Jun 19, 2018

Overuse Injuries in Youth Sport

Regina Bossart

 

As Summer is upon us, sports such as soccer, baseball, and track are in full swing. Along with these sports, come many injuries in our growing youth athletes. Injuries such as sprained ankles, cuts, bruises, and broken bones are all too common. This post will not focus on these immediate injuries, but on the overuse injuries that creep up over time and impact the health and performance of our growing athletes. Some young athletes may have persistent pain with activity for months, and simply blame growing pains or muscle soreness, when an overuse injury is the culprit.

 

Overuse injuries happen when the training load exceeds adequate recovery time, causing damage to bone, muscle, ligament, or tendon. 2 Training stresses the body causing it to adapt and develop, but adequate recovery is necessary for the body to repair, recover, and withstand injury. Youth athletes who are growing and developing are especially susceptible to overuse injuries because their bones are much less resilient.  As the bones grow, the muscles also have to catch up in strength and length. There is a lag period between bone and muscle growth, where the athlete is inflexible and weaker, making them more susceptible to injury.

 

I have had numerous experiences with coaching, including soccer, badminton, and basketball. Most of my athletes were involved in multiple sports, jumping from one to the next, with little to no rest in between. Sprained ankles, sore muscles, and taped knees were all too common.

More and more kids are choosing to participate in competitive sports. With greater emphasis placed on performance and perfection, more kids are training at higher intensities and frequencies. Often, kids will participate in multiple, overlapping sports, thus further increasing the frequency of activity. Many parents and coaches are expecting consistent effort and performance from the athletes, with the ideals of winning, post-secondary teams, and scholarships in mind. Playing through the pain has become a culturally expected norm, despite its potential repercussions to the athlete’s future performance. This high intensity and frequency of training does not allow the growing body to recover and ward off injury.

 

Some common overuse injuries include osgood-schlatters disease, runner’s knee, and shin splints. These conditions commonly present with a gradual onset of pain, which is most often provoked with repetitive sport activity.3 Physiotherapy plays a large role in prevention and treatment of these conditions. By assessing and addressing muscle length and strength issues, as well as improper alignment, most of these conditions can be easily treated.

 

Osgood-schlatters

This condition occurs when the femur grows faster than the quad muscle, causing tension over the top of the shin where the patellar (knee cap) ligament inserts into.3 Kids often complain of a painful bump under their knee, which is made worse by activities such as kneeling, running, squatting, and jumping. Risk factors for Osgood-schlatters include a recent growth spurt and inflexibility in the quads and hamstrings.3

 

Treatment

• In the acute stage, activity modification and limitation for a short time will allow for some pain relief and recovery.
• Stretching of the hamstrings and quads will ease some of the tension and pain.
• Strengthening of the weak muscles around the knee.
• Applying a Patellar tendon strap or rock taping the knee may allow for some pain relief.4

 

Runner’s knee

This is the most common running related injury in our youth population. It is characterised by generalized pain in the front of the knee that gets worse with activities such as running, jumping, stairs, or squats. [1] It is a condition where the front of the knee is overloaded due to muscle imbalances, growth spurts, or improper alignment. [2] Risk factors include sport specialization, changing running surfaces, abrupt increases in training, and muscle imbalances. 5

 

Treatment

• In the acute stage, the athlete should refrain from activities such as jumping, squatting, and kneeling. Runners should decrease their running duration as well.
• Stretching and foam rolling through ITB, Quads, calves, and hamstrings.
• Strengthening through hips, quads, and abdominals. The hips can take up to 25% of the load off the knee with landing, so strengthening hips is crucial to offloading knees. 3
• Rock taping knee to help with knee cap alignment and pain relief.  5

 

Shin Splints

It is described as pain on the front of the shins during and after running. Risk factors include inexperienced runners, female gender, poor foot alignment, and higher body weight. It is important to note that shin splints are a pre-cursor to tibial stress fractures if left untreated. 

 

Treatment

• The single most effective treatment is rest or modifying training volume. A gradual progression to running, with no more than 10% increase in intensity per week, is recommended. This includes easing into hill running and different training surfaces.1
• Stretching tight muscle groups and strengthening weak muscles.
• Rock taping shins.

 

Prevention

 

One of the most effective ways to prevent any sport injuries is to schedule 1-2 days per week of recovery from organized sport. During the year, approximately 2-3 months off from a specific sport is crucial. 2 This gap can be filled with off season training to work on strength, flexibility, and conditioning. This in turn will better prepare the athlete for re-integration into sport.

 

Some simple ways to help prevent overuse injuries during the sport season includes an effective warm-up. A sport specific, dynamic warm-up should be completed prior to practices and games. Stretching that mimics the movements of the sport most effectively guards against injury and aides in performance.6  For example, a soccer warm-up may include lunges, kicks, hamstring sweeps, hip rotations, and sprints. Static stretching and a thorough cooldown should be completed after training or games.

 

To allow the body to fully recover and repair, the athletes need an adequate amount of sleep at night. This is a critical period of repair for the body. During games and practices, proper hydration is key to prevent fatigue and dehydration, which in turn increases the risk of injury.1

 

Finally, youth sports are a wonderful opportunity for adolescents to remain active and social. By understanding overuse injuries, and how they can be prevented and treated, we can ensure the continued participation of our young athletes in sport. If you believe that you or your child has an overuse injury, see a Physiotherapist for further assessment and treatment. They can address any muscle imbalances or alignment issues, as well as tape the affected body region if necessary.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

References

 

1. Stein, C. J., & Micheli, L. J. (2010). Overuse injuries in youth sports. The Physician and  

Sportsmedicine, 38(2), 102-108. doi:10.3810/psm.2010.06.1787

1. Paterno M, Taylor-Haas J, Myer G, Hewett T. Prevention of Overuse Sports Injuries in

the Young Athlete. Orthopedic Clinics of North America [serial online]. October 1,   2013;44:553-564. Available from: ScienceDirect, Ipswich, MA. Accessed June 7, 2018.

1. Pengel, K. B. (2014). Common overuse injuries in the young athlete. Pediatric

Annals, 43(12), e297-308. doi:http://dx.doi.org.login.ezproxy.library.ualberta.ca/10.3928/00904481-20141124-09

1. DynaMed Plus [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No.

115095, Osgood-Schlatter disease; [updated 2017 Dec 19, cited place cited date here]; [about 7 screens]. Available from http://www.dynamed.com/login.aspx?direct=true&site=DynaMed&id=115095. 

1. DynaMed Plus [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No.

116002, Patellofemoral pain syndrome; [updated 2018 Apr 30, cited place cited date here]; [about 16 screens]. Available from http://www.dynamed.com/login.aspx?direct=true&site=DynaMed&id=116002.

1. Zakaria, A. A., Kiningham, R. B., & Sen, A. (2015). Effects of Static and Dynamic

Stretching on Injury Prevention in High School Soccer Athletes: A Randomized Trial. Journal Of Sport Rehabilitation, 24(3), 229-235.

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