Overuse Injuries In Youth Sports: Too Much of a Good Thing

by Greg Lopez, MD (’24)

As pediatricians, we routinely encourage exercise and participation in sports as part of a healthy lifestyle. However, with this encouragement comes the risk of overuse injuries. If these conditions go undetected, they can cause serious long-term consequences for our patients. Thus, it is important for us to be able to identify these conditions and keep a high level of suspicion in order to make the diagnosis early in the course.

Overuse injuries occur when a part of the body experiences repetitive stress or trauma without having enough time to recover afterwards. These can affect any part of the musculoskeletal system and include muscle strains, tendonitis, and stress fractures. Though people of all ages can suffer overuse injuries, children can be at particularly high risk of overuse injuries for a few reasons.

Physiologically, growth spurts can put children at risk for overuse injuries. As bones and muscles develop at different rates, imbalances in strength and flexibility can occur, which can consequently put additional strain on tendons and ligaments, consequently increasing risk of overuse injuries.

Apophysitis is a type of overuse injury specific to the pediatric population, resulting from microtrauma on the apophysis, a growth plate at which a tendon inserts. This can occur at numerous apophyses throughout the body. Two of the more common examples are Sever’s disease (calcaneal apophysitis) and Osgood-Schlatter disease (tibial tubercle apophysitis). Sever’s disease occurs in sports like basketball that involve repetitive jumping and causes pain at the heel. Osgood-Schlatter disease is common in sports that involve running and changing direction like football, soccer, and basketball – this causes pain just below the patella on the tibial tubercle.

In addition to the physiological risk factors in pediatrics, social issues can also contribute to increased risk of overuse injuries. Even from a young age, many children may feel internal or external pressures to commit to playing one sport year-round in order to maximize their chances of advancing to higher levels of play. Rather than diversifying different motions and activities across different seasons, playing a single sport puts the body through the same repetitive motions, iincreasing the risk of stress injuries like spondylolysis, a stress fracture of the pars interarticularis often affecting the lumbar spine. This injury occurs most often in activities with back extension, such as backbends in acro dance or offensive linemen being pushed backward by oncoming defenders.

In addition to the physiological risk factors in pediatrics, social issues can also contribute to increased risk of overuse injuries. Even from a young age, many children may feel internal or external pressures to commit to playing one sport year-round in order to maximize their chances of advancing to higher levels of play. Rather than diversifying different motions and activities across different seasons, playing a single sport puts the body through the same repetitive motions, iincreasing the risk of stress injuries like spondylolysis, a stress fracture of the pars interarticularis often affecting the lumbar spine. This injury occurs most often in activities with back extension, such as backbends in acro dance or offensive linemen being pushed backward by oncoming defenders.

Overuse injuries are common, but they can be prevented with a thoughtful approach that prioritizes balance. By coaching kids on proper form for their respective sports, encouraging them to try a diverse range of activities, and monitoring workload to allow for appropriate rest and recovery, we can help kids stay active and have fun while minimizing their risk of injury.