Skip Ribbon Commands
Skip to main content
Health Issues
Text Size
Facebook Twitter Google + Pinterest

Overuse Injuries

Excessive pressures often push a young body more than it is able to handle, resulting in an injury caused by overuse. Specifically, overuse is significant overload to any tissue in the body. Our bodies are very capable of handling a load, adapting to that load, and then handling a higher load the next time. This body process of microscopic breakdown and buildup is largely unseen. When that process is overwhelmed by stress and loads of effort to which the body cannot adapt before the next event or practice, the breakdown accumulates until there is a noticeable overuse injury, such as a stress fracture of a bone or tendonitis (inflammation of a tendon). Overuse injuries are spoiling the exercise experience. How wonderful that there are millions of kids involved in sports activities; how sad that their fun can be stopped by unnecessary injuries.

It is so important for exercise to be promoted positively at all levels and for all kids to be encouraged to be active, whether or not they want to be on a competitive team. Like a good old-fashioned Western movie, there are The Good, the Bad, and the Ugly. The good involves the many benefits of exercise and sports participation, such as better fitness, improved body composition, and overall health enhancement. The bad includes the factors that have a negative influence on participation, like competition and sport specialization at younger ages, excessive pressures to perform more at younger ages, emphasis on winning, and training young children like adults. The ugly is what shows up in my clinic—overuse injuries, young bodies and minds overwhelmed by a need to push harder when their bodies can’t do it, and kids quitting from burnout.

Overuse injuries are rising in number; I am seeing more and more of these overload injuries every year. Some of these injuries, like stress fractures, were unheard of in children years ago, but now have become relatively common. Stress fractures used to be an adult injury, but that’s what we get when we train kids at adult levels. The problem can stem from different causes. Two patients come to mind, both with overuse injuries to the shoulder from doing too much. One child was injured because he was a baseball pitcher and was throwing too many pitches at practice, then throwing many more pitches with dad in the backyard. He was on the local club team, an all-star team, and a traveling team. You do the math. The other child had an overuse injury to her shoulder as well, but it was because she was new on the water polo team, played shortstop in softball, and was learning overhead serves on the volleyball team. These kids both had overuse injuries, but the difference lies in the fact that he did too much of the same sport with his shoulder, while she did too many activities that all involved her shoulder. We have to be aware that overuse is overuse, no matter how it tries to disguise itself. There is nothing wrong with being a good pitcher or involved in multiple sports. However, it is important to realize how easily the body can become overloaded, especially if skill level is being pushed to the limit.

It is difficult to have hard data on the sheer number of injuries caused by overuse because many do not show up in an emergency department, but are treated by athletic trainers, physical therapists, chiropractors, nurses, physicians, or coaches and parents. This makes it possible to only estimate the numbers. Even so, it is estimated that there are millions of injuries of some kind each year that require medical attention and that approximately half of those millions are overuse injuries. That is a problem—a big problem. Just because those injuries are associated with sports and exercise doesn’t mean they are a good thing. Surveys have shown that parents often feel that injuries are just part of sports, which is partially true for acute fractures, accidents, and plain old bad luck. But overuse injuries should not be seen as routine or even as an athletic badge of courage. It is not healthy for young, growing tissues to be overloaded to the point of meltdown. Aren’t you supposed to break in a new car before you drive it too fast? Don’t you let your newborn puppy gradually run longer and longer distances with you? Your active child certainly has more value than a car or an animal, so please be sure to treat him that way. This book is about achieving maximum potential, and the athlete machine must be in great working condition for that to happen. I am not being negative; I am trying to find a way for us to let in some sunshine. I am sure we can all think of a few young athletes who have sustained an injury because of the “overpush” phenomenon from a highly intense coach or parent. You may see it on your child’s teams. You may see it in the mirror. Now we can all know better—and do something positive about it.

Overuse injuries should be preventable! Such injuries occur because of many factors, but human error is a biggie if a young athlete is pushed excessively beyond her level of sports skill development. Remember, the focus is on sports skill progression, going from point A to point B. This isn’t a game of Twister in which your child just steps from red circle A to yellow square B. Your child grows from point A to point B, and we would all be healthier and happier with the knowledge of how that happens. It is my goal and sincere desire to have a positive effect on reducing the numbers of overuse injuries, stress, and other problems in young athletes who are being pushed excessively. I truly hope you will want to join me.

How far have youth sports come? They’ve come a long way, and mostly for the better. More opportunities mean more exercise and fitness for our youth, which is extremely important in the midst of an obesity crisis. More participation means more learning of skills that can be applied to many activities, sports, and exercise for a lifetime. These skills are useful to allow young people to try multiple sports instead of learning just one specific skill set. More involvement means more chances to support your child and encourage sports achievements, no matter what level. More time spent enjoying sports activities fosters social skills and friendships and decreases downtime that might be spent getting in trouble.

Unfortunately, though, we have come even further. Younger and younger kids are being pressured by society, media, peers, parents, and coaches. Recruiting pressures were once reserved for colleges, but now even middle schools are recruiting athletes. Rarely does the neighbor come over anymore and ask if Johnny can come play. Too often, the neighbor is Johnny’s competition for the starting spot on the fourth-grade soccer team. Gold medal pressures are forcing kids to specialize in one sport at much younger ages, setting them up for adult-type injuries of overuse, sports burnout, and unrealistic expectations. Sensationalism and pressures are allowing many youngsters to think unrealistically that they can be professional athletes out of high school, with fame and fortune as a substitute for education. These collective pressures can overload parents and kids and turn situations into negative sports experiences. It is not enough to just come and play anymore, and it is virtually impossible to stop the pressure snowball that is rapidly approaching. If that’s the case, let’s find a way to slow it down by understanding how our kids develop. Then positive sports experiences can be the ruling majority, while negative pressures become a smaller minority.

To help cope with the pressures on our youth and keep ourselves from becoming overly stressed, we need to understand the core developmental processes, which will help us stay focused on what’s important without distractions from all the surrounding bells, whistles, smoke, and mirrors. See if this plan makes sense—allow your child’s early skills to improve, mature, and be refined without being pressured or rushed. When he is able to move on to the next level of development, approach it the same way. Eventually, your child will maximize each stage of development and actually increase his potential for better performance because he will not be rushed through all the stages prematurely. This patience will help your child lay the foundation on which to build as he progressively learns new skills. How exciting! That’s what this book is all about.

Most of us are competitive just by human nature—it’s part of our primitive survival instincts—but think about this. What is it about society that has allowed us to consider jeopardizing our own children’s health for dangling carrots of limited prizes that may or may not happen? Certainly we have progressed far beyond the animals that eat their own young…or have we?

Paul R. Stricker, MD, FAAP
Last Updated
Sports Success Rx! Your Child’s Prescription for the Best Experience (Copyright © 2006 American Academy of Pediatrics)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
Facebook Twitter Google + Pinterest