"Kids' Health" supplement in the
October 18-20, 2002
weekend edition of USA Today
USA Today Supplement



Sports injuries are on the rise in U.S. children and teen-agers. Each year more than 3.5 million sports-related injuries requiring medical treatment occur in children under age 15.

Today, as more and more children and adolescents participate in the same sport year-round, many young athletes are developing overuse injuries. In fact, overuse is responsible for about half of the sports injuries that happen to middle school and high school students. Overuse injuries usually occur over time with prolonged, repeated motion or impact. They range from chronic muscle strains and tendinitis to stress fractures (tiny cracks in the bone).

"Pediatricians certainly are seeing overuse injuries more often," says Douglas Gregory, M.D., FAAP, a pediatrician specializing in sports medicine. As reasons for the increase, Dr. Gregory cites more children playing competitive and year-round sports as well as training too intensely.

Overuse injuries tend to occur in competitive sports, most commonly baseball, basketball, running, gymnastics and swimming. "But just about any recreational activity that involves repetitive motion has the potential to cause an overuse injury, especially if kids are pushed too hard," says Paul Stricker, M.D., FAAP, a pediatric sports medicine specialist. Both Drs. Stricker and Gregory are members of the executive committee of the American Academy of Pediatrics (AAP) Section on Sports Medicine and Fitness.

Sports involving throwing typically cause overuse injuries to the shoulder and elbow, whereas running and jumping sports most often strain the leg from the knee to the ankle ("shin splints") or the foot. The forearm and hand are common sites for overuse injuries in sports that require gripping, such as gymnastics, golf and tennis.

A type of overuse injury unique to children is injury to the growth plate. A growth plate is an area of developing tissues at the end of long bones, such as in the arm or leg, in children and adolescents who are still maturing. Overuse injuries to the growth plate are a type of stress fracture, but most heal without any lasting effect, according to Dr. Stricker.

Besides immature bones, poor training or conditioning can contribute to overuse injuries in children, says Reginald Washington, M.D., FAAP, a Denver pediatrician and chair of the AAP Committee on Sports Medicine and Fitness. The committee sets AAP policies in this area, including recommending that young baseball pitchers limit the number of pitches in practices and games, to avoid "Little League elbow."

When a child is not accustomed to an activity and starts doing it regularly, overuse injuries can occur. "One reason why cheerleader injuries are prevalent," says Dr. Washington, "is they often don't get the same type of training that athletes in competitive sports get."

Dr. Washington also blames insufficient rest after an injury for some overuse injuries. "It's not uncommon for an injured child or teenager to resume sports activity too soon, because the coach says, 'Play through your pain.'"

It is important to take care of injuries as soon as they happen. A physician should evaluate any sports injury, recommends Dr. Gregory. Although overuse injuries are painful, most improve with rest. "Ignoring the problem may turn it into a more serious injury," he says. "With proper treatment and rest, the athlete usually can continue participating through the season."

Like other sports injuries, most overuse injuries can be prevented. Here are tips on how your child can avoid them:

  • Choose sports that are age-appropriate. The AAP recommends that children be at least 6 years old before playing team sports.
  • Before beginning a sport, get into shape. Get a physical exam and talk to your pediatrician about a conditioning program. Conditioning may include stretching, endurance training and aerobic exercise.
  • Prepare for activity with warmup exercises and end with cool-down exercises.
  • Don't overdo. Start out slowly with any new physical activity and gradually increase your training program or activity. Take time off from playing if tired or in pain.
  • Stay well hydrated by drinking enough water or sports drinks. Dehydration can cause fatigue and increase the chance of injury.
  • Wear athletic shoes that fit well and are in good condition.
  • If injured, see a pediatrician right away.

Injury prevention should not include avoiding sports and recreational activities, the pediatricians caution. Says Dr. Stricker, "We want kids to exercise, just not to overdo it or be pushed too hard."