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Background: Rates of emergency action plan (EAP) implementation and compliance with EAP guidelines vary in United States secondary schools. There are limited data on emergency preparedness in schools without athletic trainers (ATs)., Hypothesis: Rural and high poverty schools have poor emergency preparedness for high school athletic events due to financial barriers and lack of ATs., Study Design: Cross-sectional study., Level of Evidence: Level 5., Methods: A web-based questionnaire was emailed by each State High School Athletics Association to ATs, athletic directors, and coaches of recipient schools to assess emergency preparedness., Results: A total of 686 responses were received (response rate ~3.5%). Schools with an AT on staff were more likely to have an EAP ( P < 0.01). Schools with a higher enrollment were more likely to have an EAP ( P < 0.01), an AT on staff ( P < 0.01), require additional training for coaches ( P < 0.01), and have an automated external defibrillator (AED) onsite for all events ( P < 0.01). Urban (odds ratio [OR], 3.514; 95% CI [2.242, 5.507]; P < 0.01) and suburban (OR, 4.950; 95% CI [3.287, 7.454]; P < 0.01) districts were more likely than rural districts to have an AT on staff. High poverty districts were less likely to have an AED (OR, 0.660; 95% CI [0.452, 0.964]; P = 0.03) or EAP (OR, 0.511; 95% CI [0.306, 0.853]; P < 0.01) at athletic venues., Conclusion: Lower enrollment, high poverty, and rural schools are less prepared for athletic emergencies than their higher enrollment, low poverty, and suburban counterparts as these schools are generally less likely to have an AT on staff, AEDs, and EAPs and less likely to provide additional training to coaches and other staff., Clinical Relevance: This study assesses athletic emergency preparedness-a critical component of ensuring athlete safety and recovery after injury., Competing Interests: The following authors declared potential conflicts of interest: R.B. has received speaking fees from Gatorade. B.G.V. has received consulting fees from Artelon and DePuy, research support from Stryker, and holds stock options with Altior, Carbon 22, and Spinal Simplicity.

Background: Anterior cruciate ligament (ACL) injuries are among the most common injuries in adolescent athletes and result in significant financial and physical morbidity. Evidence-based programs designed to prevent ACL injury are effective. However, their adoption remains low. We sought to evaluate the awareness, evidence-based implementation, and barriers to implementation of ACL injury prevention programs (ACL-IPP) among youth athletic coaches., Hypothesis: Higher education level of the coach, higher level of training, number of teams coached, and coaching female teams would be associated with ACL-IPP implementation., Study Design: Cross-sectional survey., Level of Evidence: Level 4., Methods: We conducted an email survey sent to all 63 school districts within Section VI of the New York State Public High School Athletic Association. We employed descriptive statistics and tests of correlation to identify factors associated with ACL-IPP implementation., Results: A total of 73% of coaches said they were aware of ACL-IPP, and only 12% of coaches implemented ACL-IPP according to best evidence. Coaches of higher competitive levels were more likely to adopt ACL-IPP ( P = 0.01), more likely to use them multiple times per week ( P = 0.03), and for ≥1 seasons ( P = 0.02). Coaches of multiple teams were more likely to adopt ACL-IPP ( P = 0.01). There were no differences in evidence-based implementation of ACL-IPP with gender coached or level of education of the coach., Conclusion: Overall awareness, adoption, and evidence-based implementation of ACL-IPP remain low. These results suggest that coaches at higher levels of play and multiple teams tend to use ACL-IPP more often. Gender coached and level of education do not appear to be associated with awareness or implementation., Clinical Relevance: Evidence-based ACL-IPP implementation remains low. Targeting coaches of younger athletes and fewer teams with local outreach programs and ACL-IPP may increase the implementation of ACL-IPP., Competing Interests: The following author declared potential conflicts of interest: L.J.B. has received a grant from NIH.

Context: Participation in sports during youth is typically beneficial for mental health. However, it is unclear whether elite sport contexts contribute to greater risk of psychological distress or disorder. The aims of this paper are to highlight conceptual issues that require resolution in future research and practice, and to examine the key factors that may contribute to the mental health of elite youth athletes (EYAs)., Evidence Acquisition: A narrative overview of the literature combined with the clinical and research expertise of the authors., Study Design: Narrative overview., Level of Evidence: Level 5., Results: EYAs experience a range of biopsychosocial developmental changes that interact with mental health in a multitude of ways. In addition, there are various sport-specific factors that contribute to the mental health of EYAs that may become more prominent in elite contexts. These include - but are not limited to - patterns relating to athlete coping and self-relating styles, the nature of peer, parental, and coach relationships, organizational culture and performance pressures, and mental health service provision and accessibility., Conclusion: A range of critical factors across individual, interpersonal, organizational, and societal domains have been shown to contribute to mental health among EYAs. However, this evidence is limited by heterogeneous samples and varied or imprecise terminology regarding what constitutes "youth" and "elite" in sport. Nevertheless, it is clear that EYAs face a range of risks that warrant careful consideration to progress to best practice principles and recommendations for mental health promotion and intervention in elite youth sport., Sort: Level C., Competing Interests: The following authors declared potential conflicts of interest: V.P. has received funding support from the Margaret Cohan Research Scholarship at University of Melbourne. S.R. has received grants from Dame Kate Campbell Fellowship, National Health and Medical Research Council, Medical Research Future Fund, and Australian Football League. K.A.T. has received grants from University of Toronto, royalties from Pearson, and honoraria from the Ladd Foundation (1616 Program).

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., Competing Interests: The following author declared potential conflicts of interest: B.R.E. has received speaking fees from Medical Education Speakers Network, and her institution has received a grant through the AMSSM Minority Research Grant.

Background: Participation in high school cross-country and track has increased over the last few decades. At the same time, the rate of pedestrian-involved motor vehicle crashes (MVCs) has also increased. In the context of organized sport, pedestrian safety among runners is often not highlighted, despite the risk of catastrophic injury., Purpose: To describe incidents of pedestrian-involved MVCs involving student athletes captured by the National Center for Catastrophic Sport Injury Research (NCCSIR) at the University of North Carolina at Chapel Hill., Study Design: Case series., Level of Evidence: Level 5., Methods: This study utilized surveillance data from the NCCSIR from 2011 to 2020. It presents descriptive statistics, including frequencies and percentages, detailed summaries, and a Haddon Matrix., Results: There were 8 incidents involving 11 student athletes, resulting in 9 fatalities. Of these, 5 cases occurred in the afternoon or early evening, 4 occurred in the Fall, and 6 occurred in a rural area. Haddon Matrix analyses of case descriptions indicate schools should implement a runner safety program for all new runners and ensure that runner safety measures are included in emergency action plans., Conclusion: Runner-related MVCs are relatively rare, but tragic, incidents. Pedestrian safety measures should be incorporated into school-sponsored practices and training runs., Clinical Relevance: Pedestrian safety should be incorporated into runner safety and injury prevention efforts.

Background: Adolescent athletes report that sports specialization improves their ability to receive a collegiate athletics scholarship, though this is not well-understood. The purpose of this study was to examine self-reported trends in high school specialization and influences for sport participation between Division I (D-I) and college-aged club (club) athletes., Hypothesis: There would be no difference in high school sport specialization or sport participation influences between D-I and club athletes., Study Design: Retrospective cross-sectional study., Level of Evidence: Level 3., Methods: A survey included specialization classification (low, moderate, and high) for 9th to 12th grade, age that the athlete started organized sport and his or her collegiate sport, and several influential factors for participation in one's primary high school sport (1 = no influence to 5 = extremely influential). Chi-square analyses were used to compare specialization classifications between groups. Nonparametric tests were used to determine significant differences in age-related variables and influential factors between D-I and club athletes. All analysis were also conducted with boys and girls separately., Results: Participants included 266 D-I (girls, 155; 58%) and 180 club (girls, 122; 68%) athletes. Club athletes were more likely to be classified as low specialization at every grade in high school, and this difference was more pronounced between D-I and club female athletes than male athletes. The number of years an athlete was classified as highly specialized in high school was not different between D-I and club athletes. Club athletes were more influenced by playing with friends than D-I athletes and D-I athletes were more influenced by pursuing a collegiate scholarship than club athletes., Conclusion: High levels of specialization in high school sport may not be necessary for playing at the collegiate level, though some level of specialization in high school might be necessary., Clinical Relevance: Clinicians should advocate for healthy long-term athlete development, which does not support high specialization in high school sports.

Context: Youth athletes may be at elevated risk for adverse health due to sport specialization. Sport organizations have developed guidelines for participation during growth and development., Objective: To assess youth sport development guidelines using a 15-item framework across sport organizations and governing bodies in soccer, basketball, ice hockey, and swimming., Data Sources: English-language results from January 1, 2000, to December 31, 2018, from published sport organization guidelines and athlete development plans., Study Selection: Two investigators independently reviewed publications identified from sport organizations. A total of 23 guidelines were incorporated, including 5 general sport organizations and 18 sport-specific guidelines., Study Design: Systematic review., Level of Evidence: Level 4., Data Extraction: Two investigators independently identified all recommendations that fit within a predetermined rubric of recommendations encompassing 4 domains: Psychological Development/Approach, Physical Development/Load, Facilities and Resources, and Timing and Monitoring of Specialization. Sport-specific guidelines on volume were summarized., Results: Sport organizations and sport-specific guidelines had consensus on 2 items out of the 15-item: emphasis on early skill development and access to well-trained coaches. While recommended by all sports organization, multisport participation was emphasized by 3 of 4 sports, excluding soccer. Volume recommendations were inconsistent between and within sports. No group proposed methods to monitor athlete well-being., Conclusion: This review highlights areas of agreement within sport organizations and governing bodies. Creating a framework to guide youth sport specialization may lead to specific and consistent guidelines.

Context: Youth sport specialization may place young athletes at increased risk for negative impacts to their physical and/or psychological health. In response to these health concerns, several health organizations have created guidelines and position statements to guide parents and practitioners toward best practices for management of the young athlete., Objective: To systematically review and synthesize current organizations' recommendations and guidelines regarding youth sport specialization., Data Sources: English-language articles from January 1, 2000, to December 31, 2018, in the NCBI Pubmed, Embase, Cochrane, CINAHL, and SPORTDiscus databases., Study Selection: Articles that reported on recommendations or interventions by health organizations or health representatives of sports organizations. A total of 56 articles were assessed, with 11 meeting inclusion eligibility criteria., Study Design: Systematic review., Level of Evidence: Level 4., Data Extraction: Two investigators independently identified all recommendations within the results that fit within a 15-item framework encompassing 4 domains: Psychological Development/Approach, Physical Development/Load, Facilities and Resources, and Timing and Monitoring of Specialization., Results: Recommendations across organizations were primarily clustered in the Physical Development/Load (43%), Facilities and Resources (48%), and Sport Specialization (55%) domains. In contrast, the Psychological Development/Approach domain had fewer recommendations (20%). The most common recommendations endorsed concepts: "Monitor athlete well-being," "Youth athletes need access to well-trained, quality coaches," "Multi-sport participation," "Limit early organized participation and/or training," and "Parents require awareness of training, coaching, and best practices." The level of evidence provided to support a given recommendation varied significantly. The level of detail and the consistency of terms used throughout the results were typically low. Recommendations were frequently made without reference to potential outcome measures or specific strategies that could be used for practical implementation in the community., Conclusion: There was broad representation of different aspects of specialization but limited consistency between health organization guidelines. Adopting a framework for recommendations as used in this review could assist organizations in structuring future recommendations that are specific, measurable, and framed in a manner that will promote action in the youth sport community.

Context: Physical activity has shown to be beneficial for the overall physical and mental health of youth. There has been an increasing focus on youth sports moving from a recreational activity to becoming a launching pad for participation at elite levels. Several models of athlete development have emerged to guide specialized and nonspecialized athletes at an age-appropriate level, taking into consideration their physical and mental development. The purpose of this review is to summarize the current evidence and theoretical models regarding youth athlete development and discuss broader initiatives for sports participation and future directions for the field., Evidence Acquisition: An electronic databases search, including PubMed, Google Scholar, ScienceDirect, National Institutes of Health, UpToDate, and Springer was conducted. Articles from 1993 to 2021 were included. The search terms long term athlete development , LTAD model , youth physical development , youth athlete development , sports specialization , and pediatric athlete , among others, were used., Study Design: Narrative review., Level of Evidence: Levels 4 and 5., Results: Several models of youth athlete development are discussed in this article. More recent models have built on previous models to incorporate more age- and development-specific recommendations; however, no singular model could be identified as the gold standard for youth athlete development, especially given the lack of empirical data to support these models., Conclusion: Youth athlete development currently consists of several theoretical models, each with their own strengths and weaknesses, that can guide the training of young athletes to maximize their performance. Those involved in this process-physicians, athletic trainers, coaches, physical educators, and parents-should understand these various models and trial their various features to see what works best for their individual athlete with consideration given to factors such as their stage of development. Ultimately, more empirical data are required to definitively state which is the optimal approach.

Background: Concerns for youth sports in the United States often focus on early sport specialization, overemphasis on competition, injuries, and burnout. Little research has addressed relationships among the preceding and other concerns, including time away from organized sport, sleep, and perceptions of physical and psychological well-being., Hypothesis: There is an association between reported competitive gameplay volume and specialization, injury, and fatigue among elite youth basketball players., Study Design: Cross-sectional study; convenience sample., Level of Evidence: Level 4., Methods: An anonymous questionnaire was administered to a convenience sample of youth basketball players between 13 and 18 years of age from across the United States. Participants were queried about multiple factors, including the extent of their participation in organized basketball and other sports, time away from organized basketball, injury, sleep, and feelings of exhaustion related to basketball participation., Results: A total of 772 participants (145 girls, 627 boys) completed a survey. All participants played for a select or elite club basketball team and/or a high school basketball team. Overall, 49% played more than 50 games within the past year. A total of 73% were specialized in basketball, 58% prior to age 14 years, and 35% prior to age 11 years. In all, 70% reported less than 1 month away from organized basketball within the past year, and 28% reported no time away. A total of 54% reported sleeping less than the recommended 8 hours each night during the school year. Within the prior year, 55% reported feeling physically exhausted and 45% reported feeling mentally exhausted from basketball. Regression analysis did not find any significant relationships between early specialization prior to age 14 years and basketball-related injury or feelings of mental or physical exhaustion., Conclusion: In this select group of youth basketball players, the majority specialized in basketball prior to age 14 years and reported a large number of competitive events with little time away from organized basketball., Clinical Relevance: The results from a sample of highly competitive youth basketball players indicate issues that warrant further attention and research regarding the potential impact of specialization, frequent competitions, lack of time away from organized sport, and perceptions of well-being in young athletes.

Background: Significant evidence has emerged that sport specialization is associated with an increased risk of overuse injury in youth athletes. Several recommendations exist to reduce the risk of overuse injury in youth sports, but the risk of overuse injuries may be dependent on specific movements required by a given sport., Hypotheses: Associations between specialized sport participation and overuse injury will exist in volleyball athletes but not soccer or basketball athletes. Female athletes will be more likely to report an overuse injury in the previous year, regardless of sport., Study Design: Cross-sectional study., Level of Evidence: Level 3., Methods: Youth athletes between the ages of 12 and 18 years were recruited in-person at club team tournaments, competitions, and events around the state of Wisconsin during the 2016-2017 school year. Participants were asked to complete an anonymous questionnaire that consisted of (1) participant demographics, (2) sport specialization status, (3) monthly and weekly sport volume, and (4) sport-related injury history in the previous year., Results: A total of 716 youth athletes completed the questionnaire (70.8% female; mean age, 14.21 ± 1.50 years; 43.2% basketball, 19.4% soccer, 37.4% volleyball; 41.8% highly specialized; 32.3% reported overuse injury in the previous year). Sex was associated with overuse injury among basketball athletes, with female basketball athletes nearly 4 times more likely to report an overuse injury compared with male basketball athletes (odds ratio, [OR], 3.7; 95% CI, 2.1-6.6; P < 0.001). High specialization (OR, 2.3; 95% CI, 1.1-4.9; P = 0.02) and participating in a single sport for more than 8 months per year (OR, 2.0; 95% CI, 1.1-3.5; P < 0.05) were associated with overuse injury only among volleyball athletes., Conclusion: Specialization and exceeding 8 months per year in a single sport was associated with overuse injury in volleyball, which is one of the most popular youth sports for female athletes. Specialization was not associated with overuse injury in basketball or soccer athletes. Female basketball athletes were nearly 4 times more likely to report a history of overuse injury compared with male basketball athletes. The sex of a youth athlete and the sport that he or she plays may influence the risk of overuse injury associated with sport specialization., Clinical Relevance: Youth athletes, parents, and clinicians should be aware that the potential risks of specialization might vary based on the athlete's sport and sex.

Background: Few studies have examined white matter with diffusion tensor imaging in 8- to 12-year-old collision sport (CS) athletes., Hypothesis: Youth CS athletes will demonstrate change in brain fractional anisotropy (FA) after a season of CS compared with an age-matched noncollision sport (NCS) cohort, and the number, magnitude, and location of hits will correlate with changes in the brain determined via FA for CS athletes., Study Design: Prospective cohort study., Level of Evidence: Level 3., Methods: Thirty-five 8- to 12-year-old males in a youth tackle football league (CS) and 12 males from local swim teams (NCS) were recruited. Participants underwent brain magnetic resonance imaging with FA before and after the football season. Number, magnitude, and direction of head impacts were recorded for CS participants throughout the season., Results: A total of 1905 hits were recorded in the CS group for the season, 341 (17.9%) collected during 7 games and 1564 (82.1%) observed during 31 practices. No significant interaction between group (CS and NCS) and time (pre- and postseason) was observed for FA ( P > 0.05). Correlation analysis revealed a significantly positive and moderate relationship between increase of left cingulate cortex (CgC) FA from pre- to postseason and the total magnitude of lateral head impacts ( r = 0.40; P = 0.03)., Conclusion: There was no significant change in FA measurement of white matter integrity in a cohort of 8- to 12-year-old males after a season of youth football, nor was any difference detected in FA between youth football players and an age-matched cohort of swimmers. There was a significant correlation between total magnitude of hits sustained by youth football players and an increase in FA in the left CgC; whether this is adaptive or pathologic remains unknown., Clinical Relevance: These data can be used within the body of knowledge to counsel patients regarding the known risks of youth tackle football regarding brain health.

Background:: Sudden cardiac arrest (SCA) is the leading cause of death in young athletes during sports., Hypothesis:: Survival after SCA in young athletes is variable., Study Design:: Prospective, active surveillance study., Level of Evidence:: Level 3., Methods:: From July 1, 2014, to June 30, 2016, exercise-related SCA in competitive young athletes was identified through a systematic search of traditional and social media sources, direct reporting to the National Center for Catastrophic Sports Injury Research, searching of the National Collegiate Athletic Association Resolutions List, regular communication with national and state high school athletic associations, and review of cases in the Parent Heart Watch database., Results:: A total of 132 cases were identified during the 2-year study period (mean patient age, 16 years; age range, 11-27 years; 84% male; 51% white non-Hispanic/Latino, 30% black/African American, and 11% white Hispanic/Latino). High school athletes accounted for 78 (59%) cases, with 28 (21%) in middle school and 15 (11%) in college athletes. Overall survival was 48% (95% CI, 40%-57%; 64 survivors, 68 deaths). Survival was similar in male versus female athletes but higher in white non-Hispanic/Latino (40/67; 60%) versus black/African American (13/39; 33%) athletes (difference, 27%; 95% CI, 7%-45%; P = 0.008) and white non-Hispanic/Latino versus all minority (18/59; 31%) athletes (difference, 29%; 95% CI, 13%-46%; P = 0.001). Basketball accounted for 30% of cases, followed by football (25%), track/cross-country (12%), and soccer (11%). The majority (93%) of cases were witnessed. If a certified athletic trainer was on-site and involved in the resuscitation, 83% of athletes survived. If an on-site automated external defibrillator was used in the resuscitation, 89% of athletes survived., Conclusion:: Exercise-related SCA in young, competitive athletes is typically witnessed, providing an opportunity for rapid resuscitation. Additional research is needed to identify factors that affect survival in different athlete populations., Clinical Relevance:: Public access defibrillator programs should be universal in schools and youth sporting venues and have the potential to increase survival after SCA in young athletes.

Background: High school athletes are increasingly encouraged to participate in 1 sport year-round to increase their sport skills. However, no study has examined the association of competition volume, club sport participation, and sport specialization with sex and lower extremity injury (LEI) in a large sample of high school athletes., Hypothesis: Increased competition volume, participating on a club team outside of school sports, and high levels of specialization will all be associated with a history of LEI. Girls will be more likely to engage in higher competition volume, participate on a club team, and be classified as highly specialized., Study Design: Cross-sectional study., Level of Evidence: Level 3., Methods: High school athletes completed a questionnaire prior to the start of their competitive season regarding their sport participation and previous injury history. Multivariable logistic regression analyses were used to investigate associations of competition volume, club sport participation, and sport specialization with history of LEI, adjusting for sex., Results: A cohort of 1544 high school athletes (780 girls; grades 9-12) from 29 high schools completed the questionnaire. Girls were more likely to participate at high competition volume (23.2% vs 11.0%, χ 2 = 84.7, P < 0.001), participate on a club team (61.2% vs 37.2%, χ 2 = 88.3, P < 0.001), and be highly specialized (16.4% vs 10.4%, χ 2 = 19.7, P < 0.001). Athletes with high competition volume, who participated in a club sport, or who were highly specialized had greater odds of reporting a previous LEI than those with low competition volume (odds ratio [OR], 2.08; 95% CI, 1.55-2.80; P < 0.001), no club sport participation (OR, 1.50; 95% CI, 1.20-1.88; P < 0.001), or low specialization (OR, 2.58; 95% CI, 1.88-3.54; P < 0.001), even after adjusting for sex., Conclusion: Participating in high sport volume, on a club team, or being highly specialized was associated with history of LEI. Girls were more likely to participate at high volumes, be active on club teams, or be highly specialized, potentially placing them at increased risk of injury., Clinical Relevance: Youth athletes, parents, and clinicians should be aware of the potential risks of intense, year-round participation in organized sports.

Background: Sport specialization and movement asymmetry have been separately discussed as potential risk factors for lower extremity injury. Early specialization may lead to the development of movement asymmetries that can predispose an athlete to injury, but this has not been thoroughly examined., Hypothesis: Athletes rated as specialized would exhibit greater between-limb anterior reach asymmetry and decreased anterior reach distance on the Y-balance test (YBT) as compared with nonspecialized high school athletes, and these differences would not be dependent on sex., Study Design: Cross-sectional study., Level of Evidence: Level 3., Methods: Two hundred ninety-five athletes (117 male, 178 female; mean age, 15.6 ± 1.2 years) from 2 local high schools participating in basketball, soccer, volleyball, and tennis responded to a questionnaire regarding sport specialization status and performed trials of the YBT during preseason testing. Specialization was categorized according to 3 previously utilized specialization classification methods (single/multisport, 3-point scale, and 6-point scale), and interactions between specialization and sex with Y-balance performance were calculated using 2-way analyses of variance., Results: Single-sport male athletes displayed greater anterior reach asymmetry than other interaction groups. A consistent main effect was observed for sex, with men displaying greater anterior asymmetry and decreased anterior reach distance than women. However, the interaction effects of specialization and sex on anterior Y-balance performance varied based on the classification method used., Conclusion: Single-sport male athletes displayed greater anterior reach asymmetry on the YBT than multisport and female athletes. Specialization classification method is important because the 6- and 3-point scales may not accurately identify balance abnormalities. Male athletes performed worse than female athletes on both of the Y-balance tasks., Clinical Relevance: Clinicians should be aware that single-sport male athletes may display deficits in dynamic balance, potentially increasing their risk of injury.

Background: Sport specialization is a strategy to acquire superior sport performance in 1 sport but is associated with increased injury risk. Currently, the degree of high school specialization among Division I athletes is unknown., Hypothesis: College athletes will display increased rates of specialization as they progress through their high school careers., Study Design: Descriptive epidemiological study., Level of Evidence: Level 4., Methods: Three hundred forty-three athletes (115 female) representing 9 sports from a Midwest Division I University completed a previously utilized sport specialization questionnaire regarding sport participation patterns for each grade of high school. McNemar and chi-square tests were used to investigate associations of grade, sport, and sex with prevalence of sport specialization category (low, moderate, high) (a priori P ≤ 0.05)., Results: Specialization increased throughout high school, with 16.9% (n = 58) and 41.1% (n = 141) of athletes highly specialized in 9th and 12th grades, respectively. Football athletes were less likely to be highly specialized than nonfootball athletes for each year of high school ( P < 0.001). There was no difference in degree of specialization between sexes at any grade level ( P > 0.23)., Conclusion: The majority of Division I athletes were not classified as highly specialized throughout high school, but the prevalence of high specialization increased as athletes progressed through high school. Nonfootball athletes were more likely to be highly specialized than football athletes at each grade level., Clinical Relevance: Most athletes who are recruited to participate in collegiate athletics will eventually specialize in their sport, but it does not appear that early specialization is necessary to become a Division I athlete. Athletes should be counseled regarding safe participation in sport during high school to minimize injury and maximize performance.