High School Sport Specialization Patterns of Current Division I Athletes.

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.

Disordered eating, menstrual irregularity, and musculoskeletal injury in high school athletes: a comparison of oral contraceptive pill users and nonusers.

BACKGROUND: The female athlete triad is the interrelatedness of energy availability, menstrual function, and bone density. Currently, limited information about triad components and their relationship to musculoskeletal injury in the high school population exists. In addition, no study has specifically examined triad components and injury rate in high school oral contraceptive pill (OCP) users. HYPOTHESIS: To compare the prevalence of disordered eating (DE), menstrual irregularity (MI), and musculoskeletal injury (INJ) among high school female athletes in OCP users and non-OCP users. STUDY DESIGN: Retrospective cohort study. LEVEL OF EVIDENCE: Level 2. METHODS: The subject sample completed the Eating Disorder Examination-Questionnaire (EDE-Q) and Healthy Wisconsin High School Female Athletes Survey (HWHSFAS). Athletes were classified by OCP use and sport type. RESULTS: Of the participants, 14.8% reported OCP use. There was no difference in MI and INJ among groups. The prevalence of DE was significantly higher among OCP users as compared with non-OCP users; OCP users were twice as likely to meet the criteria for DE (odds ratio [OR], 2.47; 95% confidence interval [CI], 1.20-5.09). OCP users were over 5 times more likely to have a global score that met criteria for DE as compared with non-OCP users (OR, 5.36; 95% CI, 1.92-14.89). CONCLUSION: Although MI and INJ rates are similar among groups, there is a higher prevalence of DE among high school female athletes using OCPs as compared with non-OCP users. CLINICAL RELEVANCE: Because OCP users may be menstruating, clinicians may fail to recognize the other triad components. However, DE exists in the menstruating OCP user. As such, clinicians should be vigilant when screening for triad components in high school OCP users, particularly DE.

Menstrual irregularity and musculoskeletal injury in female high school athletes.

CONTEXT: The female athlete triad describes the interrelatedness of energy availability, menstrual function, and bone density. Although associations between triad components and musculoskeletal injury (INJ) have been reported in collegiate athletes, limited information exists about menstrual irregularity (MI) and INJ in the high school population. OBJECTIVE: To determine the prevalence of and relationship between MI and INJ in high school athletes. DESIGN: Cross-sectional study. SETTING: High schools. PATIENTS OR OTHER PARTICIPANTS: The sample consisted of 249 female athletes from 3 high schools who competed in 33 interscholastic, school-sponsored sport teams, dance teams, and cheerleading or pom-pon squad during the 2006-2007 school year. Each athlete remained on the roster throughout the season. MAIN OUTCOME MEASURE(S): Participants completed a survey regarding injury type, number of days of sport participation missed, and menstrual history in the past year. RESULTS: The prevalences of M I and INJ were 19.7% and 63.1 %, respectively. Athletes who reported MI sustained a higher percentage of severe injuries (missing ≥ 22 days of practice or competition) than did athletes who reported normal menses. Although the trend was not significant, athletes with MI were almost 3 times more likely to sustain an injury resulting in 7 or more days of time lost from sport (odds ratio = 2.7, 95% confidence interval = 0.8, 8.8) than those who sustained an injury resulting in 7 or fewer days of time lost. CONCLUSIONS: The incidences of MI and INJ in this high school population during the study period were high. Athletes who reported MI sustained a higher percentage of severe injuries than did athletes who reported normal menses. Education programs to increase knowledge and improve management of MI and its potential effects on injury in female high school athletes are warranted.

Low back and hip pain in a postpartum runner: applying ultrasound imaging and running analysis.

STUDY DESIGN: Case report. BACKGROUND: Postpartum low back and hip dysfunction may be caused by an incomplete recovery of abdominal musculature and impaired neuromuscular control. The purpose of this report is to describe the management of a postpartum runner with hip and low back pain through exercise training via ultrasound imaging (USI) biofeedback combined with running-form modification. CASE DESCRIPTION: A postpartum runner with hip and low back pain underwent dynamic lumbar stabilization training with USI biofeedback and running-form modification to reduce mechanical loading. Muscle thickness of transversus abdominis and internal oblique was measured with USI preintervention and 7 weeks after completion of the intervention. Additionally, 3-dimensional lower extremity joint motions, moments, and powers were calculated during treadmill running. OUTCOMES: The patient's pain with running decreased from a constant 9/10 (0, no pain; 10, worst pain) to an occasional 3/10 posttreatment. Transversus abdominis muscle thickness increased 6.3% during the abdominal drawing-in maneuver and 27.0% during the abdominal drawing-in maneuver with straight leg raise. Changes were also noted in the internal oblique. These findings corresponded to improved lumbopelvic control: pelvic list and axial rotation during running decreased 38% and 36%, respectively. The patient's running volume returned to preinjury levels (8.1-9.7 km, 3 days per week) with no hip pain and minimal low back pain, and she successfully completed her goal of running a half-marathon. DISCUSSION: The successful outcomes of this case support the consideration of dynamic lumbar stabilization exercises, USI biofeedback, and running-form modification in postpartum runners with lumbopelvic dysfunction. LEVEL OF EVIDENCE: Therapy, level 4.

Female athlete triad syndrome in the high school athlete.

Female sports participation at the high school level has significantly increased since the 1970s. Physical activity in females has numerous positive benefits, including improved body image and overall health. Unfortunately, a select population of exercising females may experience symptoms related to the "female athlete triad," which refers to the interrelationships among energy availability, menstrual function, and bone mineral density. Clinically, these conditions can manifest as disordered eating behaviors, menstrual irregularity, and stress fractures. Athletes with conditions related to the triad are distributed along a spectrum between optimal health and disease and may not experience all conditions simultaneously. Previous research related to the triad has primarily focused on collegiate and elite athletes. However, mounting evidence demonstrates that the triad is present in the high school population. High school athletes should be assessed for triad components at preparticipation physicals. In addition, parents, coaches, and health care professionals should be educated and informed about the female athlete triad syndrome. In the presence of triad symptoms, further evaluation and treatment by a multidisciplinary team is strongly recommended for the athlete.

Associations between disordered eating, menstrual dysfunction, and musculoskeletal injury among high school athletes.

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: To determine the prevalence of, and association between, disordered eating (DE), menstrual dysfunction (MD), and musculoskeletal injury (MI) among high school female athletes. BACKGROUND: Female athlete triad (Triad) syndrome is the interrelatedness of DE, MD, and low bone mass. Few studies have examined 2 or more Triad components simultaneously, or their relationship to injury, among female high school athletes. METHODS: The subject sample consisted of 311 female high school athletes competing on 33 interscholastic high school teams during the 2006-2007 school year. Athletes completed the Eating Disorder Examination Questionnaire (EDE-Q) and Healthy Wisconsin High School Female Athletes Survey (HWHSFAS). Athletes were classified by sport type as aesthetic (AES), endurance (END), or team/anaerobic (T/A). RESULTS: Of those surveyed, 35.4% reported DE, 18.8% reported MD, and 65.6% reported sustaining a sports-related musculoskeletal injury during the current sports season. Athletes reporting DE were twice as likely to be injured compared to those reporting normal eating behaviors (odds ratio [OR], 2.3; 95% confidence interval [CI]: 1.4, 4.0). Multivariate logistic regression analyses revealed that athletes who reported a history of DE (OR, 2.1; 95% CI: 1.1, 3.9) or prior injury (OR, 5.1; 95% CI: 2.9, 8.9) were more likely to be injured during the sports season. CONCLUSION: A high prevalence of DE and MD exists among high school female athletes. Additionally, athletes with DE were over 2 times more likely to sustain a sports-related injury during a sports season. Screening and intervention programs designed to identify and decrease the prevalence of DE should be implemented with high school females. LEVEL OF EVIDENCE: Prognosis, level 2b.