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     This project was created in part due to my clinical interests I’ve gained throughout my education in UNC’s DPT program, along with my own background in sports and athletics in general. Growing up, I always played a wide variety of sports and between myself and my two younger brothers, had our mother driving us around constantly to sports practices, games, and other various sporting events on a daily basis. This sports diversity afforded me the athletic development necessary to allow me to continue playing sports at the collegiate level, and has since contributed to my interest in this topic. Participating in athletics at the collegiate level allowed me to experience higher level sports development and sports performance, which has added to my personal background and interest in this aspect of human movement and contributed to my interest in pursuing my Doctor of Physical Therapy degree. My education in UNC’s DPT program has lead me to develop interests in orthopedics and musculoskeletal conditions, among others. A lecture in the Advanced Orthopedics elective during the fall semester of my third year peaked my interest in early sport/single sport specialization (ESS). After performing a brief literature search for a forum post in this class on this topic, it became the focus of my Capstone and has grown exponentially from there. This, combined with the interest I’ve gained during clinical rotations on post-operative care and return to sport considerations, has widely shaped the scope of my Capstone project and how it corresponds with prophylactic management and movement development in this population as well as others. 

Statement of Need:

      Early sport and single sport participation has grown increasingly in youth sports over the past several decades. This shift has coincided with youth sports transitioning from an emphasis on fun to a highly competitive and demanding environment with increased pressure placed on these youth athletes by themselves, their parents, and/or their coaches at an early age. The goals placed on many of these youth athletes has shifted from recreational enjoyment and socialization to competition for sport achievement/success, the chance for scholarship at the intercollegiate level, and professional aspirations. This increased pressure placed on the youth athletes may be leading to higher rates of burnout and drop out from organized sports, may have potential detrimental effects on the athletes development of movement skills, and may predispose the athlete to repetitive overuse injuries. The purpose of this Capstone project is to present parents, youth athletes, sports coaches, and strength and conditioning professionals with the best evidence on early sport specialization at these potential inadvertent side effects, while also providing recommendations for best practice in youth sports participation in early and late-stage adolescence. This Capstone also aims to provide modifiable risk reduction strategies to sports coaches and strength and conditioning professionals to combat these recent trends seen with early sport specialization/single sport participation to improve practice setup and programming strategies that offer youth athletes an improved environment to develop athletic skills safely and effectively.


ESS Evidence Table

ESS Presentation Outline

ESS Presentation PowerPoint

ESS Video Presentation part 1: What is ESS and what are current Recommendations?

ESS Video Presentation part 2: Modifiable Risk Prevention Strategies for coaches and clinicians

Infographic ESS Presentation 


     Throughout this project, I consistently shared my progress and ideas with my faculty advisor to help narrow my focus on project ideas and scope, formatting, evidence gathering, health literacy, and deadline drafts among other items. Each of my products was also sent to remaining committee members for feedback and guidance to refine my products and enhance the deliverables used for health literacy and target audience education.

     I also developed 2 separate Qualtrics surveys to assess parent understanding and implementation, as well as sport coach and strength and conditioning professional understanding and implementation of the presented materials. Links for each of these surveys are provided below.

Parental Survey

Coaches Survey

Self Reflection:

     The scope of this project and variety of considerations when researching early sport specialization and modifiable risk reduction has changed vastly since I began this project. In performing an in-depth literature review and creating a table to compile the evidence, I quickly realized that my original ideas on how to deliver the information required refinement. As I continued into the literature, I began to adapt my scope, target population, and other areas of consideration for deliverable education to provide to parents, athletes, coaches, and strength and conditioning professionals. This capstone has enhanced my ability to perform a high quality search into the current literature present on a given topic, to refine my search question as needed, as well as to allow the evidence to guide the direction of the utilization of the information learned from the search. It has also enhanced my ability to present best evidence in the form of educational materials to populations outside of the physical therapy community with varying levels of background knowledge on the information presented using appropriate terminology. These attributes will hopefully contribute to me becoming a better clinician as a Physical Therapist, and allow me to better serve my future patient’s by providing them with high-level care.


I would like to recognize my committee members for all of their countless support, time, and advice throughout this Capstone process. Each of you were invaluable members of my support system that allowed me to bring this project to life.

To Dr. Mike Gross, PT, PhD, FAPTA, thank you for undertaking this project as my faculty advisor, for the many zoom calls to discuss logistics, and for helping me refine my Capstone to its final product. Your lecture on ESS in Advanced Ortho peaked my interest on this topic, so it seemed only right to ask you to serve in this role. You’ve been a great mentor throughout this process, and I am very appreciative for your time, and even humor as needed to help see this project to its completion.

To Mark Hoover, USAW 1&2, IYCA-HSSC, NASM-PES, RPR-1, thank you for your expertise in strength and conditioning programming and implementation of athletic development, and your mentorship throughout this process. This project would not have happened without your guidance. Special thanks to you for helping recruit participants and helping with the logistics of presenting this material along the way. I can only hope to yearn for greater understanding and continuing to add to my knowledge base as you have exhibited. You’ve been a fantastic role model for what a professional looks like, and mentor who never hesitates to jump in and help whenever I’ve had questions. You’re one the the true ‘MONSTAHS’ of the field.

To Meghan Cesarz, PT, DPT, OCS, CMTPT, thank you for your input and advice along the way. Your experience and background in rehabilitative management of athletes was very helpful to lean on throughout this process. Being my first clinical instructor, you fostered an environment that allowed me to learn and develop my clinical reasoning and patient care, and I’m so glad to have maintained contact throughout PT school, you’ve been a great mentor and friend.

To Joe Tedesco, PT, DPT, OCS, ATC, CSCS, thank you for your support and guidance throughout this project and with helping me evaluate the state of the evidence. Your experience and background with return to sport management of athletes was extremely beneficial and a reason why I sought out your assistance with the creation of this project. You first introduced me to what Physical Therapy actually was, and were the first person to offer me shadowing experience in your clinic. You’ve been a great mentor and friend throughout this journey as I take the next steps to becoming a board-certified physical therapist.


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2 Responses to “Effects of Early Sport Specialization on Youth Athletics and Lower Extremity Risk Reduction Strategies”

  1. Mary Grace Knoll

    Great project and great topic! Early sport specialization is a huge issue among young athletes creating significant amounts of problems not only in the short term, but in the long term. You did a great job of synthesizing the important information as to why this is harmful, but also did a great job forming a recommendation. This is very clinically relevant as this is a difficult conversation we may potentially need to have with many of the these young patients and families about stopping this early sports specialization and the large volumes they are being exposed to. Not surprisingly, this had a larger effect in individuals pre/during puberty, but knowing that it was potentially safer afterwords is good, productive information to give patients and families. Additionally, educating people that once they do start doing this specialization, taking time off throughout, that 2 months off of the activity, is extremely important for their longevity and future health. Additionally, giving recommendations for injury risk reduction of common injuries in this patient population is another great thing for clinicians to have and education patients and families alongside this topic of sport specialization. This is a great topic and you included great information, formulating clinically helpful recommendations. Great job Ethan!

  2. Andrew Starck

    Ethan, awesome work! Your evidence tables and research synthesis is really helpful to consolidate quality evidence for early sport specialization. I know many parents of youth athletes have questions about injury risk reduction and nurturing their child’s athletic development; this resource will be extremely helpful for them as well as PTs. Way to go!


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