Pediatric Sports Overuse Injuries

An increasing number of boys and girls are playing recreational and organized sports. As a result, there is a rise in the number of overuse injuries seen among children and adolescents. The majority of sports and overuse injuries are due to minor trauma involving soft tissue injuries — injuries that affect the bone, muscles, ligaments and/or tendons. Overuse injuries can also lead to stress fractures. Stress fractures are weak spots or small cracks in the bone caused by continuous overuse. Stress fractures often occur in the foot after training for basketball, running and other sports. There usually is no swelling, but pain and tenderness often increase during movement.

What are the most common types of sports overuse injuries in children?
- Jumper's knee (patellar tendonitis)
  - Symptoms: Tenderness right below the knee or the upper shin area
  - Possible cause: The patellar tendon in the knee joint is repeatedly pulled on, causing inflammation and pain, especially during jumping activities
- Little Leaguers' elbow or shoulder
  - Symptoms: Pain in the elbow or shoulder area, especially after activity
  - Possible cause: Repetitive overhead throwing maneuvers that cause damage and inflammation to the growth plates of the bones in the arm (or as a result of a fracture)
- Osteochondritis dissecans
  - Symptoms: Knee pain and swelling. This condition can also cause elbow pain similar to Little Leaguers' elbow.
  - Possible cause: A piece of the cartilage in the knee joint that separates from the joint surface. Theories suggest that it may run in families or be caused by a metabolic problem.
- Sever's disease
  - Symptoms: Heel pain with limping, especially after running activities
  - Possible cause: Repetitive running or jumping activities causes the Achilles tendon to pull on the heel bone.
- Shin splints
  - Symptoms: Pain and tenderness over the shin area
  - Possible cause: Excessive running, running on hard surfaces (concrete), and improper shoe wear often cause shin splints.
- Sinding-Larsen-Johansson disease
  - Symptoms: Knee pain, especially after jumping activities
  - Possible cause: This disease is caused by a fracture of the kneecap due to repetitive extension on the patellar tendon in the knee (the tendon pulls away from the bone).
- Spondylolisthesis
  - Symptoms: Back pain
  - Possible cause: This condition is caused by excessive flexion and extension of the low back. X-rays show that a part of 1 vertebra in the low back slips forward on the vertebrae below it. It is commonly seen in football linemen, gymnasts, and ice skaters.
- Spondylolysis
  - Symptoms: Back pain
  - Possible cause: This condition is caused by excessive flexion and extension of the lower back. It is commonly seen in football linemen, gymnasts, and ice skaters. A stress fracture of 1 of the vertebrae is seen on X-ray.
What is the treatment for overuse injuries in children?
Specific treatment for an overuse injury will be determined by your child's doctor based on:
- Your child's age, overall health and medical history
- Extent of the condition
- Type of condition
- Your child's tolerance for specific medications, procedures or therapies
- Expectations for the course of the condition
- Your opinion or preference
The goal of treatment is to control the pain, promote healing, prevent complications, and restore normal use of the injured area.
Initial treatment for overuse injuries includes R.I.C.E. (rest, ice, compression and elevation).
Be sure to consult your child's doctor if there is a prolonged, visible deformity of the affected area, or if severe pain prevents use of the arm, leg, wrist, ankle or knee.
Other treatment options may include:
- Medications
- Activity restrictions
- Splint or cast
- Crutches or wheelchair
- Physical therapy (to stretch and strengthen the injured muscles, ligaments and tendons)
- Surgery (especially if the injury is reoccurring, there is persistent pain, or if a muscle, tendon or ligament is badly torn)
What is the long-term outlook for children with overuse injuries?

Overuse injuries heal quite quickly in children. It is important that the child adhere to the activity restrictions and/or stretching and strengthening rehabilitation programs to prevent reinjury.
Most sports injuries are due to either traumatic injury or overuse of muscles or joints. Many sports injuries can be prevented with proper conditioning and training, wearing appropriate protective gear, and using proper equipment.