Understanding Overuse Injuries in Young Athletes

One of the most important things that every coach can do is to work on understanding of overuse injuries in young athletes. In the world of youth sports, the push for excellence often leads athletes down a rigorous path of training and competition, often without taking healthy break, or without slowing down when necessary. This relentless pursuit carries with it the shadow of overuse injuries. Particularly common among young athletes, these injuries manifest due to repetitive stress without adequate rest.

As coaches who work with young athletes – we have great responsibility to be more familiar with this topic! Not knowing how we are influencing the health of our young athletes is just not a good enough excuse!

The overuse injuries occur gradually over time, when certain athletic activity is repeated so often that the areas of the body don’t have enough time to heal between the practices.  Nowadays it is common for a child to play just one sport year-round. And many children play in more than one team at the same time, as well. (Sounds familiar?)

So, when a young athlete participates in just one sport throughout the year, they continually use the same muscle groups and apply the same stress to specific areas of the body. This can lead to muscle imbalances that, when combined with over training and inadequate periods of rest and recovery, put young athletes at serious risk for overuse injuries.

And because young athletes are still growing, they are at a greater risk for injuries than adults. The consequences of overdoing a sport can include injuries that impair growth, and may lead to long-term health problems.

Overuse injuries can affect muscles, ligaments, tendons, bones, and growth plates. In children, these structures are still growing, and the growth is generally uneven. Bones grow first, which pulls at tight muscles and tendons. This uneven growth pattern makes younger athletes more sensitive to muscle, tendon, and growth plate injuries.

Growth plates are the areas of developing cartilage where bone growth occurs in children. The growth plates are weaker than the nearby ligaments and tendons. Repetitive stress can lead to injury of the growth plate and disrupt the normal growth of the bone.

 

What Are The Risk Factors for Overuse Injuries

Overuse injuries, characterized by pain and damage resulting from repetitive trauma rather than a single incident, are increasingly common in both athletic and non-athletic populations. Understanding the risk factors is the first step toward prevention and maintaining optimal physical health.
Here are some of the key risk factors that contribute to the development of overuse injuries:

 

Repetitive Motion

The very nature of overuse injuries stems from repetitive motion. Activities that require the same movement patterns, especially those involving high-impact or high-stress movements, significantly increase the risk. Athletes in sports like running, swimming, tennis, and those involved in repetitive work tasks, are particularly vulnerable.

 

Training Errors

Training errors are a leading cause of overuse injuries. This includes rapidly increasing the intensity, duration, or frequency of activity without adequate rest or preparation. “Too much, too soon” places excessive stress on the body, exceeding its ability to recover and adapt, leading to injury.

 

Poor Technique

Incorrect technique not only reduces performance efficiency but also increases the risk of injury. Poor form or technique places abnormal stress on muscles, tendons, and joints, leading to overuse injuries. Regular coaching and technique refinement are crucial for prevention.

 

Inadequate Equipment

Using equipment that’s not suited to one’s body or the activity can contribute to overuse injuries. This includes poorly fitting shoes, inappropriate training equipment, or even unsuitable work tools. Proper equipment that fits well and suits the activity can lower this risk.

 

Insufficient Recovery Time

Recovery is essential for the body to repair and strengthen itself. Insufficient rest and recovery time between physical activities prevent the body from healing, making it more susceptible to overuse injuries. Incorporating rest days and understanding the importance of sleep are crucial components of any training or activity.

 

Muscle Imbalance and Weakness

Muscle imbalances and weaknesses can lead to compensatory movements and overreliance on certain muscle groups, increasing the risk of overuse injuries. Strength and flexibility training customized to address these imbalances can help reduce this risk.

 

Previous Injuries

A history of injuries, especially if not fully rehabilitated, can predispose individuals to overuse injuries. Previous injuries can lead to changes in movement patterns, muscle imbalances, and a decreased range of motion, all of which can contribute to the development of new overuse injuries.

 

 

The Anatomy of Overuse Injuries

Overuse injuries arise from repeated athletic activity that applies stress to the body, going beyond its ability to recover. Unlike acute injuries that happen suddenly (like sprains and fractures), overuse injuries develop over time, often silently culminating in significant setbacks. These injuries are the body’s response to chronic stress, manifesting as pain, discomfort, and, ultimately, a forced break from the sport. Common examples include tendonitis, shin splints, stress fractures, and various forms of joint pain, each a testament to the delicate balance between pushing for growth and respecting the body’s limits.

 

Youth Are A Vulnerable Demographic

The growing bones and developing bodies of young athletes are particularly susceptible to the rigors of overuse. Young athletes are particularly susceptible to these injuries due to several factors:

• Rapid Growth Phases – Growth spurts can lead to imbalances and make bones more susceptible to stress.
• Specialization Early On – Focusing intensely on one sport increases the risk of stress on specific body parts.
• Intensity of Training – High volumes of training without adequate recovery periods can accelerate wear and tear.
• Competitive Pressure – The push to excel, often fueled by scholarship dreams and professional aspirations, can lead young athletes to train excessively and rest inadequately.

 

Recognizing The Signs

Early detection of overuse injuries is key to preventing long-term damage. Symptoms often start as mild discomfort that intensifies with activity. Warning signs may include persistent pain during or after sports, swelling, changes in form or technique due to pain, and decreased performance. Recognizing and addressing these symptoms early can be the difference between a short recovery and a chronic problem.

 

Long-Term Implications

The consequences of ignoring overuse injuries extend beyond temporary downtime. Chronic pain, lasting joint or muscle damage, and even the potential for early-onset arthritis are real risks. Moreover, the psychological impact, including frustration, burnout, and loss of interest in sports, can alter the course of a young athlete’s career and relationship with physical activity.

 

Strategies for Prevention and Management

Preventing overuse injuries is a collective effort that involves athletes, coaches, and parents. Some of the key strategies include:

• Diversification – Encouraging participation in multiple sports to ensure balanced muscle development and prevent repetitive stress.
• Education – Informing young athletes, their parents, and coaches about the risks of overuse injuries and the importance of listening to the body’s signals.
• Proper Technique – Focusing on correct form and mechanics to reduce undue stress on the body.
• Adequate Rest and Recovery – Emphasizing the need for rest days and proper recovery techniques, including nutrition, hydration, and sleep.

Recognizing and addressing these risk factors is essential for preventing overuse injuries. This includes adopting a good training program that emphasizes proper technique, adequate rest, and recovery strategies. Additionally, paying attention to equipment selection and addressing any muscle imbalances or weaknesses can go a long way in preventing overuse injuries.

Empowering oneself with knowledge and adopting a proactive approach to physical activity can significantly reduce the risk of overuse injuries. Whether you’re an athlete, a coach, a parent, a fitness enthusiast, or someone whose job involves repetitive physical tasks, understanding these risk factors is a crucial step towards maintaining a healthy, active lifestyle. Remember, prevention is always better than cure, and taking the time to care for your body will pay dividends in your overall well-being and performance.

 

 

Some of The Most Common Overuse Injuries in Young Athletes

 

Heel – Sever’s Disease

Sever’s disease is a common cause of heel pain in growing kids, especially those who are physically active. It’s a painful bone disorder that results from inflammation (swelling) of the growth plate in the heel.

Sever’s Disease, or calcaneal apophysitis, occurs when the growth plate of the heel is inflamed. This condition typically arises during the growth spurts of adolescence, when bones, muscles, and tendons are rapidly evolving, but not always at the same pace. The heel bone (calcaneus) grows faster than the leg muscles and tendons, leading to tightness and strain. This imbalance can increase stress on the growth plate, causing pain and inflammation.

A “growth plate”, also called an epiphyseal plate, is an area at the end of a developing bone where cartilage cells change over time into bone cells. As this occurs, the growth plates expand and unite, which is how bones “bloom” – grow. It usually occurs during the growth spurt . It’s approximately 2-year period in early puberty when kids grow the fastest. This growth spurt can begin any time between the ages of 8 and 13 for girls and 10 and 15 for boys.

Sever’s disease rarely occurs in older teens because the back of the heel usually finishes growing by the age of 15, when the growth plate hardens and the growing bones fuse together into mature bone.

 

Recognizing the Signs

Young athletes may not always communicate or even understand the discomfort they’re experiencing. Here are signs to watch for:

• Pain in the heel that worsens with physical activity
• Limping or walking on tiptoes to avoid putting pressure on the heel
• Swelling or redness in the heel area
• Difficulty in participating in sports or physical activities that were previously enjoyed

 

Prevention and Care

Prevention and care are paramount. Here are several strategies to help manage and prevent Sever’s Disease:

• Adequate Rest – Encourage rest periods to allow time for recovery, especially after intense activities.
• Proper Footwear – Shoes with good support and padding can reduce impact on the heels.
• Stretching Exercises – Regular stretching of the calf muscles can alleviate tightness and reduce stress on the heel.
• Ice Therapy – Applying ice to the affected area can help reduce inflammation and pain.
• Limit High-Impact Activities – Temporarily switching to low-impact sports can alleviate stress on the heels.

 

The Role of Coaches and Parents

As a coach or parent, fostering an environment where young athletes feel comfortable communicating about their pain is crucial. Encouraging regular check-ins about how they’re feeling can make a big difference. Additionally, educating them about the importance of rest, proper warm-up routines, and recognizing their body’s signals for overuse can empower them to make healthier choices.

 

Moving Forward

Sever’s Disease, while temporary, can be a roadblock in the athletic journey of a young person. However, with proper awareness, care, and preventive measures, it can be managed effectively, allowing athletes to continue pursuing their passions with strength and joy. As we support the physical development of young athletes, let’s also nurture their resilience and understanding of their bodies, laying a foundation for a lifetime of health and activity.

Awareness and proactive steps about the Sever’s Disease can not only alleviate discomfort but also pave the way for more informed and healthier approaches to sports and physical activity.

 

Shoulder – Proximal humeral epiphysitis

Shoulder overuse injuries stem from repetitive strain and stress on the shoulder joint and its surrounding muscles, tendons, and ligaments. This repetitive motion can lead to a variety of issues, including tendinitis, bursitis, and rotator cuff injuries, which can cause pain, inflammation, and reduced mobility.

Proximal humeral epiphysitis is an injury to the upper arm bone at the shoulder. It happens to young athletes who are still growing. This problem is caused by repetitive throwing. Repetitive throwing puts stress on the growth plate, and the growth plate becomes irritated. In severe cases, the stress may lead to a small break in the growth plate.

Proximal humeral epiphysitis is an overuse injury affecting the shoulder’s growth plate. It’s most commonly seen in young athletes who participate in sports requiring repetitive overhead motions, such as baseball, swimming, and tennis. The condition arises from excessive stress on the growth plate, leading to inflammation and, in some cases, a delay in bone growth.

 

 

Symptoms to Watch For

Early detection is crucial for managing proximal humeral epiphysitis effectively. Key symptoms include:

• Shoulder pain that worsens with activity, especially throwing or overhead movements
• Swelling and tenderness over the shoulder area
• Reduced throwing velocity or accuracy in athletes
• Visible discomfort during overhead activities

 

Preventive Measures – Keeping Young Shoulders Safe

Prevention is always preferable to treatment. Here are strategies to protect young athletes from proximal humeral epiphysitis:

• Limit Repetitive Stress – Implement pitch counts and limit the number of days per week of pitching to allow adequate rest for the shoulder.
• Diversify Sports Participation – Encouraging participation in a variety of sports can prevent repetitive use injuries by allowing different muscle groups to develop and rest.
• Focus on Technique – Proper technique reduces unnecessary stress on the shoulder joint. Regular training with a focus on form can significantly decrease the risk of injury.
• Encourage Open Communication – Cultivate an environment where young athletes feel comfortable reporting pain or discomfort. Early intervention can prevent more severe injuries.

 

Pathways to Recovery

If proximal humeral epiphysitis is suspected, the following steps are essential for a safe return to play:

• Rest – The first and most crucial step is to allow the shoulder to rest. This means taking a break from the activity that caused the injury.
• Consult a Professional – A healthcare provider specializing in sports medicine can provide a diagnosis and personalized treatment plan, which may include physical therapy.
• Gradual Return – Once symptoms have improved, a gradual return to activity under professional guidance ensures the shoulder is ready to handle the stress of sports participation.

Proximal humeral epiphysitis, while a challenging hurdle, offers valuable lessons in the importance of listening to our bodies and respecting the limits of growth and development. By adopting preventive measures, encouraging a diverse sports experience, and prioritizing proper technique, we can support our young athletes in pursuing their passions safely and sustainably.

 

 

Elbow – Medial apophysitis 

Medial apophysitis is an overuse injury affecting the elbow’s medial epicondyle growth plate. It’s most commonly observed in children and adolescents who engage in repetitive throwing or overhead activities, such as baseball pitchers, tennis players, and gymnasts. The condition arises from excessive stress on the growth plate, leading to inflammation and pain.

The main symptom is pain at the inner side of the elbow. It can swell and the elbow may be tender to touch.

The Symptoms

The early detection of medial apophysitis is crucial for preventing long-term damage. Key symptoms include:

• Pain and tenderness on the inside of the elbow, which may worsen with throwing or overhead activities
• Swelling and inflammation around the elbow joint
• Reduced range of motion and strength in the affected arm
• A noticeable decrease in athletic performance, particularly in throwing accuracy or power

 

Risk Factors

Several factors can increase the risk of developing medial apophysitis, including:

• Age – Children and adolescents experiencing growth spurts are particularly susceptible.
• Sport Specialization – Early specialization in sports involving repetitive throwing or overhead motions can heighten risk.
• Overtraining – An excessive volume of training or lack of adequate rest periods contributes significantly to the condition.

 

Prevention and Management – A Proactive Approach

The good news is that with informed practices, medial apophysitis can be prevented and managed effectively. Here are some strategies:

• Proper Technique – Emphasizing correct throwing or overhead motion techniques can reduce undue stress on the elbow.
• Cross-Training – Engaging in a variety of sports can help prevent overuse injuries by ensuring a more balanced development of muscle groups.
• Adequate Rest – Implementing rest periods, especially during growth spurts, allows the body to recover and reduces the risk of injury.
• Physical Therapy – Tailored exercises that strengthen the forearm muscles and improve flexibility can support recovery and prevent recurrence.

 

 

Knee – “Sinding-Larsen-Johansson”

Sinding-Larsen-Johansson (SLJ) syndrome is a painful knee condition that mostly affects teens during periods of rapid growth. SLJ syndrome is a juvenile osteochondrosis that disturbs the patella tendon attachment to the inferior pole of the patella. It is an inflammation of the bone at the bottom of the patella (kneecap), where the tendon from the shin bone (tibia) attaches.

SLJ syndrome is an overuse injury affecting the knee, specifically the area around the lower pole of the patella (kneecap) where the patellar tendon attaches. It is most commonly seen in adolescents experiencing growth spurts, as the combination of rapid bone growth and intense physical activity can lead to stress on the still-developing tendons and bones.

Repetitive stress on the patellar tendon can cause this growth plate to become irritated and inflamed. SLJ mostly happens between the ages of 10 and 15 because that’s when most of us have growth spurts. SLJ is more common in teens who play sports that require a lot of running or jumping, because these activities put excess or repetitive strain on the knee.

Some authors classify SLJ as a pediatric version of “jumper’s knee”. But unlike “jumper’s knee” which is seen at any age, SLJ syndrome is seen in active adolescents, as already mentioned – between 10-15 years of age.

 

 

 

Symptoms to Watch For

Early recognition of SLJ syndrome can significantly improve the outcome for young athletes. Symptoms include:

• Pain at the bottom of the kneecap, which worsens with activity
• Swelling or tenderness is felt at the front of your knee – at the base of your patella (kneecap), where the patella tendon inserts into the patella.
• A noticeable bump at the site of pain due to inflammation

 

Risk Factors for SLJ Syndrome

Several factors can increase the likelihood of developing SLJ syndrome, including:

• Age – The condition most commonly affects children and adolescents during their growth spurts.
• Activity Level – Sports that involve a lot of jumping, running, and abrupt changes in direction, such as basketball, soccer, and gymnastics, carry a higher risk.
• Training Intensity – Overtraining or a sudden increase in training intensity without adequate rest periods can contribute to the development of SLJ

 

Prevention and Management

The key to managing SLJ syndrome lies in a proactive approach, focusing on prevention, early intervention, and rehabilitation. Here’s how:

• Proper Warm-Up and Cool-Down – Incorporating a comprehensive warm-up and cool-down routine can prepare the body for physical stress and aid recovery.
• Strength and Flexibility Training – Exercises that strengthen the quadriceps and hamstrings, along with stretching routines, can help alleviate strain on the knee.
• Activity Modification – Temporarily modifying or reducing activities that exacerbate the pain is crucial for recovery. This doesn’t mean complete rest, but rather focusing on low-impact exercises.
• Rest and Recovery – Allowing adequate time for rest and recovery is essential. Ignoring pain and continuing to push through activities can worsen the condition.

 

The journey of a young athlete is filled with challenges and learning opportunities. Sinding-Larsen-Johansson syndrome is a reminder of the importance of listening to our bodies and responding with care. By fostering an environment that emphasizes proper training, adequate rest, and a holistic approach to physical activity, we can support our young athletes in achieving their dreams without compromising their health.

 

 

Knee – Osgood-Schlatter Disease

Osgood-Schlatter disease is an inflammation of the patellar tendon at the tibial tuberosity, just below the knee. It typically occurs during growth spurts when bones, muscles, tendons, and other structures are quickly growing but not always at the same rate. The repetitive stress of jumping, running, and changing direction puts additional strain on the area where the patellar tendon attaches to the shinbone, leading to pain and swelling. Most often only one knee is affected.  OSD usually strikes active adolescents around the beginning of their growth spurts, the approximately 2-year period during which they grow most rapidly.

 

 

 

Recognizing the Symptoms

The key to addressing OSD effectively is early recognition. Symptoms include:

• Pain and tenderness at the tibial tuberosity, the bump just below the knee
• Swelling in the same area
• Pain that worsens with activity and improves with rest
• Tightness in the surrounding muscles, especially during growth spurts

 

Risk Factors and Prevention

Understanding the risk factors for OSD is crucial for prevention. These include:

• Age – OSD typically affects children and adolescents during their growth spurts, around ages 8-15 for girls and 10-17 for boys.
• Activity – Sports that involve a lot of running, jumping, and abrupt changes in direction increase the risk.
• Gender – While both sexes are affected, boys are more commonly diagnosed with OSD, possibly due to differences in physical activity patterns.

Preventive measures focus on managing training intensity, ensuring proper technique, and emphasizing flexibility and strength training to support the knee. Regular stretching and strengthening exercises for the quadriceps, hamstrings, and calf muscles can help alleviate the strain on the tibial tuberosity.

 

Managing Osgood-Schlatter Disease – A Balanced Approach

The management of OSD primarily involves symptom relief and preventing further irritation of the area. Key strategies include:

• Rest – Taking a break from activities that worsen the pain is often necessary to allow for healing.
• Ice – Applying ice to the affected area can reduce pain and swelling.
• Pain Management – Over-the-counter pain relievers can help manage discomfort during flare-ups.
• Stretching and Strengthening – Engaging in a targeted physical therapy program can improve flexibility and strengthen the muscles around the knee, reducing the stress on the tibial tuberosity.

 

Osgood-Schlatter disease, while a temporary condition, can be a significant hurdle in a young athlete’s journey. However, with informed care, patience, and a balanced approach to training, most athletes can manage the symptoms and return to their sports with renewed strength. It’s a testament to the resilience of young bodies and spirits, and a reminder of the importance of nurturing both as we guide our young athletes toward their goals.

In conclusion, Osgood-Schlatter disease doesn’t have to be a roadblock to athletic success. By fostering an environment that prioritizes health, well-being, and balanced development, we can support our young athletes in overcoming this challenge, empowering them to achieve their fullest potential.

 

The Long-Term Consequences of Injuries in Youth Sports

The long-term consequences of injuries in youth sports can extend far beyond the immediate pain and recovery period, affecting both the physical and psychological well-being of young athletes. Recognizing and addressing these injuries promptly and effectively is crucial for minimizing their long-term impact. Here’s a look at some of the potential long-term consequences:

 

Chronic Pain and Discomfort

Injuries sustained during youth sports can lead to chronic pain and discomfort, persisting well into adulthood. For example, an improperly healed fracture can result in joint pain, while overuse injuries can lead to conditions like tendOnitis or bursitis that recur or persist over time.

 

Increased Risk of Re-Injury

An injury in youth sports increases the likelihood of re-injury in the same or surrounding areas. This is often due to incomplete healing, improper rehabilitation, or returning to sport too quickly. Repeated injuries can exacerbate the problem, leading to a cycle of injuries that have long-term implications for health and performance.

 

Long-term Joint Health Issues

Significant or repeated injuries, especially to the joints, can lead to long-term health issues such as osteoarthritis. Injuries to the anterior cruciate ligament (ACL), for example, significantly increase the risk of developing knee osteoarthritis, regardless of whether surgery is performed.

 

Growth Disturbances

Injuries to growth plates in children and adolescents can lead to growth disturbances. This may result in shortened limbs, angular deformities, or differences in limb length. Such outcomes not only affect physical capabilities but can also have psychological effects.

 

Psychological Impact

The psychological impact of sports injuries in youth can be profound. Young athletes may experience fear of re-injury, loss of confidence in their abilities, or even depression and anxiety. These effects can influence their willingness to participate in sports or physical activities in the future.

 

Loss of Athletic Potential

Significant injuries or those not properly managed can sideline young athletes for extended periods, leading to a loss of skill development and athletic potential. In some cases, this may affect opportunities for scholarships or professional pursuits in sports.

 

Impact on Physical Activity Levels

Experiencing a serious injury in youth sports can influence an individual’s attitude towards physical activity throughout their life. Some may become less active due to fear of injury or because of chronic pain, leading to broader health implications like obesity and cardiovascular disease.

 

Alleviating Long-term Consequences

To minimize these long-term consequences, it’s essential to:

• Promote education on injury prevention among athletes, parents, and coaches.
• Ensure proper technique and use of protective equipment in sports.
• Implement comprehensive rehabilitation programs for injured athletes.
• Foster a supportive environment that prioritizes the athlete’s long-term health over immediate performance.

 

The Road Ahead – Conclusion

As the landscape of youth sports continues to evolve, the approach to training and development have to also adapt. Creating an environment where young athletes can thrive involves not only nurturing their physical talents but also taking care of and safeguarding their health and well-being. By understanding and addressing the risk of overuse injuries, we can support the next generation of athletes in achieving their dreams without sacrificing their health.

By understanding the nuances of overuse injuries, especially in high-impact sports like handball, everyone involved can better protect young athletes. With a proactive approach to prevention and management, the long-term health and well-being of these athletes can be protected, making sure their continued enjoyment and success in the sports they love.

The impact of injuries in youth sports can extend well into adulthood, affecting physical health, psychological well-being, and overall quality of life. A proactive approach to prevention, early intervention, and rehabilitation is crucial for protecting the long-term health and potential of young athletes. By fostering a culture that prioritizes health and safety, we can help ensure that sports remain a positive, enriching experience for youth, contributing to their development into healthy, active adults.

 

References

• Overview of injuries in the young athlete
• Anterior cruciate ligament reconstruction and the long-term incidence of gonarthrosis
• Anatomical factors associated with overuse sports injuries
• The younger athlete. In: Brukner P, Khan K, editors. Clinical Sports Medicine
• Prevention of anterior cruciate ligament injuries in female team handball players: a prospective intervention study over three seasons
• Sports injuries in high school athletes: a review of injury-risk and injury-prevention research
• Overuse injuries in sport: a comprehensive overview
• Overuse injuries and burnout in youth sports
• Preventing Overuse Injuries in Young Athletes
• The Most Common Handball Injuries: A Systematic Review
• Development and validation of a new method for the registration of overuse injuries in sports injury epidemiology
• An epidemiologic comparison of acute and overuse injuries in high school sports
• Prevalence and burden of overuse injuries in elite junior handball
• Risk factors for shoulder injuries in handball: systematic review
• Shoulder Injuries in Handball

 

The last update of the article: March, 2024

 

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