Children & Adolescent Overuse Injuries: The Neglected Pandemic?

Main Category: Pediatrics / Children's Health
Also Included In: Sports Medicine / Fitness;  Obesity / Weight Loss / Fitness
Article Date: 21 May 2008 - 5:00 PDT

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In a day when the majority of attention directed towards children revolves around the alarming rate of obesity, mainly due to lack of exercise and poor dietary routines, the opposite side of the card has failed to be addressed with equal measure: How much exercise is too much? For the children and adolescents who do participate in sports, while they are keeping themselves healthy, active and off the couch, a misconception lies in failure to remember that too much of a good thing will likely result negatively. Young athletes who might play on a team or two throughout the course of a year but have an adequate off-season need not worry about more than the normal risks associated with all sports. Athletes on multiple teams for multiple sports, however, who are constantly engaged in some form of organized practice or competition are ideal candidates for overuse injuries, which are debilitating, painful and can potentially be lifelong.

Overuse injuries come about from overtraining a particular muscle, joint or ligament in the body. Despite popular belief about youths, 30 million children and adolescents (ages 5-14) nationwide participate in some type of sport today. Of that number, at least 3.5 million serious injuries are reported annually.1 Though that percentage may not seem substantial, consider the fact that youths account for 40% of all sports-related injuries.1 This injury-domination has not always been the case, but has rather increased along with the growth of sports for youngsters. In 1980, 10% of sports-related injuries in youths were due to overuse, while today, that number has risen to 70%.2 As perplexing a figure as that seems, the good news is the Centers for Disease Control and Prevention (CDCP) estimates 50% of all sports-related injuries to be avoidable.3

Why such a drastic increase in numbers?

The underlying change youth athletics is currently undergoing is a shift away from recreational, unorganized sports towards incessant year-round participation, usually in a single sport. Instead of using muscles, joints and ligaments in all regions of the body, a one-sport approach causes specific areas to be used repetitively, and in some instances, indefinitely, until an injury occurs. Most "serious" youth athletes remain active not only on one team, but are sometimes members of travel teams, club teams and various camps and clinics to the point where sports engulf almost all free time in their yearly schedules. Over-participation such as this pushes the threshold of the body to the limit, and the culminating breaking point can be devastating to both athletes and their respective teams.

The field of athletes in the country has grown significantly in every sport. For high schoolers, there is often times a strong motivation to receive athletic scholarships, which brings about an increased emphasis on excelling from coaches and parents alike. In this predicament, many young athletes find themselves stuck with no alternative but to play or compete as much and as hard as possible. Although they may believe the more they do, the better it is for their bodies, the unfortunate truth of overwork is it's likely to be more counterproductive and teeming with risks.

Dr. Lyle Micheli, director of the world's first Sports Medicine Clinic at Children's Hospital in Boston, explains, "Today's overachieving kids are starting sports earlier and training longer and harder than ever before."2 Many coaches and parents do not understand the importance and individual variability of rest, conditioning and training on young athletes, and are unaware of the risks that accompany an overly-stacked regimen.

What sports lead to what injuries on which parts of the body?

Many injuries are area-specific, meaning they're likely to occur in one or more areas of the body that's being overused. Aside from these common area-specific injuries, athletes participating in high contact sports and younger athletes who have not fully matured are at an additional risk than others. The following is a breakdown of some of the more common injuries suffered by youth athletes in specific areas.

Shoulder-growth plate injuries, instability, impingement, tendonitis and little leaguer's shoulder are all common to the shoulder and are mainly incurred by the repetitive motion of overhead sports, including baseball, swimming and tennis. Symptoms that one of these injuries may be in progress are pain in the shoulder or upper arm and loss of speed throwing. Pitchers who throw frequent curve balls are more likely to induce injury.

Elbow-apophysitis and ulna collateral ligament sprains and tears occur often in elbows. Baseball serves as the primary cause of these injuries also, which are usually harbingered by inner or posterior (back) elbow pain and loss of speed throwing.

Knee-Osgood-Schlatters and Pastella-Femoral pain are two conditions triggered by overusing the knee, primarily in basketball, track/cross country and volleyball. Symptoms of injury are knee pain and loss of jumping ability.

Shin/Foot/Ankle-shin splints, Sever's disease (inflammation of growth plates) and stress fractures are seen especially with athletes who run competitively in either track or cross country, and also with volleyball and basketball players. Foot or heel pain, loss of speed and dull aches after running all signify the possible onset of one of these injuries.

Strains (injuries to the muscle or tendon) and sprains (injuries to the ligament) are common and may occur at any area in the body. Sprains are the more serious of the two and may lead to tears, which require surgery.3

What do I do if I think an overuse injury is apparent?

If an injury is suspected in an athlete, the first step should always be to contact a health care professional and stop the child or adolescent from participating in the sport immediately, as this will only worsen the situation. "Playing through" an injury is a method that never results in a positive outcome. Once a proper diagnosis is determined, the athlete should follow guidelines of how much time, if any, should be dedicated to sport.

Aside from what is recommended or prescribed by the physician, a popular treatment that can be performed by the athlete on their own is RICE. RICE represents: Rest-reduce or stop using the injured area for 48 hours; Ice-ice the injured area for 20 minutes, four to eight times a day; Compression-use an elastic wrap, air cast or splint for injuries to the knee, ankle or wrist, and Elevation-elevate the injured area above heart level to reduce swelling4.

For whatever reason, parents and/or coaches sometimes suggest a doctor perform a "fix-it-quick" procedure so the injured athlete can perform in an upcoming game or competition. Procedures such as this are not meant for young athletes and are likely to have long lasting, many times permanent effects.

More importantly, how do I prevent one from happening in the first place?

The single, chief concept that should be kept in the minds of every parent, coach and young athlete engaged in competitive sports is moderation. Laborious workouts and relentless schedules that leave time for little else are almost certain to improve performance and bring immediate results on a short-term basis. What needs to be considered for all involved, however, is the possibility of a career-ending, life-altering injury, and if overworking is worth the risk.

Medical professionals recommend the following precautions be taken by any youth in the sporting world and by those who regulate and oversee them:

-- Athletes should take ample amounts of rest on a week-to-week basis, usually at least one day off completely per week. Yearly, an off-season should take place at some point. Most suggest it be about three months of moderate activity, if anything.

-- Work with a health care professional or physician to address inherent weaknesses which may contribute to injury or modify training programs and establish a limit on how much of the sport should be done on a weekly and yearly basis. If overuse symptoms occur, the program should change accordingly.

-- Be sensitive to changes that occur in the performance and behavior of athletes. Visible signs almost always become apparent when an injury is developing or pain is felt, though it might not be discussed due to fear of being benched.

-- Emphasize warm-ups and cool-downs before and after practice, as they will make tissues more flexible before practice and loosen up tight tissues afterwards.

-- A final measure suggested by many, especially Dr. Lyle Micheli, is "mandatory safety education and maybe even certification" for coaches of school-age children.5

While kids and adolescents are the actual participants in the ever-expanding world of youth sports, the power to regulate and prevent overuse injuries lies primarily in the hands of their higher-ups, as in their parents and coaches. Being conscious, aware and perceptive of some of the more common injuries and their symptoms should be an essential priority of coaches on all levels. Sadly, but truly, most youths will not play an organized sport beyond their high school, sometimes college careers. When taking into account the futures of all adolescents, perhaps the most pertinent question is: what's more important, the long-term condition of their bodies or winning an upcoming title game?

Sources

1- "Adolescent Medicine: Sports Injury Statistics." 2007. Lucile Packard Children's Hospital at Stanford.

2- Pennington, Bill. "Doctors See a Big Rise in Injuries as Young Athletes Train Nonstop." UConn Health Center. 22 February 2005.

3- Cassas, Kyle J. "Childhood and Adolescent Sports Related Overuse Injuries." American Family Physician. 15 March 2006. http://www.aafp.org/afp/20060315/1014.html

4- "Childhood Sports Injuries and their Prevention: A Guide for Parents with Ideas for Kids." National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). June 2001. br>
5- Rauscher, Megan. "Overuse Sports Injuries often seen in kids." Medline Plus. 1 March 2007.

6- Dixon, Kim & Klayman, Ben. "Intense Young Athletes Boost Therapy Demand." Medline Plus. 27 February 2007.

7- McKeag, Douglas. The Physician and Sports Medicine. May 2003. "Kid's Sports: A Training Ground for Life."

Greg Gargiulo
Strulowitz and Gargiulo Physical Therapy Web editor
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