaging in a sport for at least three seasons a year at the exclusion of other sports, and early sports specialization occurs in children under the age of 12. Although physical activity is beneficial for overall health, sports specialization can increase the risk of injury and burnout, and decrease enjoyment due to excessive training. It also decreases an athlete's ability to cross train and gain physical benefits from other sports. In fact, the AAOS and American Orthopaedic Society for Sports Medicine just launched a new campaign called OneSport™ to help address this and prevent overuse injury.

    A new study "Quantifying Parental Influence on Youth Athlete Specialization: A Survey of Athletes' Parents," set out to uncover extrinsic influence from parents and assess parental influences placed on young athletes to specialize.

    The team of researchers surveyed 201 parents of pediatric patients in the practice of the study's lead author, Charles A. Popkin, MD, assistant professor of orthopaedic surgery at Columbia University Medical Center, and assistant attending physician at New York-Presbyterian Hospital.

    Survey findings included:
    57.2 percent of parents hoped for their children to play collegiately or professionally.
    One-third of respondents stated their children only played a single sport, and 53.2 percent had children who played multiple sports, but had a favorite sport.
    Only 13.4 percent had children who balanced their multiple sports equally.
    Additionally, approximately 80 percent of parents who hired personal trainers for their children were more likely to believe their children held collegiate or professional aspirations, and those children who received outside skill development had a higher injury risk due to the number of hours spent training and playing.
    "Culturally, we have found that parents have unrealistic expectations for their children to play collegiately or professionally and as a result, they invest in private lessons, trainers or personal coaches to help their kids," explains Dr. Popkin. "When you're investing this amount of time and resources, there can be unwritten, indirect pressure from parents to specialize."

    In the future, the researchers of both studies hope to raise awareness to address the factors, dangers and myths associated with youth sports specialization. Additionally, it's important to analyze the data and develop common sense recommendations of how much is too much in certain children to reduce injuries and burnout, and allow children to enjoy the benefits associated with a lifelong involvement with sports.

    Another new study "Injury Risk Associated with Sports Specialization in Youth," analyzed data from the Growing Up Today Study, which focused on the children of registered nurses. Analysis of 12,000 youth, ages 9-14, was conducted over a four-year period (1997, 1998, 1999, 2001), in addition to the 2004 data on injury history completed by their mothers.

    "It's important to note that other studies on sports specialization have been retrospective, in that they look at kids who are injured, and then asked them if they specialized and how many hours they were playing," explained lead author of the study Mininder Kocher, MD, MPH, associate director, division of sports medicine at Boston Children's Hospital and professor at Harvard Medical School, department of orthopaedic surgery. "Correlating this data to their injury leaves room for potential bias. Our study took a future-forward approach by having mothers, who are registered nurses, record their children's sports and activities, the number of hours a week and detailing their children's injuries. Therefore, the quality and depth of data are much greater."

    In addition to determining whether time spent and/or sports specialization lead to a greater risk of injury in boys and girls, the study also found that early sports specialization in baseball and cheerleading/gymnastics showed an increased risk of injury in boys. For girls, early sports specialization in running, swimming, volleyball and cheerleading/gymnastics were all independently predictive of developing an injury in girls.

    The increased phenomenon of sports specialization begs the question of who is driving this trend.
     
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    Parents' Awareness and Perceptions of Sport Specialization and Injury Prevention Recommendations
    Bell, David R., PhD, ATC et al
    Clinical Journal of Sport Medicine: August 08, 2018 - Volume Publish Ahead of Print - Issue - p
     
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    The Influence of Sport Specialization on Landing Error Scoring System Scores in High School Athletes
    Kyle J. Peckham, MS, ATC; Lindsay J. DiStefano, PhD, ATC; Hayley J. Root, PhD, MPH, ATC; Eric G. Post, PhD, ATC; Lindsey K. Lepley, PhD, ATC; Stephanie M. Trigsted, PhD, ATC; M. Alison Brooks, MD, MPH; Samantha E. Scarneo, PhD, ATC; David R. Bell, PhD, ATC
    Athletic Training and Sports Health Care. 2018;10(6):253-259https://doi.org/10.3928/19425864-20180830-02
     
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    Sport Specialization and Participation Characteristics of Female High School Volleyball Athletes
    Kevin M. Biese, MA, ATC; Eric G. Post, PhD, ATC; Daniel A. Schaefer, MS, RSCC; David R. Bell, PhD, ATC
    Athletic Training and Sports Health Care. 2018;10(6):247-252https://doi.org/10.3928/19425864-20180830-01
     
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    Sport Specialization Is Associated With Injury History in Youth Soccer Athletes
    David R. Bell, PhD, ATC; Pamela J. Lang, MD; Tamara C. Valovich McLeod, PhD, ATC, FNATA; Kelsie A. McCaffrey, PT, DPT, PCS; Tracy L. Zaslow, MD, FAAP, CAQSM; Scott D. Mckay, MD; PRiSM Sport Specialization Interest Group
    Athletic Training and Sports Health Care. 2018;10(6):241-246https://doi.org/10.3928/19425864-20180813-01
     
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    Associations Between Sport Specialization, Running-Related Injury, and Menstrual Dysfunction Among High School Distance Runners
    Mitchell J. Rauh, PhD, PT, MPH, FACSM; Adam S. Tenforde, MD; Michelle T. Barrack, PhD, RD; Michael D. Rosenthal, DSc, PT, ATC; Jeanne F. Nichols, PhD, FACSM
    Athletic Training and Sports Health Care. 2018;10(6):260-269https://doi.org/10.3928/19425864-20180918-01
     
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    Acute and overuse injuries among sports club members and non-members: the Finnish Health Promoting Sports Club (FHPSC) study
    L. Ristolainen, K. Toivo, J. Parkkari, S. Kokko, L. Alanko, O. J. Heinonen, R. Korpelainen, K. Savonen, H. Selänne, T. Vasankari, L. Kannas, J. Villberg and U. M. Kujala
    BMC Musculoskeletal Disorders 19 January 2019
     
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    PUBLIC RELEASE: 16-MAR-2019
    Early sports specialization tied to increased injury rates in college athletes

    LAS VEGAS, NV -Sixty million kids participate in organized athletics each year with ever increasing amounts of children specializing in one sport before the age of 14 with hopes of a college scholarship or professional career on the line. However, researchers presenting their work at the AOSSM/AANA Specialty Day today reveal that this early intense participation might come at the cost of increased injuries during their athletic careers.

    "Our research indicated that athletes who specialized in their varsity sport before the age of 14 were more likely to report a history of injuries and multiple college injuries during the course of their athletic career," said author, Brian M. Cash, MD from the Department of Orthopaedic Surgery at the University of California at Los Angeles.

    Cash and his colleagues sent a voluntary survey to 652 athletes who participated in athletics at a single institution. Participants were asked about demographics, scholarship status, reasons for sports specialization, age of specialization, training volume, and injury/surgical history. A total of 202 surveys were available for analysis after some were excluded due to incomplete or incorrect survey completion. Injuries were defined as those which kept an athlete out of participation for more than one week. High training volume was defined as greater than 28 hours per week during pre-high school years. 86.9% vs. 74% of individuals who specialized early reported a history of injury, (64.6% vs. 49.4%) reported multiple injuries and these athletes were held out of sport participation an average of 15.2 vs. 7.0 weeks in those that did not specialize early. However, early specializers were also more likely to receive a college scholarship (92.9 vs 83.1%). Full-scholarship athletes were more likely to report multiple surgical injuries (11.7 vs 3.5%).

    In addition, those who trained more than 28 hours per week in their varsity sport before high school were more likely to report multiple injuries (90.0 vs. 56.7%). Individuals with a pre-high school training volume greater than 28 hours/week were not more likely to be recruited (90.0 vs. 89%) or receive a scholarship (80% vs. 74.5%).

    "Sports participation is an excellent way for kids to maintain their health and possibly even receive a college scholarship. However, our research further highlights that avoiding sports specialization before the age of 14 and minimizing training time to less than 28 hours per week, may significantly minimize a child's injury chances and promote long-term, athletic college or even elite success," said Cash.
     
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    Participation in sports in childhood and adolescence and physical activity in adulthood: A systematic review
    Mariana Biagi Batista, Catiana Leila Possamai Romanzini, Cynthia Correa Lopes Barbosa, Gabriela Blasquez Shigaki, Marcelo Romanzini & Enio Ricardo Vaz Ronque
    Journal of Sports Sciences : 08 Jun 2019
     
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    Early sport specialization in elite weightlifters: weightlifting injury occurrence and relevant opinions.
    Bush, CM, Wilhelm, AJ, Lavallee, ME, and Deitch, JR.
    J Strength Cond Res XX(X): 000–000, 2019
     
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    NEWS RELEASE 23-SEP-2019
    For young athletes, sport specialization means increased risk of injury

    PROVIDENCE, R.I. [Brown University] -- A new study finds that kids who specialize in a chosen sport tend to engage in higher levels of vigorous exercise than their peers and may be more likely to sustain injuries, such as stress fractures, tendinitis and ACL tears.

    The findings, which draw from a multi-year, ongoing study of 10,138 older children and teens living throughout the United States, suggest that volume of vigorous activity is a strong predictor of injuries for both boys and girls. In other words, those who engage in the most hours of intense activity per week are the most likely to be injured.

    "It's wonderful for a child to love a sport and to want to engage in it, but we must keep in mind the number of hours spent playing," said study author Alison Field, a professor of epidemiology and pediatrics at Brown University. "They add up pretty quickly."

    She hopes the study's conclusions will help coaches, parents and doctors guide young athletes toward less intense, less specialized training.

    This study, published in the Orthopaedic Journal of Sports Medicine on Wednesday, Sept. 18, helps to explain some of the dangers of sports specialization. Athletes who focus on one particular sport tend to practice more frequently and intensely compared to athletes who do not.

    "But if we send out a message that says kids shouldn't specialize, the worry is that parents and kids will just add another sport on top," Field said. "So they'll keep their current sport and do it at a very high level and just add one more sport so they're not 'specializing.' That would really increase their volume, so it probably would not be a good idea."

    Instead, Field said the best recommendation is to moderate the amount of time young athletes spend engaging in vigorous physical activity -- and if they must specialize in a sport, replace some of their training with different forms of exercise, such as yoga and conditioning.

    Field said a common fear among parents is that if their children don't play more and more, they'll fall behind in their sport and won't ultimately be as good of an athlete.

    "But it may actually be the opposite," she said. "If children do too much, they may get injured and fall behind. And it's important also to remember that they should enjoy doing their sport; it should be something that doesn't overwhelm their life."

    The study also suggests that sports specialization carries risks even when considered separately from volume of activity. These risk patterns differed for girls versus boys. For girls, once volume was accounted for, no particular sport stood out as being extra risky to specialize in. However, specialization in general increased girls' risk of injury by about 30 percent.

    In contrast, specialization in general did not significantly increase boys' risk of injury, once volume was accounted for. But certain sports -- baseball or gymnastics/cheerleading -- did increase their risk.

    Field said the precise reasoning behind the gender differences in risk is not yet clear, but it's an area the researchers hope to explore further in future studies. For girls in particular, they also plan to examine age-related differences.

    "There's been a lot of concern about females having higher risk of certain injuries," Field said. "The question is: Is that risk highest just as they're going through their pubertal growth spurt, and then does it come back down a bit? And then we need to talk to coaches and trainers and say, 'What can we do to mitigate that risk?'"
     
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    The associations of early specialisation and sport volume with musculoskeletal injury in New Zealand children
    Jody McGowan et al
    February 2020Volume 23, Issue 2, Pages 139–144
     
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    Comparing Burnout in Sport-Specializing Versus Sport-Sampling Adolescent Athletes: A Systematic Review and Meta-analysis
    Nicolas E. Giusti, BS, Seth L. Carder, BS, Lisa Vopat, MD, ...
    Orthopaedic Journal of Sports Medicine March 2, 2020
     
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    Associations of Early Sport Specialization and High Training Volume With Injury Rates in National Collegiate Athletic Association Division I Athletes
    Seth Ahlquist, BS, Brian M. Cash, MD, Sharon L. Hame, MD
    Orthopaedic Journal of Sports Medicine March 12, 2020
     
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    Achieving a desired training intensity through the prescription of external training load variables in youth sport: More pieces to the puzzle required
    Sean Scantlebury et al
    Journal of Sports Sciences: 30 Mar 2020
     
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    EARLY SPORT SPECIALIZATION IN YOUNG FEMALE FIGURE SKATERS
    D Sugimoto, PhD, ATC, K Lambrinakos-Raymond, MD, GP Kobelski, BS, ...
    Orthopaedic Journal of Sports Medicine April 30, 2020
     
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    EFFECTS OF SPORTS SPECIALIZATION ON LOWER EXTREMITY SAGITTAL PLANE LOADING IN ADOLESCENT MALES AND FEMALES
    Shiho Goto, PhD, ATC, Joseph P. Hannon, PT, PhD, Angellyn N. Grondin, MS, CCRP, ...
    April 30, 2020
     
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    FAMILY AFFLUENCE RELATIONSHIP TO SPORTS SPECIALIZATION IN YOUTH ATHLETES
    Gregory A. Walker, MD, Aubrey Armento, MD, Katherine S. Dahab, MD, ...
    Orthopaedic Journal of Sports Medicine April 30, 2020
     
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