Sport specialization in female military cadets led to higher risk of overuse injuries
Higher levels of sports specialization prior to U.S. military service led to an increased risk of lower extremity stress fractures in female cadets, according to results presented at the NATA Virtual Clinical Symposia and AT Expo.
Kenneth L. Cameron, PhD, MPH, ATC, director of orthopedic and sports medicine research at Keller Army Hospital, and colleagues researched the relationship between level of sports specialization and lower extremity injury in 2,012 U.S. Service Academy cadets.
Researchers followed the cadets through their first year at the academy, collecting demographic data on sports specialization history, incidence of lower extremity stress fractures, as well as sex and odds ratios, according to the abstract.
Among all participants, 43.78% (881) reported low levels, 36.23% (729) reported moderate levels and 19.98% (402) reported high levels of sports specialization through high school. Thirty-four lower extremity stress fractures were reported through the 1-year follow-up – an overall incidence of 1.69%.
“Females were over five times more likely to experience an incident stress fracture (4.47%) when compared to males (0.84%),” Cameron and colleagues wrote in the abstract. “In univariate models, [female athletes] with moderate specialization were 2.49 times more likely to sustain an incident lower extremity stress fracture, and those with high specialization were 4.25 times more likely when compared to those with low specialization,” they added.
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Cameron and his team are commended on their prospective study of stress fractures in collegiate athletes. The sports medicine team at West Point continues to produce quality prospective research that helps illuminate the epidemiology and treatment of sports injuries, in this case stress fractures.
In this prospective cohort study of more than 2,000 military cadets (23% were women), subjects were assessed with baseline questionnaires regarding sports participation during high school. Baseline bone density measures were not obtained but this can be challenging with a large population. A total of 34 lower extremity stress fractures were diagnosed during the 1 year of surveillance, with female cadets sustaining fractures at five times the rate of male cadets.
This finding is not surprising given what is known about bone stress injuries in female athletes. They also found that a high level of sport specialization in female athletes resulted in a more than four times greater risk of bone stress injury compared with low specialization. They did not find the same relationship for male athletes.
This finding adds to the growing literature on the risks of sports specialization in young athletes. I applaud this research study and look forward to seeing further work from this group on bone stress injuries.
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Cameron KL, et al. Presentation 204865AA. Presented at: National Athletic Trainers Association Virtual Clinical Symposia and AT Expo; July 13-16, 2020 (virtual meeting).