Elite US college admissions: could the quest for admission increase overuse injury risk?

This commentary addresses the intriguing correspondence of two trends. First, we describe the increasing selectivity for undergraduate admission to elite colleges and universities in the United States and an apparent preference for “angular” applicants who have demonstrated tremendous accomplishment in a single non-academic pursuit such as music, athletics, or the arts. Second, we describe an apparent increase in overuse injuries among American children and adolescents, a trend that many experts attribute to specialization within a single athletic, musical or artistic pursuit among youth who in previous generations were more “generalist” in their extracurricular activities. It is premature to demonstrate causality and suggest increasing college selectivity has led to increasing rates of overuse injuries, but we speculate there may be a causal relation present and encourage scholarly research on the topic.