Prevention and Treatment of Pediatric and Adolescent Overuse Injuries

Kaitlyn Sippel
California University of Pennsylvania


Today, children do not participate in interscholastic sports alone; they are also members of club teams and travel teams outside of interscholastic play that are year round. Thus, the body is not allowed to fully rest before continuing to the next sport season. Overuse injuries can affect multiple parts of a young athletes' body including the physis' and the tendons. Because these overuse injuries affect multiple parts of the body, there are different ways to treat and prevent these injuries. An overview of the most common overuse injuries is presented with the most reciprocated ways to prevent each injury, therefore the purpose of this literature review is to investigate the current preventative measures and treatments for pediatric and adolescent overuse injuries.


Pediatric and adolescent overuse injuries are becoming more common as the number of children participating in athletics increases (Lord & Winell, 2004). Overuse injuries are defined as chronic injuries that have been related to constant, high levels of physiologic stress without sufficient time to recover (Hogan & Gross, 2003). Some common injuries are physeal injuries, osceochondritis dissecans, epicondylitis, epiphysitis, and tendonitis. Over the recent years preventative measures have been created to try to reduce the number of occurrences. For example, the National Athletic Trainers' Association (NATA) offered a position statement with recommendations on how to prevent pediatric overuse injuries (Decoster et al., 2011). Along with the attention given to the prevention of overuse injuries, there also needs to be additional consideration given to the treatment of these injuries so individuals are not tarnished for life, thus allowing children the opportunity to compete throughout their lifespan.

There are intrinsic and extrinsic factors that affect overuse injuries (Kerssemakers, Fotiadou, de Jonge, Karantanas, & Maas, 2009). The intrinsic factors, which are internal factors that predispose an athlete to an overuse injury, include bone growth, growth of musculotendinous units, decreased bone density, skeletal maturity, muscle bulk, decreased flexibility and strength, extremity malalignment, and psychological factors like high risk behaviors (Kerssemakers et al., 2009). The extrinsic factors, which are external factors not caused by a person's body, are inappropriate changes in training, improper training surfaces, improper equipment, parental pressure, coaching pressure, and peer pressure (Kerssemakers et al., 2009).

Overuse injuries can affect people of all ages and have been divided into three major classifications. The first classification consists of the athletes who hastily increase their levels of exercise without building up (Hogan & Gross, 2003). The second group consists of athletes who lack sport-specific skills (Hogan & Gross, 2003). This is very common in young or novice athletes, for example an adolescent may try out for football without ever being taught how to properly tackle or throw a football. The third classification consists of the motivated athletes who participate in high levels of competition and do not allow proper time for rest and recovery (Hogan & Gross, 2003). This classification has multisport athletes and athletes that participate in multiple teams included in it (Hogan & Gross, 2003). As defined earlier, overuse injuries are a result of constant high levels of stress without sufficient recovery time. Therefore, by participating in multiple sports or multiple teams, athletes can be exposed to the conditions that subject them to an overuse injury.

The growth process in children puts pediatrics and adolescents at an increased risk for injury (Cuff et al., 2010). Physis injuries are very common in young athletes. The physis and the epiphysis are where growth is initiated in bones. Two kinds of epiphyses exist in the extremities; they are traction and pressure epiphyses. A traction epiphysis is located at the insertion of muscles and tendons. These epiphyses control the development of bone shape, not longitudinal growth. Skeletal muscle and tendons are more resistant to stress than an apophyseal growth plate. For example, the repetitive microtrauma can lead to a traction apophysitis, which in turn can lead to an apophyseal avulsion (Kerssemakers et al., 2009). Pressure epiphyses, on the other hand, are found at the proximal and distal ends of long bones. Longitudinal bone growth happens from the growth plate between the metaphysis and the epiphysis, therefore physis injuries can result in a disturbance to the growth of the long bone (Kerssemakers et al., 2009). Overuse injuries affect many different parts of the body in young athletes.


Preparticipation Physical Examinations or PPEs should be used to screen young athletes for risk factors before participation in sports. Preparticipation Physical Examinations, like the examinations used to screen collegiate athletes, screen young athletes for risk factors including injury history, stature, maturity, joint stability, strength, and flexibility (Decoster et al., 2011). It is very important to obtain a complete past medical history and physical exam to decrease the incidence of serious and overuse injuries. Educating coaches and parents about risk factors and signs can help prevent childhood overuse injuries. Parents and coaches should be aware that when scheduling youth sporting events, the amount of days per week, volume of hours per day, and intensity of activity should be taken into consideration (Luke et al., 2011). Recovery time between bouts should be evaluated and considered by coaches, parents, and organizers to enhance athlete safety and the efficiency of scheduling (Luke et al., 2011). A general guideline for parents and coaches to follow is to allow no more than 16 to 20 hours per week of vigorous physical activity and at least one to two days off per week for competitive practices, competitions, and sport specific play (Decoster et al., 2011). Pediatric athletes should have about two to three nonconsecutive months away from a specific sport if they participate in that sport year round, according to the NATA guidelines (Decoster et al., 2011).

With continued attention and research specific to overuse injuries, Luke et al. (2011) went as far as proposing a new category of injury known as the "overscheduling injury."  The "overscheduling injury" is an injury that is related to excessive physical activity without adequate time for rest and recovery. Parents, coaches, and young athletes need to be properly educated and provide sufficient rest and recovery to prevent overuse injuries.

Pediatric and adolescent athletes can participate in preseason and in-season training programs that focus on neuromuscular control, balance, coordination, flexibility, and strengthening which can be particularly effective for athletes who have a previous injury history (Decoster et al., 2011).  NATA recommends participating in a general fitness program at least two months prior to the beginning of a sports season. These programs help athletes to progress into their sport specific training. Athletes should increase their training intensity by 10 percent each week specific to load, time, and distance, which will help to avoid overload and allow for adequate adaptation (Decoster et al., 2011).

Parents and coaches should monitor environmental factors, which include sport-specific equipment. A "one size fits all" approach is unacceptable for children because many children considered in the same age bracket have different statures (Hogan & Gross, 2003).  Proper biomechanics and sport-specific skills can help prevent injuries especially in young athletes whose interests exceed their skill level (Hogan & Gross, 2003). Although some specialization may be helpful for young athletes, NATA encourages delayed specialization and participation in multiple sports and recreational activities throughout the year to improve overall fitness and aid in development (Decoster et al., 2011).

The treatment for pediatric and adolescent overuse injuries varies with each injury. Overuse injuries can be treated with proper rest and modalities if reported early enough to the health care professional, and rarely is surgery or elaborate treatment needed for these injuries (Lord & Winell, 2004). However, if left untreated, these injuries can have life-long consequences like physeal or articular cartilage injuries, which would require elaborate treatment and possibly surgery (Latz, 2006).


The key to preventing injuries lies in the responsibility of the coaches, parents, and athletes. Coaches need to be educated about overscheduling and giving athletes proper rest. A 10 percent increase in training intensity should be followed by coaching staff to avoid overload and allow overall adaptation (Decoster et al., 2011). Parents of young athletes should have their children evaluated and given a PPE before participating in athletics. Parents should understand the risks of overscheduling and the proper rest. Children should only be participating in 16-20 hours of vigorous physical activity with at least one to two days off per week from competitive practice, competition, and sport specific play (Luke et al., 2011). Parents and coaches, together, need to monitor the fit of equipment and delay sport specific specialization. Participation in a general fitness program two months prior to sports participation can also help prevent overuse injuries. The best way to treat overuse injuries in pediatrics and adolescents is to rest. Elaborate treatment like surgery is rarely used to treat these types of injuries in young athletes.

Therefore, the overall education of parents and coaches seems to be the key in preventing and treating pediatric and adolescent overuse injuries.


Cuff, S., Loud, K., & O'Riordan, M. (2010). Overuse injuries in high school athletes. Clinical Pediatrics , 49 (8), 731-736. Retrieved from http://cpj.sagepub.com/.

Decoster, L., Loud, K., Micheli, L., Parker, J., Sandrey, M., White, C., Valovich McLeod, Tamara, C. (2011). National Athletic Trainers' Association position statement: Prevention of pediatric overuse injuries. Journal of Athletic Training, 46 (2), 206-220. Retrieved from http://www.nata.org/journal-of-athletic-training.

Hogan, K., & Gross, R. (2003). Overuse injuries in pediatric athletes. Orthopedic Clinics of North America, 405-415. Retrieved from http://www.orthopedic.theclinics.com/.

Kerssemakers, S. P., Fotiadou, A. N., de Jonge, M. C., Karantanas, A. H., & Maas, M. (2009).  Sport injuries in the paediatric and adolescent patient: A growing problem.

Pediatric Radiology, 39, 471-484. Retrieved from http://www.springer.com/medicine/radiology/journal/247.

Latz, K. (2006). Overuse injuries in the pediatric and adolescent athlete. Missouri Medicine, 103 (1), 81-85. Retrieved from http://www.msma.org/mx/hm.asp?id=MissouriMedicine.

Lord, J., & Winell, J. (2004). Overuse injuries in pediatric athletes. Current Opinion in Pediatrics (16), 47-50. Retrieved from http://journals.lww.com/co-pediatrics/pages/default.aspx.

Luke, A., Lazaro, R. M., Bergeron, M. F., Keyser, L., Benjamin, H., Brenner, J., d'Hemecourt,P., Grady, M., Philpott, J., Smith, A. (2011).Sports-related injuries in youth athletes: Is overscheduling a risk factor? Clinical Journal of Sport Medicine, 21 (4), 307-314. Retrieved from http://journals.lww.com/cjsportsmed/pages/default.aspx.


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