Overuse Injuries on the Rise

What’s the deal with so many kids getting hurt in sports?

With so many kids playing recreational sports today, it’s no wonder that injuries are a common occurrence. Half of all injuries in children and teens are due to overuse. An overuse injury is damage to bone, ligament, tendon or muscle that occurs as a result of repetitive use. Tennis elbow, swimmer’s shoulder and shin splits are three common overuse injuries you may have heard about.

The American Academy of Pediatrics says there are four stages of overuse injuries:

  1. Pain in the affected area after physical activity
  2. Pain during physical activity, that doesn’t restrict play
  3. Pain during physical activity, that does restrict play
  4. Chronic, persistent pain even at rest

Children and teens differ from adults in the types of overuse injuries that can occur. Plus, in a growing child, the growth plate is susceptible to injury, which can lead to deformity and even an arrest in growth.


Children and teens are at increased risk for overuse injuries because their growing bones are less resilient to stress than an adult’s bones. Young athletes may not realize that certain symptoms are signs of an overuse injury, such as an aching shoulder or shin pain, and they may chalk it up to a tough game or match and keep playing with the injury, making it worse.

Doctors are seeing an increase in overuse injuries like stress fractures in the back, elbow ligament injuries, and damage to cartilage and bone. These serious injuries can sideline a kid for many months. “Although this is likely multifactorial, a big part has to do with increased involvement in team sports, playing on several same sports teams, sometimes concurrently, and improper technique or mechanics,” says Jonathan Dunn, MD, a Baltimore orthopedic surgeon with a subspecialty in sports medicine at Sinai Hospital of Baltimore.

Dr. Neeru Jayanthi, medical director of Primary Care Sports Medicine at Loyola University Health System in Chicago says kids who specialize in one sport are most at risk. Jayanthi and his colleagues followed 1200 young athletes in the Chicago area aged 7-18 and found that the young athletes who were highly specialized in a single sport were 1.5 times more likely to receive an overuse injury.

What’s more, lower back injuries were the third most common injuries suffered by youth athletes. The only injuries more common were to the knee and ankle. Thirty-nine percent of the back injuries were serious, including stress fractures and complications of stress fractures.

“If a young athlete has lower back pain for two weeks or longer, it is imperative that the athlete be evaluated by a sports medicine physician,” says Jayanthi. “If a serious injury such as a stress fracture is not properly treated and does not heal properly, the athlete could be at risk for long-term back problems.”

The study confirmed that children shouldn’t participate in just one sport until puberty around age 12-14, when their physical endurance, motor skills and aerobic capacity, among other milestones, have developed fully.

Some sports may be exceptions, such as figure skating and gymnastics, where peak performance often comes before physical maturity, but these sports also have very high risk of overuse injuries. “While a single motion may not cause an injury, repetitive activity over a single season or several seasons can lead to injury,” says Dunn.


First, keep kids from specializing in just one sport until puberty. Children athletes should only play one sport per season, keeping practice and games to five days per week to help prevent overuse injuries.

Kids and teens should incorporate at least one day per week with no physical activity to rest. Many experts recommend taking 2-3 months per year off from sports (not necessarily consecutive), which can prevent not only overuse injury but general burnout.

“Do not spend more hours per week than your age playing sports. If a child is 10, he should not play more than 10 hours per week. Younger children are developmentally immature and may be less able to tolerate physical stress,” says Jayanthi.

Any increase in training, like adding distance to a run, or repetitions to an exercise should be kept to 10 percent increments per week. If a child runs 2 miles one week, the next week he can increase to 3.

An often overlooked component to children’s sports is preparation. Though adults know enough to warm up before exercise, stretch before a run, or condition before an event, children’s sport teams may skip these steps. Kids should understand their importance and practice warm up and cool down exercises. They should also be encouraged to condition train for overall strength, endurance and aerobic benefit rather than just sport-specific train.

Teach kids to listen to their bodies, for example, when they are tired, when something aches, when they aren’t feeling tip-top. Even if they can’t put their finger on exactly what is wrong, it’s a crucial skill for the youth athlete that can serve them well as they develop.

Jayanthi and colleagues at Loyola and Lurie Children’s Hospital are planning a follow-up study to find out whether counseling recommendations on proper sports training can reduce the risk of overuse injuries in young athletes. He believes many of these serious overuse injuries can be prevented.