Sex Differences in Youth and Young Adult Sport Training Patterns, Specialization, and Return to Sport Durations.

Background: Young female athletes may have higher rates of overuse injuries and sport specialization than male athletes. The association of sports specialization and return to sport (RTS) timeframe is also unknown.

Hypothesis: Specialized female athletes will have more intense, year-round training patterns, more overuse injuries, and longer RTS times than male athletes.

Study design: Cohort study.

Level of evidence: Level 3.

Methods: Injured athletes aged 10 to 23 years presenting to a sports medicine clinic reported their degree of sport specialization and training patterns. Skeletal maturity was estimated using the Khamis-Roche method. Injury type and RTS timeframes were categorized from electronic medical records. Chi-square tests and logistic regression analysis assessed associations between variables.

Results: A total of 485 athletes (40.2% female) were enrolled. Higher degrees of sport specialization were associated strongly with overuse injuries (P < 0.01). After adjusting for specialization, female athletes were more likely to sustain an overuse injury (adjusted odds ratio, 1.49; P = 0.04). Female athletes participated in fewer total physical activity hours per week (P < 0.01), fewer free play hours per week (P < 0.01), and participated in their main sport for more months of the year than their male counterparts (P = 0.02). Female athletes were more likely to be at a higher developmental stage than male athletes (P < 0.01). RTS timeframes were increased in athletes with serious overuse injury; however, no association was found between degree of specialization and RTS time regardless of sex.

Conclusion: Female athletes are more likely to sustain overuse injuries with more organized, year-round, training and less free play compared with their male counterparts.

Clinical relevance: Female sex may be an independent risk factor of overuse injury. Future strategies to mitigate these risks may include increased free play hours and limiting year-round training through seasonal rest.