Overuse Injuries in Youth Sports
Little League elbow. Torn ACL. Swimmer’s shoulder. Shin splints. Gymnast’s wrist. All of these injuries share a common theme: overuse.
As youth sports participation continues to rise, so does the commitment to training of these athletes. Some kids take it easy and participate a few times per week, while others discover something they love and become heavily involved in one particular sport multiple days per week. Overuse occurs when the same active body movements occur again and again without enough time for recovery.
Young athletes involved in sports with a lot of running and jumping (cross country, soccer, basketball, dance) may experience pain in the knee due to tendon stress. Those involved in sports with frequent overhead arm motions (baseball, softball, swimming) experience pain in the shoulder joint or elbow. Gymnasts and cheerleaders experience wrist pain due to frequent intense pressure on a bent wrist.
Every body needs time to recover and heal after strenuous workouts, but none so much as those bodies that are still growing and developing. Tough, frequent workouts place extra stress on immature bones, ligaments and tendons, sometimes even pushing them past their limits into injury.
Progression of injury
According to the AAP, overuse injuries in children follow a pattern of stages.
Stage 1: Pain in a specific area of the body after training or games
Stage 2: Pain in a specific area of the body during training or games, but not significant enough to stop the activity.
Stage 3: Pain in a specific area of the body that prevents participation in the sport.
Stage 4: Pain in a specific area of the body that is chronic and occurs even when at rest.
Prevention
While overuse injuries in youth sports are common, they do not have to be a guarantee for a young athlete. Here are some suggestions for prevention of overuse injuries:
- Encourage varied activities. Exposure to different types of physical activities promotes movements of all parts of the body, developing strength evenly and helping to avoid unbalanced stress on joints, muscles, and bones.
- Take breaks. Young athletes should not play or train in one sport more than 5-6 days per week (less for the younger kids). They should also have 2-3 months off of their primary sport during the year.
- Avoid stacking practices. This can occur when an athlete plays on two different teams in one sport, or by layering two different sports at a time. Attending more than one practice in one day puts extra stress on the body and can lead to fatigue and poor form, leading to injuries.
- Get enough sleep. Sleep affects all aspects of life, but this restful time is particularly important to allow young athletes to recover.
- Get a sports physical. Before signing your child up for a sport, go to the Pediatrician for a physical exam. Discuss your sport, training requirements, and overall health concerns with the doctor prior to starting the season.
- Gradually increase activity level. If your child is new to a sport or has been taking a break, go slowly with adding practice time and play. If your child has had a sports-free summer, work with him or her to increase athletic activity prior to restarting a sport.
Risk factors
Overuse sports injuries occur more often in young athletes who specialize in one sport with repetitive physical activities, particularly if they do not learn the correct form and techniques for those movements. Taking the time to warm up and cool down with stretching and other slow movements is a necessary part of injury prevention. Issues with inadequate calorie and nutrient intake, lack of proper sleep, and adequate time off from the sport do not allow for proper recovery from repetitive activities. Highly competitive athletes may ignore warning signs of injury (Stage 1 and Stage 2 from above) because they are afraid of losing playing time or a spot on the team.
Avoiding burnout
As they grow older, many young athletes drop out of sports activities. In fact, studies have shown that nearly 70% of players quit their favorite sport by age 13. For some, they find a different interest. For many others, they experience burnout. Unfortunately, free play amongst American youth is seen less and less, replaced with rigorous training schedules and regimented activities. There is a simple solution to burnout: keep it fun.
When athletes start to view their sport as a job or a chore, they are not longer having fun. Overtraining often leads to burnout as a result of increasing amounts of pressure on the child. This pressure comes from coaches, parents, and the athletes themselves. The constant striving to “do better” and “be better” becomes too much for them, and rather than disappoint those around them in the activity, they choose to quit participating in it instead.
Listen to what your child is saying about his or her sport, how they feel about it on a day-to-day basis. If it appears to no longer be a fun activity, help to evaluate if it is simply a change of interest or if he or she simply needs to step back and change the intensity of the participation.
Final thoughts
This is a topic near and dear to my heart, not only as a Pediatrician who takes care of young athletes but also as a Mama of two competitive young athletes and a family friend of many of their teammates. There is a delicate balance between allowing children to pursue a sport they love and become great at it, and protecting them from injuries caused by that same pursuit. Sports participation can be an important part of developing a healthy lifestyle that lasts into adulthood, but it must be handled with balance. This article is not an argument against sports participation or specialization, but rather a call to be wary of overuse injury and to remind parents that highly competitive young athletes need breaks, too.
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