High Specialization Among Female Youth Soccer Players Is Associated With an Increased Likelihood of Serious Injury

Michelle Xiao; Jacie L. Lemos; Calvin E. Hwang; Seth L. Sherman; Marc R. Safran; Geoffrey D. Abrams


Med Sci Sports Exerc. 2021;53(10):2086-2092. 

In This Article

Abstract and Introduction


Purpose: This study aimed to assess the associations between serious injury (≥3-month time loss) and level of specialization among high-level female soccer players and to compare the specialization and college commitment ages of female youth soccer players to Division I college and professional soccer athletes.

Methods: Youth, college, and professional female soccer players in the United States playing in the top league at each level were recruited to complete an anonymous online survey. The survey collected information about player demographics, soccer specialization and training patterns, history of serious injuries from soccer, and perceptions surrounding soccer specialization. Comparisons between groups were performed using two-sample t-tests, χ 2 analyses, and multiple logistic regression models controlling for differences in age. A P value of less than 0.05 was set as significant.

Results: A total of 1,018 (767 youth, 251 college/professional) athletes completed the survey. Serious injuries affected 23.6% of youth and 51.4% of college/professional athletes. Anterior cruciate ligament tears were more prevalent in college/professional players compared with youth athletes (18.3% vs 4.0%; P < 0.001). Highly specialized youth athletes (66.5%) were more likely to have sustained a serious injury from soccer compared with athletes with low specialization (odds ratio, 2.28 (1.38–3.92); P = 0.008) but not moderate specialization (odds ratio, 1.37 (0.83–2.27); P = 0.43). A higher proportion of youth athletes specialized at a young age (≤10 yr) compared with college/professional players (44.2% vs 25.9%; P < 0.001).

Conclusions: High specialization in female youth soccer players is associated with an increased likelihood of sustaining a serious injury. Current youth soccer players are specializing earlier and committing to play college soccer at a younger age compared with when current college and professional players did.


With over 1.5 million registered female youth soccer players in the United States, soccer is one of the most popular sports for young women.[1] Although there are many health benefits that come with playing team sports,[2,3] the increasing number of participants and competitive nature of youth sports has led to a trend toward earlier sport specialization. Previous estimates have shown that the prevalence of sport specialization among high school athletes is between 22% and 48%.[4,5]

Sport specialization is commonly defined as participation in a single sport at the exclusion of other sports as well as intense training in a sport for greater than 8 months per year.[6–9] Reasons for specialization are multifactorial, and in women's soccer, may be attributed to goals of playing at an elite level, competition for college scholarships, and pressure from parents and coaches.[9–11] Multiple position statements from organizations including the American Orthopaedic Society for Sports Medicine,[8] the American Medical Society for Sports Medicine,[9] and the American Academy of Pediatrics[12] have voiced concerns about the consequences, including injury risk and burnout, of early sport specialization.

A great majority of studies on sport specialization have grouped youth athletes from different sports into a single analysis[4,7,13–15] or have focused on overuse injuries in sports with repetitive motions such as baseball.[10,16,17] However, the prevalence of specialization has been shown to be dependent on age, sex, and sport.[4,7,14,15,18] In addition, types of injuries and injury rates can vary between sport, sex, and competition level.[19,20] In youth soccer, there are a wide range of levels in which a player can compete, spanning from recreational local leagues to competitive national leagues and selective youth national teams. Previous studies on soccer specialization have included participants from either athletes that play at heterogenous levels,[5,21] or from all male populations.[22,23] We are unaware of any previous studies that have examined sport specialization patterns and serious injuries specifically for high-level female athletes. Although most soccer injuries are minor to moderate and result in less than 1 month of time loss,[24] serious injuries that cause athletes to miss significant time may negatively affect player development and performance, especially for players competing at a high level. Missed time has been shown to lead to psychological consequences such as a loss of identity in youth athletes.[25]

The primary purpose of this study was to assess the association between serious injury (≥3-month time loss) and level of specialization among high-level female soccer players. A secondary aim was to compare the degree of specialization and college commitment ages of youth soccer players to Division I college and professional soccer athletes. The authors hypothesized that youth athletes who focused specifically on soccer (and trained ≥8 months per year) would have an increased number of serious injuries compared with those who were less specialized in soccer. In addition, we hypothesized that differences in specialization and age at time of college commitment would be seen between youth soccer players and college/professional players.