Kids & Sports: Preventing Overuse Injuries - Promise

Kids & Sports: Preventing Overuse Injuries

Take a drive on any given Saturday morning in the spring, summer and fall and you’re bound to see kids of all ages playing a sport at your local school, community center or neighborhood field. What you may not see is that even when winter hits, some kids are playing these sports indoors. In other words, what used to be a “seasonal” sport — like soccer, tennis, swimming, baseball, etc. — has now become a year-round sport … and many kids are paying the price, experiencing “overuse injuries.”

What’s an Overuse Injury?

An overuse injury is defined as “damage to a bone, muscle, ligament or tendon due to repetitive stress without allowing time for the body to heal.” They can occur in the knees, heels and joints. According to the American Academy of Pediatrics (AAP), half of all sports medicine injuries in children and teens are from overuse. And the more time a child spends playing a sport, the more likely an overuse injury can occur.

Of course, anyone can experience an overuse injury. But in kids, these injuries most often take place in the growth plate, which is made more from cartilage than bone, making it more fragile and susceptible to injury. And simply because kids are still growing, they’re more prone to these injuries — which can be problematic because some of these injuries can affect bone growth.

Types of Overuse Injuries

Kids can sustain overuse injuries playing a variety of sports, from lacrosse, soccer and crew to track, cross country, and baseball and softball (specifically pitchers). Unlike an acute injury — which is sudden, usually involves a collision or twisting, and causes immediate severe pain — an overuse injury in more of a nagging pain. The child can still play the sport and most likely has no idea what caused the pain or how it started.

Here are some of the most common types of overuse injuries:

  • anterior knee pain: Usually caused by muscle tightness in the hamstrings or quadriceps, this is pain in the front of the knee under the kneecap. The knee will be sore and may become swollen due to tendon or cartilage inflammation.
  • Little League elbow: Repetitive throwing by pitchers in baseball and softball can sometimes cause pain and tenderness in the elbow. Pitchers sometimes complain of loss of velocity, loss of control, pain while throwing (and sometimes after), or decreased endurance.
  • swimmer’s shoulder: The repeated stress of the overhead motions used with swimming or throwing a ball can result in pain, which usually begins intermittently but can become continuous pain in the back of the shoulder.
  • shin splints: These are characterized by pain and discomfort on the front of the lower parts of the legs. They’re often caused by repeated running on a hard surface or overtraining at the beginning of a season.
  • spondylolysis: This often results from constant overextension, which puts too much stress on the bones of the lower back. This can cause persistent lower back pain. Spondylolysis is commonly seen in kids who participate in soccer, football, weight lifting, gymnastics, wrestling and diving.
  • Osgood-Schlatter disease (OSD): Not a disease at all, Osgood-Schlatter is an inflammation of the bone, cartilage and/or tendon at the top of the shinbone, where the tendon from the kneecap attaches. It can actually feel like a bump just below the knee. Kids increase their risk for OSD if they play sports involving running, twisting and jumping, such as basketball, football, volleyball, soccer, tennis, figure skating and gymnastics.

Causes and Symptoms

There are really three main causes of overuse injury:

  • an increase in how much/how often a child plays a sport. Examples include excessive activity, such as increased intensity, duration or frequency of playing and/or training, as well as playing the same sport year-round.
  • a decrease in strength and flexibility. Growth spurts can be one of causes of this.
  • poor technique. Inadequate warm-up, improper technique — like overextending on a pitch — and even improper equipment, such as nonsupportive athletic shoes, are good examples of poor technique that can lead to an overuse injury.

The most common symptoms of overuse injuries include:

  • chronic joint pain while playing or later, after a child’s done playing the sport
  • recurrent ankle sprains
  • swelling of the affected area
  • tenderness in the affected joint
  • a feeling of “giving out” or weakness in the joint
  • overall fatigue

Treatment for overuse injuries can vary based on the specific injury and part of body affected, but there are three common themes: rest, medicine to ease inflammation and physical therapy.

Preventing Overuse Injuries

1. Avoid playing the same sport for more than eight months of the year.

This simply can’t be stressed enough. The best way to avoid overuse injury is to allow those growing bones and growth plates to rest by taking a break from the sport of choice. If a child really has a desire to stay active, then suggest a totally different sport, or even encourage free play. Kids are more likely to stop playing when they feel tired and will rest more during unstructured play (e.g., a pick-up basketball game, flag football with friends, etc.) than during competition and organized sports.

2. Get physical therapy.

A sports medicine physical therapist can help kids learn how to properly warm up and cool down as well as work on their technique to make sure it’s being performed properly and safely.

3. Stick with one team per sport.

Try to avoid allowing a kid to play on multiple teams for the same sport.

4. Use the proper equipment.

Kids should always use the proper equipment and safety gear that’s the correct size and fits well.

When our children have a passion for a sport, of course we want them to excel and succeed. But, more importantly, we should be reminding them — and ourselves — that their health comes first. It’s not all about winning. Even if their goal is to become an elite athlete, their ultimate goal should be to have fun, and reap all the benefits sports can offer — not just in childhood, but throughout their lifetime.

Learn More:
Nemours Center for Sports Medicine
Preventing Children’s Sports Injuries (Nemours’
Sports Medicine Center (Nemours’
Preventing Overuse Injuries (American Academy of Pediatrics’

Alfred Atanda, Jr., MD

About Alfred Atanda, Jr., MD


Dr. Atanda is an orthopedic surgeon with the Nemours Center for Sports Medicine at Nemours/Alfred I. duPont Hospital for Children in Wilmington, Del.