Preventing Overuse Injuries in Young Athletes

Young athletes who specialize in one sport often view their dogged training as a route to athletic success. But the intense workload often leads to another destination — a doctor’s office.

Overuse injuries account for more than 50% of medical visits by young athletes. Study after study shows that repetitive stress from focused year-round training puts children at greater risk of getting hurt.

The evidence is clear, reports the American Academy of Pediatrics: Kids are breaking down and burning out from the “professionalization” of youth sports, a trend with long-term health consequences.

So, how can you keep your child injury-free and in the game as they chase after goals? Let’s put a playbook together with sports medicine specialists Molly McDermott, DO, and Paul Saluan, MD.

What is an overuse injury?

Do something once — like throwing a baseball — and your body barely notices. But do it 10,000 times over months or years of relentless training and you begin to learn the true meaning of wear and tear.

Repeating the same movement again and again stresses affected muscles, tendons and even bones, explains Dr. Saluan. That’s a reality that makes one-sport athletes particularly vulnerable to injury.

“You have kids who live, sleep and breathe a sport — and they’re paying a price,” he says.

Certain sports lend themselves to overuse injuries, especially to joints. The roster includes:

• Baseball (particularly with shoulder and elbow injuries linked to pitching).
• Basketball (jumper’s knee).
• Gymnastics (back, elbow, wrist and ankle injuries).
• Running (plantar fasciitis and knee injuries).
• Soccer (knee and ankle injuries).
• Tennis (elbow injuries).
• Volleyball (jumper’s knee).

Factors leading to overuse injuries

Training volume is a driving force behind overuse injuries, but it’s not the only factor putting young athletes on the injured list. Other contributing causes include:

Training intensity

The intensity level that accompanies many year-round training programs also drives up the risk of injury. Put simply, many young athletes push harder for longer without giving their bodies time to recover.

Physical breakdowns seem almost inevitable in that scenario. “If you’re constantly trying to work at the highest level, you’re never giving your body the rest and recovery time it needs,” says Dr. McDermott.

Improper mechanics

Less-than-perfect form during an activity can add strain to already taxed joints and muscles.

“Proper mechanics can really help limit the risk of overuse injuries,” notes Dr. McDermott. “It’s essential for young athletes to learn proper form before increasing workload to stay healthy as they train.”

Conditioning level

Athletes are more prone to injury when they push to reach a high level of performance too quickly or following a layoff or interruption. “There’s a process that needs to be followed to build up,” says Dr. Saluan.

Signs of overuse injuries in young athletes

How can you tell if your young athlete is pushing their training a little too far? Signs pointing toward potential overuse injuries (or that someone is on track for one) include:

• Joint or muscle pain during an activity.
• Stiffness, swelling or loss of motion after activities.
• Unusual fatigue despite getting normal rest.
• Changes in sleep routines, especially if it’s linked to pain.
• Unexplained moodiness.
• A decline in physical or academic performance.

“Sometimes, young athletes won’t be open about how they’re feeling because they’re worried about being shut down — and that can be challenging,” notes Dr. McDermott. “Trust your gut if you sense that something is off.”

Are children more prone to overuse injuries than adults?

Absolutely. “Repetitive stress takes a toll on the body, especially at the growth centers on our young athletes which are vulnerable to injury before skeletal maturity,” explains Dr. McDermott. “That’s a big reason we see so many overuse injuries in kids.”

Impact of overuse injuries on young athletes

Trying to push a young athlete through an overuse injury can lead to long-term damage. Joint degradation at an early age can set the stage for arthritis and chronic tendonitis years in the future.

Young athletes need to listen when their body communicates through pain, stiffness or soreness. What seems like small problems can quickly blossom into more serious injuries if ignored.

“Pain is not something that should be tolerated in young athletes,” stresses Dr. Saluan. “It’s a call for attention.”

Consider this, too: Overuse injuries and burnout from sports specialization often contribute to children “retiring” from competition by the time they’re teens. Research shows that 70% of young athletes choose to discontinue team sports by age 13.

That attrition plays a role in the obesity epidemic threatening the health of our youngest generation, says Dr. McDermott.

“We see the implications of overuse injuries in more ways than just sport,” she says.

Preventing overuse injuries in young athletes

The best defense against overuse injuries can be summed up in three words: Take time off.

A three-month break is recommended for young athletes focused on a single sport, says Dr. Saluan. Stepping away from the activity allows the body — specifically, overtaxed joints and muscles — time to recover.

To be clear, though, the recommendation for a “break” isn’t a challenge to log 90 consecutive days on a couch. “Keep moving your body,” he continues. “Just move it differently.”

That means switching things up. If you’re a runner, maybe try swimming for a bit to lessen the pounding on your knees and ankles. (Vice versa, too.) Or just dedicate a few months to full-body weight training.

In the old days, that happened naturally as young athletes moved from sport to sport with the seasons. The pattern minimized overuse injuries because different activities work different areas of the body.

Basically, the transition from football or field hockey in the fall to basketball, swimming or wrestling in winter to baseball or softball in spring kept specific joints from being used the same way all year.

“By focusing on just one sport, the concern is that these young athletes are accelerating joint degradation,” he adds. “There’s a fine line between being active and healthy and overdoing it.”

In-season tips to prevent overuse injuries

The in-season grind of training and competition can make young athletes more susceptible to overuse injuries. Encouraging kids to follow these tips may offer some defense, says Dr. McDermott.

• Take rest days. Young athletes should set aside at least one day a week for rest. And rest means REST. “A light jog or swim isn’t part of a rest day,” she emphasizes. “It should be a full day off to let the body recover.”
• Get enough ZZZs. Sleep allows young bodies and minds to recharge to meet tomorrow’s challenges. Be wary of school and training schedules that steal hours of shut-eye.
• Eat healthy. Late practices can lead to less-than-nutritious dinners served out of drive-thru windows. Young athletes need the right fuel in their tanks to operate at peak efficiency. (A pediatric dietitian offers some healthy snack ideas for kids.)
• Stay hydrated. Putting down enough fluids can boost performance and help prevent injury.

“The idea is to build a mentality that recovery and taking care of your body is a key part of being an athlete,” Dr. McDermott says. “It’s not just about pushing through training. It’s about being ‘the best’ outside of that, too.”

Final thoughts

Self-awareness is critical for athletes to avoid overuse injuries. Knowing when something feels off and — more importantly — taking steps to address it is key to staying healthy and in the lineup.

Taking time off isn’t always easy either, given the pressure to succeed that often comes with sports.

“That’s where mindset comes in,” states Dr. McDermott. “If we can start thinking of recovery and rest as part of being an athlete, we may be able to reduce overuse injuries and help kids stay healthy and fit.”

Or to put it another way: “The best way to deal with an overuse injury,” says Dr. Saluan, “is to stop it before it happens.”