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Overuse Injuries in Youth Sports

What are overuse injuries?

According to the American Academy of Orthopaedic Surgery (AAOS), over 3.5 million sports-related injuries occur in athletes 14 years old and under. The AAOS also estimates that roughly 50% of injuries in middle and high school athletes can be classified as overuse injuries. Overuse injuries are a result of micro-trauma occurring to tissues such as muscle, tendons, or bone as a result of repetitive stress. There is an ongoing balance in our bodies between tissue breakdown and tissue healing. When the balance shifts towards tissue breakdown, an overuse injury will occur. Typical examples of overuse injuries include: stress fractures, shin splints, tennis elbow, jumper’s knee, and Little League elbow.

How do overuse injuries occur?

The most common cause of overuse injuries are errors in training technique. Rapid increases in frequency or intensity of an activity lead to overloading of tissues. Use of inadequate equipment, such as an older pair of running shoes, can lead to injury as well. Physical factors such as limb malalignment, imbalances in muscle flexibility and strength, as well as variations in the arch of the foot can make an athlete more susceptible to injury. Poor nutrition and lack of adequate sleep may also impair the body’s healing ability.

How are these injuries diagnosed?

Pain is the hallmark symptom for all overuse injuries. The pain may not be severe enough initially to stop an athlete from participating, but it will typically lead to a subtle impairment in overall performance. Swelling, stiffness, or bruising can also occur. A thorough evaluation by an orthopaedic specialist in sports-related injuries will lead to proper diagnosis of the specific injury. Imaging studies such as plain x-rays and magnetic resonance imaging may also be helpful.

How are overuse injuries treated?

Rest is the most important component to treating overuse injuries. Rest allows the body’s healing processes to catch up. Initially this entails decreasing the intensity, frequency, and/or duration of activity. In very difficult cases, an athlete may have to stop participating in the offending sport. Modifications in both the training program and technique usually are also required to obtain complete resolution of the symptoms. Ice and anti-inflammatory use can be helpful to reduce symptoms initially. Proper warm up and cool down exercises are also beneficial. Rarely, if caught early, will surgical intervention be necessary. If left untreated, however, overuse injuries can lead to significant and potentially permanent damage to tissues.

How can overuse injuries be prevented?

The most critical factor for prevention is to have instruction in appropriate training technique prior to beginning a sport. Pre-season physical evaluations can provide insight into athletes at risk for injuries and can also be utilized to design the proper training program. All training programs should progress gradually. A 10% increase per week in one’s training regimen is usually safe. Proper strength training which also incorporates flexibility and core stability is beneficial. Maintaining good hydration during sports activities is also critical. Make sure any equipment worn for the sport is in good condition and well fitting. Lastly, taking one season off from competition per year will allow the body to fully recover. During that downtime, a training program can allow for improvements in overall strength, endurance, and flexibility that will reduce injuries in the next competitive sport season.