Overuse injuries in children

What are overuse injuries in children?

Overuse injuries occur after repeated trauma and injury to a child’s joints, bones, growth plates, tendons, or muscles. Many overuse injuries are sports-related. Typically, overuse injuries feel worse at the end of physical activity.

Sports-related overuse injuries are becoming more common as more children and teens play sports year-round and don't give their growing bodies enough time for rest and recovery. Young athletes are more at risk for developing overuse injuries because their bones are still growing.

At Children’s Health, we are the area’s experts at helping your child recover and preventing future injuries from sidelining them.

What are the different types of overuse injuries in children?

Growth plate injuries

Growth plate injuries are when the growing part of your child’s bone fractures or swells. They are caused by untreated, mild overuse injuries.

• Osgood-Schlatter disease - One example of a growth plate injury is Osgood-Schlatter disease. With Osgood-Schlatter’s, the growth plate at the top of your child’s shinbone swells, causing pain and tenderness in the knee joint. Running or jumping can make the symptoms worse.

Tendon, ligament, muscle and bone injuries

Your child may experience pain and a limited range of motion from overuse injuries to their tendons, ligaments, muscles or joints.

• Jumper’s knee (patellar tendonitis) - This injury to the tendon that connects the kneecap (patella) to the shinbone can cause pain, swelling and tenderness. It is common among basketball and volleyball players.
• Little league elbow or shoulder - Also called pitcher’s elbow or shoulder, this injury is caused by repetitive overhand throwing and leads to swelling in the affected joint. Learn more about elbow instability and shoulder instability.
• Osteochondritis dissecans - This joint condition happens when a small piece of cartilage and bone breaks loose. Osteochondritis dissecans causes joint pain and limits range of motion.
• Sever’s disease - A common heel injury in children, Sever’s disease is caused by frequent stress and pressure placed on the heel bone and the Achilles tendon, which connects the calf muscle to the heel.
• Strains and sprains - Children’s muscles, ligaments and tendons may tear or stretch with overuse, leading to strains and sprains.
• Stress fractures - These tiny cracks can occur when too much repetitive pressure is placed on a child’s bone. These are common in runner’s feet.
• Spondylolysis and spondylolisthesis - Spinal problems like spondylolysis and spondylolisthesis result from stress fractures in the spine and are more common in sports where the spine is frequently hyperextended, such as gymnastics and football.
• Shin splints - These tiny tears in the muscle or bone tissue cause pain and tenderness in the shin. They happen when young athletes run, especially on hard surfaces, without enough time to heal. They can also happen when children wear improper footwear while active.
• Gymnast wrist - Landing repeatedly on the wrist can cause the growth plates in the wrist to swell. This results in painful movements and decreased range of motion.

What are the signs and symptoms of overuse injuries in children?

• Pain without known injury
• Decreased strength, speed, or general athletic performance
• Change in athletic form or technique
• Soreness or fatigue
• Using pain medications for athletic activity including Tylenol® or NSAIDs (ibuprofen)
• Increased emotional stress or anxiety about the injury

How are overuse injuries in children diagnosed?

• Physical exam - Our team of sports medicine physicians, surgeons and physical therapists are experts in diagnosing children with overuse injuries. We start by giving your child a physical exam, which includes gathering a detailed history of their health.
• Imaging - Our physicians are all trained in using ultrasound imaging to help identify your child’s injury. That means we can start to get a picture of what’s going on with your child during their very first appointment. Then, we may order more imaging, like X-rays and MRIs, so we can see your child’s injury and the surrounding area.

What causes overuse injuries in children?

Overuse injuries happen from repetitive trauma or impact over time. Overuse injuries are common in children who:

• Participate in a sport requiring repetitive motions, such as baseball pitchers, volleyball servers, football linemen, swimmers, and dancers.
• Participate in a sport with high impact or a lot of running, such as cross-country, basketball, and gymnastics.
• Specialize in a single sport early on in their development.
• Play on multiple teams for the same sport, like playing both high school and club at the same time.
• Playing their sport of choice for more hours a week than is appropriate for their age. For example, a 12-year-old baseball player should not play baseball for more than 12 hours each week
• Have chronic medical conditions that interfere with recovery and healing, such as diabetes or eating disorders.

How are overuse injuries in children treated?

Our team works together and with your family to give your child a safer, faster return to their normal activities and sports. We focus on improving your child’s movement and function as quickly as possible while also teaching them how to avoid re-injury.

Therapies include:

• Medication to help manage pain
• Rest
• Activity modification
• Crutches or bracing
• In-house physical therapy (PT) and rehabilitation

Our goal with treatment is to prevent the need for surgery whenever possible. However, we may recommend surgery if your child’s symptoms do not improve or their doctor detects a more complex condition.