August 2020

Sport Specialization Ups Fracture Risk for Female Military Cadets 

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Early sports specialization appears to take an even greater toll on young females than previously thought. Research presented at the recent 2020 NATA Virtual Clinical Symposia & AT Expo suggests that prior sports specialization is associated with an increased risk of a lower extremity stress fracture in female U.S. Service Academy cadets, but not males during their first year of service.

The study found that females were over 5 times more likely to experience an incident stress fracture (4.47%) when compared to males (0.84%). The investigators observed a dose-dependent relationship between the level of prior sport specialization and the likelihood of lower extremity stress fracture. In univariate models, females 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, however only the later was statistically significant.

Similar results were observed in multivariable models controlling for weight, injury history, and lower extremity movement quality at baseline.

“Like many athletes, first-year cadets undergo rigorous physical activity and they are at increased risk for overuse injuries like stress fractures. Understanding how prior level of sport specialization is associated with the risk of these injuries during military training can provide insight into opportunities for injury prevention and risk mitigation,” said Kenneth Cameron, PhD, MPH, ATC, director of Orthopedic and Sports Medicine Research at Keller Army Hospital: John A. Feagin Jr. Sports Medicine Fellowship.

Cameron also noted “Previous studies have reported that females in high school were more likely to participate at high competition volume, participate on a club team, and be highly specialized which was associated with an increased risk of lower extremity injury. This may continue to impact these athletes after high school graduation, particularly in female service academy cadets.”

A total of 2,012 participants from the freshman class of 2020 and 2021 consented (470 females, 23.4%) and agreed to participate in this study. Those that consented completed a baseline questionnaire that included demographic information, lower extremity injury history and standard items on level of sports specialization using the 3-point Jayanthi scale. The subjects were followed during their first year at the academy to identify all incident lower extremity stress fractures.

The study abstract, Prior Sport Specialization is Associated With Lower Extremity Stress Fracture in Female Service Academy Cadets, will be published in the Journal of Athletic Training, the scientific journal of the National Athletic Trainers’ Association, later this year.

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