Over-exertion, overscheduling, and insufficient rest can result in serious injuries to developing children. It has been estimated that among the 60 million children between the ages of 6 and 18 years that participate in an organized sport, approximately 46-54 percent of injuries are due to overuse.
Pediatric overuse injuries, as opposed to acute injuries, result from the repetitive application of force over a period of time. These injuries are notably common among children whose bones are still developing and growing, and therefore are not as strong as the bones of older adolescents and adults. In addition to bones, overuse injuries can affect multiple areas and systems of the body, including muscles, ligaments, tendons, and growth plates.
Causes of Overuse Injuries
Overuse injuries are on the rise primarily due to a phenomenon called “early sports specialization,” which refers to participation in a single sport year-round at the exclusion of other sports. This prolonged engagement in certain sport-specific movements can result in overuse injuries. Dr. Kenneth Swan, a sports medicine surgeon at UOA, elaborates on this point, stating, “The increase in overuse injury rates is largely due to the increased pressure to specialize at an earlier age and play on multiple teams year-round.”
Furthermore, Dr. Swan suggests that although most parents, coaches, and athletes believe that specializing in one sport at a young age is the formula to achieve success in that sport, all of our data on this topic show that it is actually multi-sport athletes that more likely to achieve elite level success in their sport and avoid overuse injuries. Constant conditioning for a single sport coupled with inadequate rest has shown to be the main driver of pediatric overuse injuries.
Common Overuse Injuries
Bony Stress Injuries
Bony stress injuries are some of the most common overuse injuries that affect children. Bony stress injuries are the failure of the skeleton bone to withstand repetitive force applied to that particular area of the body. They often lead to localized pain, structural fatigue and tenderness around the bone. These injuries are most often a result of overuse rather than acute injury. If not recognized and treated appropriately, severe cases of bony stress injury can lead to stress fractures when the failure to properly transfer the pressure generated by this stress results in a fracture. In a presentation given on stress fractures and overuse injuries, Dr. Charles Gatt of UOA stated, “Clinical symptoms for stress fractures typically start about three weeks into a training season.”
Below is a brief overview of the most common bony stress injuries found among children.
Tibial Stress Fracture
Tibial stress fractures refer to fractures sustained to the lower leg bone or shin. Patients suffering from tibial stress fractures generally experience a slow onset of pain that is localized on the shin. This pain typically worsens with increased activity and decreases with rest. In more severe cases, daily movements, including walking, can aggravate these symptoms.
The tibia can also be subject to chronic pain around the shin and may or may not be indicative of a stress fracture. Tendonitis and exertional compartment syndrome are two other possible causes of shin pain, and proper diagnosis is necessary in order to develop the appropriate treatment plan.
Foot Stress Fracture
Foot stress fractures, also known as “metatarsal fractures,” refer to fractures sustained in one of the five long bones (or metatarsals) of the foot. The most common foot stress fractures occur on the second metatarsal, which is the toe directly adjacent to the big toe, and the navicular, which is the bone located at the top of the foot’s arch, as this is the area of greatest impact on your foot when you walk or run. In fact, weight-bearing activities, such as running and jumping, are the most typical culprits in navicular stress fractures, and can often affect children, as the navicular is the last foot bone to fully ossify and fuse into solid bone.
Sever’s Disease (calcaneal apophysitis)
Sever’s Disease is a painful disorder that results from the swelling of the growth plate located in the heel of the foot. Growth plates—also called epiphyseal plates—are located at either end of bones that have not fully ossified yet and are still in the process of growth and development. These plates are composed of cartilage cells that allow for expansion during growth and ultimately transform into bone cells over time. A swollen growth plate in the heel of the foot is an injury specific to children, typically affecting individuals between the ages of 8 and 15, with a greater rate of occurrence among males. Because growth plates have already fused in older adolescents and adults, Sever’s Disease is found almost exclusively in the foot bones of children.
Osgood-Schlatter Disease is characterized by an inflammation of the patellar tendon at the top of the tibia where the tendon attaches. In some cases, a painful lump presents below the kneecap in children and adolescents. This indication of Osgood-Schlatter Disease occurs as a result of increased stress placed on the growth plate in this area during repetitive activities in growing athletes. The disease can occur as a result of activities such as running and jumping on hard surfaces such as a track, or from the swift changes in direction of typical sports like hockey, figure skating and basketball. Osgood-Schlatter has traditionally been more common among boys than girls, but as participation in sports by girls continues to increase, this pattern has begun to change.
Little Leaguer’s Elbow
Little Leaguer’s elbow refers to the injury that results from repetitive stress on the growth plate of the elbow. The greatest stress occurs during the acceleration phase of the movement involved in throwing a baseball. This injury is found primarily among pitchers, however, Little Leaguer’s elbow has been found in individuals occupying other high-volume throwing positions in any sport.
Dr. James Monica of UOA addressed these baseball-specific overuse injuries in a recent press release, stating, “Baseball has seen an incredible rise in ulnar collateral ligament injuries, which can be linked to the repetitive damage that can occur on a developing elbow from pitching without adequate rest or pitch count limits. All too often, we see athletes that pitch on multiple teams and are pitching when they are fatigued. In response to the increase in injuries, Major League Baseball (MLB) has created pitch count guidelines called ‘Pitch Smart,’ which looks to limit the innings pitched and the number of throws made during a calendar year.”
Based on years of research by experts studying the behaviors that put adolescent pitchers at risk for injury, Pitch Smart is a series of age-appropriate recommendations for parents, coaches and young athletes created by MLB and USA Baseball™ to reduce arm injuries and promote safe pitching practices. Additionally, the Pitch Smart guidelines also list a variety of risk factors involved with these types of overuse injuries, such as pitching on consecutive days and/or while suffering from injuries to other areas of the body. The expert physicians at UOA highly endorse the techniques and practices as outlined by the Pitch Smart Guidelines.
Diagnosis and Treatment of Overuse Injuries
Overuse injuries can be properly diagnosed through a combination of assessing individual medical histories and physical examinations conducted by a doctor specializing in sports medicine. In some cases, X-ray or magnetic resonance imaging (MRI) may be required to confirm a suspected overuse injury. Treating overuse injuries typically involves a combination of rest, anti-inflammatory medicines and physical therapy, with the course of treatment depending on the specifics of the injury itself.
UOA is World-class in Treating Sports-related Injuries
UOA is a leader in comprehensive care for all sports-related injuries and conditions, with an award-winning, caring and compassionate staff of board-certified sports medicine physicians. Our state-of-the-art facilities allow us to best serve your needs, from prevention and diagnosis to treatment and rehabilitation. UOA works with athletes of all ages and skill levels; including adolescent athletes, professional athletes and weekend warriors. We will develop the best treatment plan to help return you to the field and offer a complete variety of non-surgical solutions and minimally invasive procedures.
To learn more about what UOA can do for your child athlete, read about our pediatric sports medicine capabilities.