By Dr. Alfred Atanda, Jr.
Orthopedic surgeon, Nemours Center for Sports Medicine, Nemours/Alfred I. duPont Hospital for Children
Take a drive on any given Saturday, and you’re bound to see kids of all ages playing sports outside. 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, or baseball—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 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 becomes.
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.
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.

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 the causes of this.
• Poor technique. Inadequate warm-up, improper technique —like overextending on a pitch—and even improper equipment, such as non-supportive 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

Here are some ways you can avoid these problems:

• Avoid playing the same sport for more than eight months of the year
• Get physical therapy and learn how to properly warm up and cool down
• Stick with one team per sport
• Use the proper equipment

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.
Dr. Alfred Atanda, Jr. is an orthopedic surgeon with the Nemours Center for Sports Medicine at Nemours/Alfred I. duPont Hospital for Children in Wilmington, Delaware, and also sees patients at Nemours duPont Pediatrics, Bryn Mawr.