Overuse Injuries

Pain is our body’s way of telling us something is wrong. Injuries are going to happen when
you play sports, but many injuries can be prevented if proper precautions are taken. In
this section we will look at how overuse injuries occur and which injuries are common
overuse injuries. We will also look at which injuries occur most often in various sports.

When we watch professional sports we often hear the sportscasters discuss this player or
that player who is playing with such and such an injury. Young athletes, however, are not
paid professionals, and they should be encouraged to listen to their bodies and let parents
and coaches know when something is not right. Many times young athletes are
encouraged or feel pressure to play through the pain. While this may help them feel
psychologically tough, their bodies are only capable of taking so much.

Overuse injuries get worse, not better, when the activity that caused the injury is repeated,
so children should never be encouraged to play through the pain (1, 2). Playing through
the pain will only increase the damage to the body and add weeks, if not months, onto the
total time needed to recover from the injury. Certain injuries may also contribute to long
term physical maladies that may forever plague your child (3). As the parent, you may
need to intervene when a child with an injury wants to play and a coach is ready and willing
to allow that injured player to participate. You are the one responsible for your child’s
health and looking out for their best interests, not the coach. Sometimes young athletes
act in a way that they feel pressured to, or to please the adults around them, and may
want to play through an injury. It is important that you discuss with them how this could
affect their future participation and help them really understand treating the injury early on
is best.

With any overuse injury, the best recommendation is selective rest, not participating in the
particular activity or exercise that causes the pain. If you suspect your child has an
overuse injury, or any injury at all for that matter, let them rest and give their body time to
heal. In addition, any persistent injury needs to be checked out by a doctor. They are the
only ones who can properly diagnose the injury. Going to a school athletic trainer is not
enough. Oftentimes athletic trainers do not have the advanced equipment available to
make a proper diagnosis of an injury. For example, I know an athlete who completely tore
two ligaments in his knee while playing collegiate baseball and couldn’t even stand. The
athletic trainer who examined him immediately after the injury told him he didn’t think
anything was torn!

It is estimated that up to half of all sports injuries are overuse injuries (4) and that these
injuries result in 54% more lost training time than other types of injuries (4). The sad thing
about these statistics is that most overuse injuries are preventable! It is important to know
the factors contributing to overuse injuries so you as a parent or coach can be proactive in
preventing such injuries. O’Neill and Micheli (5) have identified seven main factors that
predispose athletes to overuse injuries. These seven factors are: training error, natural
growth spurts, anatomical malalignment, footwear, playing surface, nutritional factors,
cultural deconditioning.

Training Error

Sports programs for adolescents should not be identical models of adult programs. One of
the biggest contributing factors for overuse injuries (5) is participating “too much, too
soon” in an activity. Exercise breaks the body down, and it needs time to repair and
rebuild. The repetitive trauma that occurs during practice and competition can lead to
injury if adequate rest is not taken. One recommendation is to allow a minimum of two
days of recovery per week (1). Training intensity should also increase gradually. The body
needs time to adapt to the training load, and increasing the intensity “too much too soon”
is a main cause of injury.

Natural Growth Spurts

Youth and adolescence is a time of rapid growth, and this can leave a young athlete
susceptible to injury. When bones grow and lengthen, the muscles attached to those
bones have to in turn lengthen and become stronger in reaction to the bone getting longer
and heavier. This growth does not occur simultaneously, and can leave these areas of
growth weak and inflexible, opening them up to injury (6, 7). It is important to know when
a growth spur is occurring in your child so that you and your family physician can monitor
their activity level and make sure they are not developing any injuries. Some cutback in
practice intensity or duration may be necessary to avoid injury during these periods of
growth.

Anatomic Malalignment

Anatomic malalignment refers to things such as one leg being longer than the other, flat
feet, and hip rotation that is not quite normal, among other possibilities. It is important for
your child to have a complete physical exam before participation in sports. During a
routine physical you should make sure the physician checks for such possibilities because
they could later contribute to injury. Some conditions may have an easy fix, such as
wearing orthotics (5). Early prevention is a lot less painful than having to deal with the
injury, the costs of healing the injury, and lost participation time.

Footwear

Each person’s feet are unique, and it is important that the shoes your young athlete wears
are appropriate for his or her sport and feet type. With runners especially shoe selection
and replacement becomes critical. Shoes wear out sooner than you might think. The
recommendation is to replace your shoes every 250-500 miles because they loose a
significant amount of their shock absorbing capacity (4). Bad shoes can lead to overuse
injury.

Playing Surface

Some surfaces are less forgiving than others. Injuries have been reported when athletes
have switched playing surfaces, for instance switching from asphalt to clay in tennis (5). Be
aware of the playing surface your child practices and competes on. Switching surfaces
may require a gradual shift so the body can get used to the new way it is experiencing
shock.

Nutritional Factors

The young, growing athlete is expending a tremendous amount of energy. Proper
nutrition is needed to ensure that the body is able to repair itself and build up a stronger
and better athlete. Unfortunately, some athletes purposely restrict their food intake, or
maybe they are not specifically restricting their food intake but they are exercising and not
consuming enough calories to meet their energy demand. This can lead to a very
problematic situation called the Female Athlete Triad. We will talk more in depth about the
Female Athlete Triad in another section, but basically this situation can lead to a decrease in
bone density and leave female athletes, especially, susceptible overuse injury and to stress
fractures (5). The Triad appears to be more common in runners and girls participating in
aesthetic sports such as dancing and gymnastics.

Cultural Deconditioning

A final factor contributing to overuse injuries is cultural deconditioning. We have a youth
population that is sedentary, spending on average 40 hours in front of the television each
week (5). When these children are put in sports, the intensity of the practice and games is
much more than their bodies are used to, leading to overuse injuries (5).

Other Factors

Other factors not mentioned by O’Neill and Micheli (5) contributing to injury are previous
injury, and poor technique (4). All coaches should emphasize skill and technique
development with young athletes.

Common Overuse Injuries by Sport



Symptoms of an Overuse Injury

Some pain is normal when playing sports. Muscles might be sore after a hard practice or
game. So how do you know when the soreness is indicative of an injury? Well, Koutures
(1) suggests that if the pain if the pain occurs during the activity and/or is above a three on
a scale of 0 to 10 then an injury might be present. Injuries may start off as a minor
discomfort after practice and then progress to sharp pain during the activity itself. You
know your child and their normal habits of complaining about pain. If you detect
something different in their complaints, please stop the activity and have them checked out
by a doctor.

Conclusion

It is so important to catch overuse injuries early and not let them go until the end of a
season. It is important for you to monitor your child’s practice activities. Beware if a coach
seems to be requiring “too much, too soon.” Insist on rest days following heavy practice
and competition, monitor your child’s growth spurts, make sure they have the proper
equipment and it is replaced as often as necessary, and keep a watchful eye on their
nutrition. By taking a pro-active role, you can help your child’s athletic experience to be as
injury free as possible.

Further Information on Other Sites

Overuse Injuries in Children and Adolescents by John P. DiFiori, MD
(1999) published by the Physician and Sportsmedicine, Vol 27(1)

Child’s Play? Kids, Sports, and Injury – by Susan Gaines
(2000) published by the Minnesota Medical Association, Vol 83

References

(1) Koutures, C. G. (2001). Contemporary Pediatrics, 18, 43-57. Retrieved November 15,
2005 from Health & Wellness Resource Center database.

(2) Cimons, M. (1999). Youth movement: children and teens vulnerable to sports injury.
Runners’s World, 34(4), 42. Retrieved November 15, 2005 from Health & Wellness
Resource Center database.

(3) Goldberg, B. & Hershman, E. B. (1994). Understanding overuse injuries in young
people. Physician and Sportsmedicine, 22, 53. Retrieved November 15, 2005 from
LexisNexis database.

(4) DiFiori, J. P. (1999). Overuse injuries in children and adolescents. The Physician and
Sportsmedicine, 27(1). Retrieved November 15, 2005 from http://www.physsportsmed.
com/issues/1999/01_99/difiori.htm

(5) O’Neill, D. B. & Micheli, L. J. (1988). Overuse injuries in the young athlete. Clinics in
Sports Medicine, 7, 591-610.

(6) Marsh, J. S. & Daigneault, J. P. (1999). The young athlete. Current Opinion in Pediatrics,
11, 84.

(7) Hawkins, D. & Metheny, J. (2001). Overuse injuries in youth sports: Biomechanical
considerations. Medicine & Science in Sports & Exercise, 33, 1701-1707.

*Disclaimer: The information on this site is not intended to substitute for advice from a
medical professional.

Baseball	Basketball	Gymnastics	Running	Soccer	Swimming	Tennis	Volleyball
Little League Elbow	Shin splints	Stress Fractures	Stress Fractures	Stress Fracture	Little League Shoulder (and other shoulder injuries)	Tennis Elbow	Patellofem- oral Syndrome
Little League Shoulder (and other shoulder injuries)	Patellofem- oral Syndrome	Injuries to the Spine	Shin Splints	Seaver's Disease			Jumper's Knee
	Osgood- Schlatter's Disease	Patellofemoral Syndrome	Achilles Tendonitis	Tendonitis			Osgood- Schlatter's Disease
	Jumper's Knee			Osgood- Schlatter's Disease