Sport specialization is theorized to increase the risk of sustaining overuse musculoskeletal injuries.


To complete a systematic review and meta-analysis of the literature to determine if sport specialization is associated with overuse musculoskeletal injuries.


An electronic search was conducted using the search terms “specialization,” “year-round,” “overuse,” “repetitive stress,” “injury,” “young,” “pediatric,” and “sports.”


Studies were included if their population was ≤18 years of age, if they compared athletes with high or single-sport specialization with athletes with low or multisport specialization, and focused on overuse injuries.


Of the 12 articles that were identified for full-text review, 5 studies met all the inclusion criteria. Four studies provided adequate data for the meta-analysis. Quality scores on the modified Downs and Black scale ranged from 69% to 81%.


Athletes with high specialization were at an increased risk of sustaining an overuse injury compared with athletes with low (pooled relative risk [RR] ratio: 1.81; 95% confidence interval [CI]: 1.26–2.60) and moderate (pooled RR: 1.18; 95% CI: 1.05–1.33) specialization. Athletes with moderate specialization were at a higher risk of injury compared with athletes with low specialization (RR: 1.39 [95% CI: 1.04–1.87]).


Four of the 5 studies included in this systematic review were included in the meta-analysis because of the lack of access to the original data set for 1 article.


Sport specialization is associated with an increased risk of overuse musculoskeletal injuries (Strength of Recommendation Taxonomy grade: B).

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