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ABSTRACT: Bush, CM, Wilhelm, AJ, Lavallee, ME, and Deitch, JR. Early sport specialization in elite weightlifters: weightlifting injury occurrence and relevant opinions. J Strength Cond Res 35(11): 3260-3264, 2021-Sports specialization has been associated with increased injury and burnout. This study sought to determine the age, rate of injury, influence to specialize, and opinions surrounding the impact of sports specialization in attainment of elite-level weightlifting status. A link to an anonymous survey was distributed to the top 20 weightlifters in each weight class (8 male and 7 female weight classes). The survey questioned athletes about both age and motivation to specialize, previous injuries and/or surgeries, and level of competition. Injuries and surgeries were compared between those who specialized at the Youth level (≤age 16), Junior level (ages 17-20), and nonspecialized weightlifters. One hundred forty-one athletes (47.0%) completed the survey. Sixteen subjects (11.3%) specialized at the Youth level, 18 (12.8%) specialized at the Junior level, and the remaining 107 (75.9%) did not specialize before age 21. There was a statistically significant difference in the occurrence of injury before age 21 between weightlifters specializing at the Youth level and those who did not specialize (Χ2(1) = 22.4, p < 0.0001). There were no statistically significant differences in serious injury after age 21 between groups. Weightlifters cited primarily themselves (45.4%) or coach (43.1%) as a driving influence to specialize. The majority of athletes (68.8%) felt that specializing during the Youth age group was not necessary to achieve elite status. Despite a relatively small sample size, injuries occurred more frequently in weightlifters specializing at younger ages, suggesting that risks associated with early sport specialization also apply to weightlifters. These risks should be considered before implementing an early specialization training regimen.

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BACKGROUND: Sports specialization is becoming an increasingly common training strategy in young athletes. Very little research currently exists examining the occurrence of serious injury (>3 months off sport or loss of season) in elite-level wrestlers who specialize early (before age 12 years). HYPOTHESIS: Wrestlers who specialize early will sustain more serious injuries than wrestlers who specialize at age 12 years or older. STUDY DESIGN: Descriptive epidemiological study. METHODS: We sent an anonymous online survey to a total of 312 elite-level wrestlers (National Collegiate Athletic Association Division I athletes and World/Olympic team members) containing questions documenting age of specialization and number of serious injuries sustained. The number of serious injuries both before and after starting college were compared between wrestlers specializing at <12 years old and ≥12 years old using an independent-samples t test. Respondents' opinions on the necessity of early specialization and their primary source of encouragement to specialize were also reported. RESULTS: A total of 143 wrestlers completed the survey, for a total response rate of 46%. Thirty-six (25%) wrestlers specialized at <12 years old. The early specialization group sustained significantly more serious injuries than the late specialization group (1.14 vs 0.60; P = 0.035). Sixty-two (43%) believed early specialization was necessary to achieve elite-level status. The decision to specialize was encouraged primarily by the athlete (78/143; 55%), parents (37/143; 26%), and coaches (22/143; 15%). CONCLUSION: Elite wrestlers who specialize prior to age 12 years sustain a greater number of serious injuries before starting college than those who specialize at or after the age of 12 years. CLINICAL RELEVANCE: Athletes, coaches, and parents should consider the risk of injury before adopting a wrestling-specialized training strategy at a young age.

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BACKGROUND: The rate of early sport specialization in professional baseball players is unknown. PURPOSE: To report the incidence and age of sport specialization in current professional baseball players and the impact of early specialization on the frequency of serious injuries sustained during the players' careers. We also queried participants about when serious injuries occurred, the players' current position on the field, and their opinions regarding the need for young athletes to specialize early to play at the professional level. STUDY DESIGN: Descriptive epidemiological study. METHODS: A total of 102 current professional baseball players anonymously completed a 7-question written survey. Early sport specialization was defined as "single-sport participation prior to high school." Injury was defined as "a serious injury or surgery that required the player to refrain from sports (baseball) for an entire year." Chi-square tests were used to investigate the risk of injury in those who specialized early in baseball versus those who did not. Independent-sample t tests were used to compare injury rates based on current player position. RESULTS: Fifty (48%) baseball players specialized early. The mean age at initiation of sport specialization was 8.91 years (SD, 3.7 years). Those who specialized early reported more serious injuries (mean, 0.54; SD, 0.838) during their professional baseball career than those who did not (mean, 0.23; SD, 0.425) (P = .044). Finally, 63.4% of the queried players believed that early sport specialization was not required to play professional baseball. CONCLUSION: Our study demonstrated a statistically significant higher rate of serious injury during a baseball player's professional career in those players who specialized early. Most current professional baseball players surveyed believed that sport specialization was not required prior to high school to master the skills needed to play at the professional level. Our findings demonstrate an increased incidence of serious injuries in professional baseball players who specialized in baseball prior to high school. Youth baseball athletes should be encouraged not to participate in a single sport given the potential for an increased incidence of serious injuries later in their careers. No data are available to suggest that early specialization is needed to reach the professional level.

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PURPOSE: With the increase in knowledge and management of sport-related concussion over the last 15 years, there has been a shift from a grading scale approach to an individualized management approach. As a result, there is an increased need to better understand the factors involved in delayed recovery of concussion. The purpose of this retrospective study was to examine factors that may be associated with recovery from sport-related concussion in student athletes aged 11 to 18 years old. METHODS: Of the 366 patients who met the inclusion criteria, 361 were included in our analysis. The primary dependent variable included days until athlete was able to return to play (RTP). Independent variables of interest included age, gender, academic performance, comorbid factors, sports, on-field markers, days until initial neurological evaluation, Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT®) scores, acute headache rescue medications, chronic headache medication, sleep medication, and referral to concussion rehabilitation program. RESULTS: Variables associated with longer median RTP were being female (35 days), having a referral to concussion rehabilitation program (53 days), being prescribed acute headache rescue therapy (34 days), and having chronic headache treatment (53 days) (all p < 0.05). Variables associated with shorter RTP were on-field marker of headache (23 days) and evaluation within 1 week of concussion by a concussion specialist (16 days) (Both p < 0.05). CONCLUSION: This study supports the need for a concussed athlete to have access to a provider trained in concussion management in a timely fashion in order to prevent delayed recovery and return to play.

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BACKGROUND: Collagen hydrolysate is a nutritional supplement that has been shown to exert an anabolic effect on cartilage tissue. Its administration appears beneficial in patients with osteoarthritis. OBJECTIVE: To investigate the effect of collagen hydrolysate on activity-related joint pain in athletes who are physically active and have no evidence of joint disease. DESIGN AND SETTING: A prospective, randomized, placebo-controlled, double-blind study was conducted at Penn State University in University Park, Pennsylvania. Parameters including joint pain, mobility, and inflammation were evaluated with the use of a visual analogue scale during a 24-week study phase. STUDY PARTICIPANTS: Between September 2005 and June 2006, 147 subjects who competed on a varsity team or a club sport were recruited. Data from 97 of 147 subjects could be statistically evaluated. INTERVENTION: One hundred and forty-seven subjects (72 male, 75 female) were randomly assigned to two groups: a group (n = 73) receiving 25 mL of a liquid formulation that contained 10 g of collagen hydrolysate (CH-Alpha) and a group (n = 74) receiving a placebo, which consisted of 25 mL of liquid that contained xanthan. MAIN OUTCOME MEASURES: The primary efficacy parameter was the change in the visual analogue scales from baseline during the study phase in relation to the parameters referring to pain, mobility, and inflammation. RESULTS: When data from all subjects (n = 97) were evaluated, six parameters showed statistically significant changes with the dietary supplement collagen hydrolysate (CH) compared with placebo: joint pain at rest, assessed by the physician (CH vs. placebo (-1.37 +/- 1.78 vs. -0.90 +/- 1.74 (p = 0.025)) and five parameters assessed by study participants: joint pain when walking (-1.11 +/- 1.98 vs. -0.46 +/- 1.63, p = 0.007), joint pain when standing (-0.97 +/- 1.92 vs. -0.43 +/- 1.74, p = 0.011), joint pain at rest (-0.81 +/- 1.77 vs. -0.39 +/- 1.56, p = 0.039), joint pain when carrying objects (-1.45 +/- 2.11 vs. -0.83 +/- 1.71, p = 0.014) and joint pain when lifting (-1.79 +/- 2.11 vs. -1.26 +/- 2.09, p = 0.018). When a subgroup analysis of subjects with knee arthralgia (n = 63) was performed, the difference between the effect of collagen hydrolysate vs. placebo was more pronounced. The parameter joint pain at rest, assessed by the physician, had a statistical significance level of p = 0.001 (-1.67 +/- 1.89 vs. -0.86 +/- 1.77), while the other five parameters based on the participants' assessments were also statistically significant: joint pain when walking (p = 0.003 (-1.38 +/- 2.12 vs. -0.54 +/- 1.65)), joint pain when standing (p = 0.015 (-1.17 +/- 2.06 vs. -0.50 +/- 1.68)), joint pain at rest with (p = 0.021 (-1.01 +/-1.92 vs. -0.47 +/- 1.63)), joint pain when running a straight line (p = 0.027 (-1.50 +/- 1.97 vs. -0.80 +/- 1.66)) and joint pain when changing direction (p = 0.026 (-1.87 +/- 2.18 vs. -1.20 +/- 2.10)). CONCLUSION: This was the first clinical trial of 24-weeks duration to show improvement of joint pain in athletes who were treated with the dietary supplement collagen hydrolysate. The results of this study have implications for the use of collagen hydrolysate to support joint health and possibly reduce the risk of joint deterioration in a high-risk group. Despite the study's size and limitations, the results suggest that athletes consuming collagen hydrolysate can reduce parameters (such as pain) that have a negative impact on athletic performance. Future studies are needed to support these findings.

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This article introduces the Toggle Loc with Zip Loop as a fixation technique for a single-incision distal biceps tendon repair. The ease with which the Toggle Loc can be attached to the ruptured tendon is a distinct advantage of this technique. Because the suture loops (Zip Loop) can be shortened after the tendon is sutured over it, the surgeon can attach the implant to the tendon away from the wound. The implant can then be inserted and seated on the dorsal cortex of the radius prior to final tendon reinsertion and tensioning of the repair. This allows for a technically easier reinsertion while maintaining appropriate elbow flexion and rotation.

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BACKGROUND: Gender-based differences in injury rates have been reported in scholastic and collegiate basketball. The purpose of this study was to retrospectively compare injury rates in women's and men's professional basketball. HYPOTHESIS: Female professional basketball players are injured at a higher rate than are men. STUDY DESIGN: Cohort study (prevalence); Level of evidence, 2. METHODS: Women's National Basketball Association and National Basketball Association injury data were retrospectively reviewed for 6 full seasons. The frequency of all injuries and the rate of game-related injuries were calculated. RESULTS: Complete player profiles were obtained on 702 National Basketball Association athletes and 443 Women's National Basketball Association athletes who competed in their respective leagues during the data collection period. Total game exposures totaled 70,420 (National Basketball Association) and 22,980 (Women's National Basketball Association). Women's National Basketball Association athletes had a higher overall game-related injury rate (24.9 per 1000 athlete exposures; 95% confidence interval, 22.9-26.9; P < .05) when compared with National Basketball Association athletes (19.3 per 1000 athlete exposures; 95% confidence interval, 18.3-20.4) and sustained a higher rate of lower extremity injuries (14.6 per 1000 athlete exposures; 95% confidence interval, 13.1-16.2; P < .05) than seen in the National Basketball Association (11.6 per 1000 athlete exposures; 95% confidence interval, 10.8-12.4). The lower extremity was the most commonly injured body area (65%), and lateral ankle sprain (13.7%) was the most common diagnosis in both leagues. The incidence of game-related knee injury was higher in Women's National Basketball Association players. The incidence of anterior cruciate ligament injury in the National Basketball Association (n = 22, 0.8%) and Women's National Basketball Association (n = 14, 0.9%) accounted for 0.8% of the 4446 injuries reported. CONCLUSION: The lower extremity is the most frequently injured body area in both leagues, and Women's National Basketball Association athletes are more susceptible than are National Basketball Association athletes. There were, however, few statistical differences in the actual injuries occurring between the 2 leagues.

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BACKGROUND: Recurrent instability is the most common complication after traumatic anterior shoulder dislocation in young patients. HYPOTHESIS: The rate of recurrent instability in a homogeneous population of adolescents after initial traumatic anterior shoulder dislocation is significant and is associated with a guarded prognosis for full recovery. STUDY DESIGN: Retrospective cohort study. METHODS: We identified 32 patients 11 to 18 years of age treated at our institution for a radiographically documented traumatic anterior shoulder dislocation; we performed a functional outcome assessment on 30 patients with use of two standard scoring systems. RESULTS: Overall, instability recurred in 24 of 32 patients, with 23 experiencing at least one recurrent dislocation. Persistent instability led 16 of 32 to undergo a shoulder stabilization procedure. There were no significant differences in the functional outcome of patients who had undergone surgical stabilization and those who were treated nonoperatively. CONCLUSIONS: The recurrence rate of shoulder instability was 75%. Outcome scores were similar for patients treated with a surgical procedure and those treated nonoperatively. CLINICAL SIGNIFICANCE: Treatment efforts must be aimed at optimizing shoulder strength and stability. Prognosis for full recovery remains guarded. Available outcome instruments may not discriminate well between patients who do and do not choose surgery.

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STUDY DESIGN: A case report is presented. OBJECTIVES: Primary tumors of the rib are relatively uncommon in the adult population, and even more rare in children. A case of osteogenic sarcoma of the rib and a literature review are presented. SUMMARY OF BACKGROUND DATA: Osteogenic sarcoma represents approximately 30% of all malignant sarcomas diagnosed in the United States. A single case of osteogenic sarcoma of the rib has been reported in the literature involving a 9-year-old child. METHODS: Clinical data analysis. RESULTS: A 9-year-old white boy presented with a mass of the left posterior thorax. The initial chest radiograph showed a nonhomogeneous mass with calcifications adjacent to the 11th rib. The final diagnosis was osteogenic sarcoma. Chemotherapy was initiated. The patient underwent radical excision of the mass. Given the extent of the patient's resection, it was thought that he would be at high risk for the development of spinal deformity. He was placed in a TLSO brace (Bolt Systems, Orlando, FL) and followed closely. At 15 months after excision of his tumor, he was noted to have progression of a thoracolumbar scoliosis and significant kyphosis. At this writing, it has been 52 months since resection. The patient has no evidence of local recurrence or metastatic disease, and his spinal curvature remains stable. CONCLUSIONS: The patient's short-term (4-year) disease-free survival illustrates the efficacy of neoadjuvant chemotherapy and radical surgical resection. Patients with osteogenic sarcoma of the rib should be monitored closely for the development of spinal deformity if the required resection includes the vertebral column. Casting and bracing may help to limit progression of the deformity.

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