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Sport specialization is a training method now commonly used by young athletes who hope to achieve elite-level success. This may be defined as (1) choosing a main sport, (2) quitting all other sports to focus on 1 sport, and (3) year-round training (greater than 8 months per year). A number of sports medicine organizations have published recommendations based on the limited evidence available on this topic. The objective of this article was to perform a narrative review of the currently available evidence and sports medicine organizational recommendations regarding sport specialization and its effects on health to guide athletic trainers and sports medicine providers. To accomplish this goal, we conducted a narrative review of articles and position statements on sport specialization published from 1990 through 2018. Injury, overuse injury, serious overuse injury, and lower extremity injury were likely associated with higher degrees of sport specialization in various populations. Sports medicine organizations in general recommended against sport specialization in young athletes and instead promoted multisport participation for physical and psychological benefits. Few long-term data suggest that sport specialization has negative health-related quality-of-life consequences. Higher degrees of sport specialization likely pose risks of overuse injury; however, the age of specialization at which this risk occurs is not known. Because different populations and sports activities may put children at risk for certain injuries, future researchers should monitor large populations with sport-specific prospective active surveillance.

The effects of injury and illness on sports performance remain incompletely understood in Olympic athletes. This study investigated whether sustaining an injury or illness at the 2024 Paris Summer Olympic Games affected the probability of winning a medal, which combinations of injuries or illnesses were most impactful on the probability of winning a medal, and how injury or illness influenced athletes’ final percentile ranking. Data from injury and illness events among Team USA athletes were merged with final event results and ex ante (i.e., based on forecasts) market-derived probabilities of success. Logistic and general linear regression models were used to assess the impact of injury and illness on outcomes, controlling for the expected probability of success. Results showed no significant effect of injury or illness on the probability of medaling ( p  = 0.945). However, sustaining an injury or illness was significantly associated with a lower percentile rank finish ( p  = 0.004), with a stronger effect among athletes with lower initial probabilities of success ( p  = 0.013). These findings highlight the measurable impact of injury and illness beyond only time loss and reinforce the importance of robust injury and illness prevention strategies for elite athletes.

Significant health care disparities exist in the United States based on socioeconomic status (SES), but the role SES has in secondary school athletes' access to athletic training services has not been examined on a national scale. To identify differences in access to athletic training services in public secondary schools based on school SES. Cross-sectional study. Database secondary analysis. Data for 3482 public high schools. Data were gathered from the Athletic Training Locations and Services (ATLAS) database, US Census Bureau, and National Center for Education Statistics. We included schools from 5 states with the highest, middle, and lowest poverty percentages (15 states total) and collected county median household income, percentage of students eligible for free or reduced-price lunch, race and ethnicity demographics, and access to athletic training services (full-time athletic trainer [AT], part-time AT only, no AT) for each school. Data were summarized in means, SDs, medians, interquartile ranges (IQRs), frequencies and proportions, 1-way analyses of variance, and Kruskal-Wallis tests. Differences were present in school SES between schools with full-time, part-time-only, and no athletic training services. Schools with greater access to athletic training services had fewer students eligible for free or reduced-price lunch (full time: 41.1% ± 22.3%, part time only: 45.8% ± 24.3%, no AT: 52.9% ± 24.9; P < .001). Similarly, county median household income was higher in schools with increased access to athletic training services (full time median [IQR]: $56 026 [$49 085-$64 557], part time only: $52 719 [$45 355-$62 105], and no AT: $49 584 [$41 094-$57 688]; P < .001). Disparities in SES were seen in access to athletic training services among a national sample of public secondary schools. Access to ATs positively influences student-athletes' health care across several measures. Pilot programs or government funds have been used previously to fund athletic training services and should be considered to ensure equitable access, regardless of school SES.

Sports medicine epidemiology has advanced considerably over the past two decades, with standardized surveillance systems and consensus statements improving the quality of data collection and reporting. Yet the field continues to face structural challenges, including small cohorts, heterogeneous samples, and rare outcomes that undermine reproducibility and limit generalizability. In practice, researchers and clinicians frequently rely on implicit expert judgment to bridge these gaps, but such judgments are often undocumented and irreproducible. Expert elicitation offers a structured, transparent approach to formalizing this knowledge into quantitative priors that can complement empirical data within Bayesian analyses. This commentary introduces expert elicitation to sports medicine epidemiology, drawing on applications of the Sheffield Elicitation Framework (SHELF) in our ongoing work. We highlight three key areas where elicitation can strengthen research and practice: 1) studies involving small, sport-specific cohorts, such as Paralympic athletes; 2) analyses of rare or severe events, including catastrophic injuries and sudden illnesses; and 3) underpowered intervention trials, where structured priors can improve interpretation and guide future prevention and treatment strategies. We also share practical insights from our pilot work, including strategies for framing questions, conducting warm-up and challenge exercises, and using real-time visualization to improve accuracy and engagement. Expert elicitation is not without challenges, requiring careful facilitation and appropriate expertise, but it provides a rigorous, reproducible method for transforming clinical judgment into usable data. Wider adoption of this methodology could accelerate progress in athlete health research by formalizing knowledge that already shapes practice but remains largely untapped. Key Points Structured expert elicitation provides a transparent and flexible way to incorporate clinical judgment into sports medicine epidemiology when empirical data are sparse or incomplete. This approach is particularly valuable for rare events, emerging conditions, and small or specialized athlete populations where empirical data are limited. Standardized methodology and reporting practices are essential to support further use of elicitation-based methods in sports medicine.

Context: California is currently the only state that does not regulate who can and cannot call themselves athletic trainers (ATs). Therefore, previous national or state-specific investigations may not have provided an accurate representation of AT availability at the secondary school level in California. Similarly, it is unknown whether the factors that influence AT availability in California, such as socioeconomic status, are similar to or different from those identified in previous studies. Objective: To describe the availability of ATs certified by the Board of Certification in California secondary schools and to examine potential factors influencing access to AT services in California secondary schools. Design: Cross-sectional study. Setting: Online survey. Patients or Other Participants: Representatives of 1270 California high schools. Main Outcome Measure(s): Officials from member schools completed the 2017-2018 California Interscholastic Federation Participation Census. Respondents provided information regarding school type, student and student-athlete enrollment, whether the school had ATs on staff, and whether the ATs were certified by the Board of Certification. The socioeconomic status of public and charter schools was determined using the percentage of students eligible for free or reduced-price lunch. Results: More than half (54.6%) of schools reported that they either did not employ ATs (47.6%) or employed unqualified health personnel (UHP) in the role of AT (7.0%). Nearly 30% of student-athletes in California participated in athletics at a school that did not employ ATs (n = 191 626, 28.9%) and 8% of student-athletes participated at a school that employed UHP in the role of AT (n = 54 361, 8.2%). Schools that reported employing ATs had a lower proportion of students eligible for free or reduced-price lunch than schools that did not employ ATs and schools that employed UHP (both P values ( .001). Conclusions: With ongoing legislative efforts to obtain regulation of ATs in California, secondary school administrators are encouraged to hire ATs with the proper certification to enhance the patient care provided to student-athletes and improve health outcomes.

In many US high schools, the athletic trainer (AT) has the responsibility to identify and manage athletes with concussions. Although the availability of ATs varies a great deal among schools, how the level of AT availability in high schools affects the reported incidence and management of sport-related concussions (SRCs) is unknown. To determine how the presence of an AT affects the reporting and management of SRCs. Prospective cohort study. A total of 2459 (female = 37.5%, age = 16.1 ± 1.2 years) athletes from 31 Wisconsin high schools were categorized as having low availability (LoAT), mid availability (MidAT), or high availability (HiAT) of ATs. Athletic trainers recorded the incidence, days lost from sport, and postconcussion management through return to sport. The incidence of SRC reporting among categories was examined using a multivariate Cox proportional hazards model. Fisher exact tests were used to determine if postconcussion management differed based on AT availability. The incidence of reported SRCs was lower for the LoAT schools (2.4%) compared with the MidAT (5.6%, hazard ratio = 2.59, P = .043) and HiAT (7.0%, hazard ratio = 3.33, P = .002) schools. The median time before the first AT interaction was longer for LoAT schools (24.0 hours) than for MidAT (0.5 hours, post hoc P = .012) and HiAT (0.2 hours, post hoc P = .023) schools. The number of post-SRC interactions was different in all groups (LoAT = 2 interactions, MidAT = 3, and HiAT = 4; all post hoc P values < .05). Days lost were greater for MidAT and HiAT (both 14 days lost) schools compared with LoAT schools (11.5 days lost, post hoc P = .231 and P = .029, respectively). Athletes at LoAT schools were less likely to undergo a return-to-play protocol (9/18 SRCs, 50.0%) than athletes at MidAT (44/47 SRCs, 93.6%; post hoc P = .001) or HiAT (64/64 SRCs, 100%; post hoc P < .001) schools. The level of AT availability positively influenced the reported incidence of SRCs as well as postconcussion management activities in this sample of high schools.

Purpose To determine possible differences in single-hop kinematics and kinetics in females with anterior cruciate ligament reconstruction compared to healthy controls. A second purpose was to make comparisons between the healthy and reconstructed limbs. Methods Subjects were grouped based on surgical status (33 ACLR patients and 31 healthy controls). 3D motion capture synchronized with force plates was used to capture the landing phase of three successful trials of single hop for distance during a single data collection session. Peak values during the loading phase were analysed. Subjects additionally completed three successful trials of the triple hop for distance Tegner activity scale and International Knee Document Committee 2000 (IKDC). Results Controls demonstrated greater peak knee flexion and greater internal knee extension moment and hip extension moment than ACLR subjects. Within the ACLR group, the healthy limb exhibited greater peak knee flexion, hip flexion, hip extension moment, single hop and triple hops for distance and normalized quadriceps strength. Conclusion Patients who undergo anterior cruciate ligament reconstruction land in a more extended posture when compared to healthy controls and compared to their healthy limb. Level of evidence III.

To investigate the effects of sex as an effect modifier of objectively measured moderate-to-vigorous physical activity (MVPA) in individuals following ACLR and healthy controls. Cross-sectional research study. University community. 59 participants (42.4% male) with a history of ACLR and 55 healthy control participants (40.0% male). Participants were outfitted with an ActiGraph wGT3X-BT accelerometer for a period of 7 days to assess MVPA. Weekly time engaged in MVPA (in bouts≥ 10 min), % of total time engaged in MVPA, and odds of meeting national physical activity guidelines (MVPA≥ 150 min/wk) were compared between males and females with a history of ACLR and healthy controls. There were significant sex X group interactions for weekly MVPA (p = 0.02) and % total time in MVPA (p = 0.01). The odds of a female ACLR participant meeting national physical activity guidelines were significantly worse (X2 = 4.18, OR = 2.54, CI95 = 1.03–6.27) when compared to participants without ACLR. Female participants with ACLR were found to be less active than healthy control participants and their odds of meeting national MVPA guidelines were also 2.54 times worse than healthy participants. •Participants with ACLR are less likely to be physically active when compared to participants without a history of ACLR.•Females with ACLR are less likely than healthy controls to meet PA guidelines despite similar pre-injury activity levels.•Clinicians must actively educate patients and promote PA participation after ACLR to prevent persistent physical inactivity.

Background: There are a variety of proposed motivations for sport specialization, such as improving sport skills to an elite level, making all-star or travel teams, or receiving a scholarship or professional contract. However, there has not been a quantitative examination of the attitudes and beliefs that may be contributing to the trend of sport specialization and year-round sport participation. Purpose: The primary aim was to describe the attitudes and beliefs of youth club sport athletes regarding sport specialization and sport participation. A secondary objective was to investigate whether an association exists between the level of sport specialization and the belief in receiving a college scholarship. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 974 youth athletes (578 female; mean age, 14.2 ± 1.6 years) completed an anonymous questionnaire that focused on attitudes and beliefs toward sport specialization and sport participation. Questions were developed utilizing the feedback of a panel of content area experts and the University of Wisconsin Survey Center. Data were summarized using frequencies, proportions (%), and means ± SDs. Results: Fewer than half of all athletes (45.8%) believed that specialization increased their chances of getting injured either “quite a bit” or “a great deal.” However, 91% of athletes believed that specialization increased their chances of getting better at their sport either “quite a bit” or “a great deal.” Similarly, the majority of athletes believed that specialization increased their chances of making their high school team (80.9%) or a college team (66.9%) either “quite a bit” or “a great deal.” Overall, 15.7% of athletes believed that they were either “very” or “extremely” likely to receive a college scholarship based on athletic performance. Highly specialized athletes were nearly twice as likely to have a high belief in receiving a college scholarship compared with low-specialization athletes (20.2% vs 10.2%, respectively; χ2 = 18.8; P = .001). Conclusion: Most youth athletes in this study believe that specialization increases their sport performance and ability to make not only a college team but also their high school team. Highly specialized athletes were more likely to believe that they will receive a college scholarship.

IntroductionThe Sport Mental Health Assessment Tool-1 (SMHAT-1) was developed to screen elite athletes for mental health concerns. Previous work demonstrated high false negative rates (FNRs) for the initial triage step of the tool, but given the novelty of the deployment of the SMHAT-1 during large multisport, multinational competitions, replication of these findings was justified and required. This study, therefore, aimed to recalculate classification performance metrics at the triage step and investigate potential reasons for the high FNRs observed.MethodsAll athletes (n=847) completed steps 1 and 2, including an additional Posttraumatic Stress Disorder questionnaire, and FNRs were calculated. Exploratory analysis, including an exploratory factor analysis (EFA), was used to investigate the latent constructs being captured.ResultsClassification performance metrics indicated FNRs ranging from 0% (Patient Health Questionnaire-9 (PHQ9) and PHQ9 Item 9) to 63.16% (Brief Eating Disorder in Athletes Questionnaire (BEDAQ)), consistent with previous findings. The EFA identified nine latent factors in step 2, with each instrument appearing to mostly favour its own independent factor, highlighting a range of distinct latent constructs. An exploratory mixed graphical model revealed some step 2 clusters that were not closely linked with the Athlete Psychological Strain Questionnaire (APSQ) items.ConclusionsThese findings confirm previous concerns regarding the APSQ’s sensitivity and underscore the challenge of using a single triage tool to capture the broad spectrum of mental health issues assessed by the SMHAT-1. Future work should consider a bespoke triage tool to better capture the diverse mental health needs of elite athletes.