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.

Sex and Gender Differences in Pediatric Knee Injuries.

The participation of females in sports has increased significantly since the passage of Title IX. Sports participation may place young athletes at risk for knee injuries, including patellofemoral pain syndrome (PFPS), osteochondritis dissecans (OCD), and anterior cruciate ligament (ACL) rupture. Differences in anatomy, hormone production, and neuromuscular patterns between female and male athletes can contribute to disparities in knee injury rates with female athletes more vulnerable to PFPS and ACL injury. Biological differences between sexes alone cannot fully explain worldwide differences in musculoskeletal health outcomes. Social, cultural and societal attitudes toward gender and the participation of girls and women in sports may result in a lack of accessible training for both injury prevention and performance optimization; one must recognize the effects of gender disparities on injury risk. More nuanced approaches to assess the complex interplay among biological, physiologic, and social influences are needed to inform best practices for intervention and sports injury prevention.

The Impact of Race, Insurance, and Socioeconomic Factors on Pediatric Knee Injuries.

Disparities persist in pediatric sports medicine along the lines of race, ethnicity, insurance status, and other demographic factors. In the context of knee injuries such as anterior cruciate ligament (ACL) ruptures, meniscus tears, and tibial spine fractures, these inequalities affect evaluation, treatment, and outcomes. The long-term effects can be far-reaching, including sports and physical activity participation, comorbid chronic disease, and socio-emotional health. Further research is needed to more concretely identify the etiology of these disparities so that effective, equitable care is provided for all children.

Athletic Identity in Youth Athletes: A Systematic Review of the Literature.

Athletic identity (AI), the degree of personal connection to sport, is well-described in adult research; however, this social trait has been less studied in younger age groups. This systematic review describes epidemiological characteristics of AI in youth athletes. PubMed, Embase and PsycInfo were searched to identify AI studies involving quantitative athlete identity outcomes and cohorts 22 years and younger. The search strategy was developed for each database using the Boolean method. PRISMA guidelines and the Appraisal Tool for Cross-Sectional Studies (AXIS) were utilized. Ten out of ninety-one studies met inclusion criteria. AI scores differed by race/ethnicity. Two studies found increased AI during adolescence compared to later in ones' training. Mental health-focused studies revealed higher AI levels protect against burnout, but in injured athletes, increased depression risk. Transitioning to a higher level of play during adolescence can correlate with stronger senses of AI. Further research should explore the concept of athletic identity saliency as one moves through an athletic career or training program and how thoughts of perceived success, professional progression, recruitment prospect or injury affect levels of athletic identity.

Movement variability in pre-teen and teenage athletes performing sports related tasks.

BACKGROUND: Understanding movement variability is important to guide biomechanical assessment. Variability may change with age, and more repetitions of a movement need to be assessed when variability is high. RESEARCH QUESTION: This study quantified the trial-to-trial (within subject) variability of three tasks commonly assessed during sports biomechanical testing: vertical drop jump, heel touch (single leg squat from step), and single leg hop. We hypothesized that pre-teen athletes would exhibit greater variability than more mature teenage athletes when performing all of these movements. METHODS: Fifty-five uninjured pediatric athletes ages 7-15 years performed 3 repetitions of vertical drop jump, heel touch, and single leg hop for distance tasks during 3D motion analysis testing. Trial-to-trial variability was assessed using the standard deviation (SD) and range (maximum-minimum) of clinically relevant kinematic and kinetic metrics among the multiple repetitions of each task performed by each participant. Variability was compared between age groups using 2-sided t-tests. Standard error of measurement (SEM) and minimum detectable difference (MDD) were also calculated for each variable of interest. RESULTS: For drop jump and heel touch, kinetic variability was similar between groups, but the younger group had greater kinematic variability. However, the older group was much more variable than the younger group during single leg hop landing, particularly in terms of kinetics and sagittal plane kinematics. Overall, kinematic variability had a median within-subject SD of 1-9°, median range of 2-17°, and 95th percentile for range of >15-20° for many of the variables examined. MDD was >10° for many kinematic variables, >0.2 Nm/kg for all frontal plane moments, >0.4 Nm/kg for most sagittal plane moments, and >0.5 W/kg for most energy absorption variables. SIGNIFICANCE: The high within-subject trial-to-trial variability in performing sports tasks suggests that multiple trials should be analyzed for a more complete and representative evaluation.

Assessing the effects of sleep on neurocognitive performance and injury rate in adolescent athletes using actigraphy.

The National Sleep Foundation recommends that adolescents (age 14-17 years) sleep 8 to 10 hours per night. Sleep loss is associated with cognitive dysfunction, decreased reaction time, and poorer athletic performance. This study evaluated the effects of sleep on sports injury rate and academic and cognitive performance. Seventeen high school track and field athletes (7 males, 10 females, mean age 15.9 years) wore an actigraph device for 10 weeks and performed a computerized neurocognitive assessment. Overall, 900 nights of nocturnal sleep data were analysed. Total minutes in bed averaged 501 minutes (8 hours and 21 minutes) and total sleep time averaged 378 minutes (6 hours and 18 minutes). Statistically significant correlations were observed between mean total sleep time and age-adjusted scores for the neurocognitive domains of episodic memory (p = .03) and fluid cognition (p = .03). Sleep loss in student-athletes may result in greater cognitive difficulties and impair academic abilities in the classroom.

Improvements in landing biomechanics following anterior cruciate ligament reconstruction in adolescent athletes.

Motion analysis offers objective insight into biomechanics, rehabilitation progress and return to sport readiness. This study examined changes in three-dimensional movement patterns during drop jump landing between early and late stages of rehabilitation in adolescent athletes following anterior cruciate ligament reconstruction (ACLR). Twenty-four athletes (58% female; mean age 15.4 years, SD 1.2) with unilateral ACLR underwent motion analysis testing 3-6 months and again 6-10 months post-operatively. Kinematics and kinetics were compared between visits and between limbs using repeated measures ANOVA. The operative side exhibited lower vertical ground reaction force, less energy absorption and lower sagittal external moments at the knee and ankle, and lower peak dorsiflexion angles compared with the non-operative side regardless of visit. Between visits, hip and knee flexion increased bilaterally, as well as hip flexion moments and energy absorption. During early rehabilitation following ACLR, adolescent athletes reduced flexion and loading of the knee and ankle on their operative limb. Motion and loading increased over time, particularly at the hip, but remained reduced at the knee and ankle 6-10 months post-operatively.

Side Plank Pose Exercises for Adolescent Idiopathic Scoliosis Patients.

BACKGROUND: Fishman et al. reported that side plank poses asymmetrically strengthened the convex side of the curve and decreased primary Cobb angle by 49% among compliant patients with adolescent idiopathic scoliosis (AIS). METHODS: AIS patients with curves of 10° to 45° were randomized into the front plank (control) or side plank group. The side plank was performed with their curve convex down. A weekly survey monitored compliance, defined by completing poses 4 or more times a week. RESULTS: A total of 64 patients were enrolled; 34% (22 of 64) of patients (mean age = 13 years) were compliant. In the control group, there were 11 compliant patients with 6 undergoing brace treatment. At enrollment, they had a mean Cobb angle of 30° (range: 14°-40°) and mean scoliometer reading of 13°. At 6 months, they had a mean Cobb angle of 30° (range: 14°-42°) and mean scoliometer of 12°. In the side plank group, there were 11 compliant patients with 5 undergoing brace treatment. At enrollment, they had a mean Cobb angle of 32° (range: 21°-44°) and mean scoliometer reading of 12°. At 6 months, they had a mean Cobb angle of 31° (range: 17°-48°) and a mean scoliometer reading of 13°. There were no significant changes in either the control or side plank group in regards to primary Cobb angle (control: P = .53, side plank: P = .67) or scoliometer (control: P = .22, side plank: P = .45). CONCLUSION: There were no significant changes in primary Cobb angle or scoliometer after 6 months of side plank exercises. In contrast to a prior study, there was no improvement in curve magnitude in AIS patients performing side plank exercises.

A Pilot Study on Resident and Pediatrician Knowledge and Confidence in the Diagnosis of Slipped Capital Femoral Epiphysis.

Introduction. The purpose of this study was to identify deficiencies in pediatric residents' and pediatricians' knowledge and confidence in diagnosing slipped capital femoral epiphysis (SCFE). Methods. Pediatricians and residents at our institution answered an anonymous 12-question survey on knowledge and confidence in SCFE diagnosis. Results. Twenty pediatricians and 30 pediatric residents participated in the survey. Of 30 residents, 22 (77%) reported low confidence ordering radiographs evaluating for SCFE in patients with hip pain. Four of 20 pediatricians (20%) reported low confidence ordering radiographs for patients with hip pain. Forty percent (8/20) of pediatricians did not feel comfortable diagnosing a SCFE based on radiographs, which was significantly different from 80% (24/30) of residents who did not feel comfortable diagnosing a SCFE based on radiographs (P = .004). There was a significant difference between residents and pediatricians in comfort ordering and diagnosing radiographs (P < .01). There was no significance between pediatrician and resident scores for knowledge-based questions (P = .50). Discussion. Despite scoring well on knowledge-based questions, more than half of pediatricians and pediatric residents felt uncomfortable ordering radiographs to evaluate for SCFE in patients with hip or knee pain. This may be one factor contributing to the continued delay in SCFE diagnosis.

Hop Distance Symmetry Does Not Indicate Normal Landing Biomechanics in Adolescent Athletes With Recent Anterior Cruciate Ligament Reconstruction.

Background Return-to-sport protocols after anterior cruciate ligament reconstruction (ACLR) often include assessment of hop distance symmetry. However, it is unclear whether movement deficits are present, regardless of hop symmetry. Objectives To assess biomechanics and symmetry of adolescent athletes following ACLR during a single-leg hop for distance. Methods Forty-six patients with ACLR (5-12 months post surgery; 27 female; mean ± SD age, 15.6 ± 1.7 years) were classified as asymmetric (operative-limb hop distance less than 90% that of nonoperative limb [n = 17]) or symmetric (n = 29) in this retrospective cohort. Lower extremity biomechanics were compared among operative and contralateral limbs and 24 symmetric controls (12 female; mean ± SD age, 14.7 ± 1.5 years) using analysis of variance. Results Compared to controls, asymmetric patients hopped a shorter distance on their operative limb (P<.001), while symmetric patients hopped an intermediate distance on both sides (P≥.12). During landing, the operative limb, regardless of hop distance, exhibited lower knee flexion moments compared to controls and the contralateral side (P≤.04), with lower knee energy absorption than the contralateral side (P≤.006). During takeoff, both symmetric and asymmetric patients had less hip extension and smaller ankle range of motion on the operative side compared with controls (P≤.05). Asymmetric patients also had lower hip range of motion on the operative, compared with the contralateral, side (P = .001). Conclusion Both symmetric and asymmetric patients offloaded the operative knee; symmetric patients achieved symmetry, in part, by hopping a shorter distance on the contralateral side. Therefore, hop distance symmetry may not be an adequate test of single-limb function and return-to-sport readiness. J Orthop Sports Phys Ther 2018;48(8):622-629. Epub 30 Mar 2018. doi:10.2519/jospt.2018.7817.

Biomechanical Modeling of Spine Flexibility and Its Relationship to Spinal Range of Motion and Idiopathic Scoliosis.

STUDY DESIGN: Cross-sectional. OBJECTIVE: To examine the relationships between spine morphology, spine flexibility, and idiopathic scoliosis. BACKGROUND: Girls have a higher incidence of clinically significant scoliosis than boys, along with smaller vertebrae and greater flexibility. Based on biomechanical modeling, we hypothesized that smaller vertebral width relative to intervertebral disc (IVD) height would be associated with both greater lateral flexibility of the spine and with idiopathic scoliosis. METHODS: Magnetic resonance imaging was used to measure IVD height, vertebral width, and paraspinous musculature in 22 girls with mild and moderate idiopathic scoliosis and 29 girls without scoliosis ages 9-13 years. Clinical measurement of maximum lateral bending was also performed in the girls without scoliosis. A simple biomechanical model was used to estimate bending angle from the ratio of IVD height to vertebral half-width for L1-L4. The average ratio (Ravg) and calculated total bending angle (αtot) for L1-L4 were compared to the clinical measurements of lateral bending flexibility in the control group. These measures were also compared between the scoliosis and control groups. RESULTS: There was a significant positive relationship between clinical flexibility and both Ravg (p = .041) and αtot (p = .042) adjusting for skeletal age, height, body mass index, and paraspinous muscle area as covariates. The ratio was significantly higher (Ravg = 0.45 vs. 0.38, p < .0001) and the bending angle was significantly greater (αtot = 107° vs. 89°, p < .0001) for girls with scoliosis compared with controls. CONCLUSION: These results suggest that differences in spine morphology and corresponding changes in spine flexibility may be related to idiopathic scoliosis. If these relationships can be corroborated in larger prospective studies, these easily measured morphologic traits may contribute to a better understanding of the etiology of idiopathic scoliosis and an improved ability to predict scoliosis progression. LEVEL OF EVIDENCE: Level III.

Assessment of parental knowledge and attitudes toward pediatric sports-related concussions.

BACKGROUND: Parents of young athletes play a major role in the identification and management of sports-related concussions. However, they are often unaware of the consequences of concussions and recommended management techniques. HYPOTHESIS: This study quantitatively assessed parental understanding of concussions to identify specific populations in need of additional education. We predicted that parents with increased education and prior sports- and concussion-related experience would have more knowledge and safer attitudes toward concussions. STUDY DESIGN: Cross-sectional survey. LEVEL OF EVIDENCE: Level 5. METHODS: Participants were parents of children brought to a pediatric hospital and 4 satellite clinics for evaluation of orthopaedic injuries. Participants completed a validated questionnaire that assessed knowledge of concussion symptoms, attitudes regarding diagnosis and return-to-play guidelines, and previous sports- and concussion-related experience. RESULTS: Over 8 months, 214 parents completed surveys. Participants scored an average of 18.4 (possible, 0-25) on the Concussion Knowledge Index and 63.1 (possible, 15-75) on the Concussion Attitude Index. Attitudes were safest among white women, and knowledge increased with income and education levels. Previous sports experience did not affect knowledge or attitudes, but parents who reported experiencing an undiagnosed concussion had significantly better concussion knowledge than those who did not. CONCLUSION: Parents with low income and education levels may benefit from additional concussion-related education. CLINICAL RELEVANCE: There exist many opportunities for improvement in parental knowledge and attitudes about pediatric sports-related concussions. Ongoing efforts to understand parental knowledge of concussions will inform the development of a strategic and tailored approach to the prevention and management of pediatric concussions.