As more children are participating in organized sports at younger ages, often specializing in a single sport with high levels of competition, overuse injuries have become increasingly common among young athletes. It is important for providers to recognize common overuse injuries and their accompanying symptoms for proper diagnosis and management.

Some common pediatric sports overuse injuries may be identified and managed in the primary care setting, while others require referral to an orthopedic specialist. In some cases, surgery is necessary.

Overuse injuries are caused by repetitive stress to the bones, muscles and tendons without proper time for recovery between training sessions. These types of injuries can be especially concerning for pediatric athletes with open growth plates, causing more serious or long-term consequences if they are not managed and treated properly.

“Kids are very prone to overuse injuries, especially those who are specialized in one sport. The pathology and the treatments are very different. You have to treat the growth plate, and you have to treat the child,” said Jennifer M. Brey, M.D., pediatric orthopedic surgeon who specializes in sports injuries at Norton Children’s Orthopedics of Louisville, affiliated with the UofL School of Medicine.

Common overuse injuries in pediatric athletes

Treatment of overuse injuries always involves activity modification with periods of rest and recovery. Following the RICE (rest, ice, compression, elevation) method and a short course of pain relief medication (nonsteroidal anti-inflammatory drugs, also known as NSAIDs) may be helpful. For some injuries, physical therapy may be recommended. Gradual return to play or monitoring training is important to avoid overuse and reinjury. Following up with a provider is important to ensure proper healing and avoid further injury and/or complications.

Some of the most common pediatric overuse injuries include:

Little Leaguer’s shoulder: A stress injury of the proximal humeral growth plate, located at the top of the humerus, caused by overhand throwing motions. Symptoms present as shoulder pain that usually begins when the patient is throwing and resolves after the session. As it worsens, pain continues at night and into the next morning. Treatment includes cessation of throwing (sometimes stopping all activity), physical therapy and a short course of scheduled anti-inflammatory medications.

Little Leaguer’s elbow: This is a stress injury of the apophysis that can affect the medial epicondyle or trochlea, the two growth plates at the medial part of the distal humerus, caused by overhand throwing motions. Symptoms present as elbow pain or decreased range of motion. Treatment protocol includes cessation of throwing. If an X-ray shows separation of the growth plate, the patient should be casted and treated in the same manner as an acute stress fracture.

Panner disease: This condition is an overuse syndrome of the capitellum, the lateral portion of the elbow, which causes an idiopathic avascular necrosis impacting the artery to the affected bone. While the blood flow always returns, providers should ensure that patients do not experience flexion contractures in the meantime. Symptoms present as vague elbow pain or range of motion issues. Treatment includes rest and physical therapy.

Gymnast’s wrist: This overuse injury results in the widening of the distal radial physis in the wrist, often bilateral, caused by repeated stress and impact on the hands and wrist. Treatment includes casting the wrist, rest and physical therapy.

Jumper’s knee: Also known as patellar tendonitis, this is a degeneration and inflammation of the patellar tendon, usually closest to the patella, due to jumping motions causing repeated stress on the knee. Treatment includes rest and physical therapy.

Osgood-Schlatter disease: This is the name for a growth plate issue, often bilateral, where the tibial tubercle causes pain. It is known as a “growing pain” that can cause bumps on the knee that may resolve with age. Treatment includes icing the knees, stretching that targets the extensor mechanism, quadriceps and patellar tendon, and wearing a Cho-Pat strap to help relieve patellar tendon pressure.

Sinding-Larsen-Johansson syndrome: A traction injury, this affects the growth plate at the bottom of the patella. Treatment is the same as for Osgood-Schlatter.

Sever disease: Inflammation of the calcaneal apophysis in the heel, usually occurring from running or wearing cleats, is known as Sever disease. Treatment includes rest, ice and stretching of the Achilles tendon. Shoe inserts, such as heel cups, may be helpful until the growth plate fuses.

Risk factors contributing to overuse injuries

Risk factors contributing to overuse injuries include sports specialization, where a young athlete specializes in a single sport that often involves year-round participation. Rapid growth spurts, inadequate recovery time between training sessions, and improper technique or equipment also can contribute to overuse injury. High social pressure from parents, coaches or peers can impact an athlete’s overall physical and mental health. It is necessary for parents to understand the importance of rest if their child is injured, regardless of what is happening in their child’s sports season.

Protecting young athletes from further complications

Pediatric sports overuse injuries require early diagnosis and management. Recognizing the signs of injury, emphasizing rest and avoiding overtraining can help prevent the onset or return of pediatric sports overuse injuries.