Overuse injuries were once virtually unknown in young athletes. All that changed with the emergence of organized sports and their emphasis on repetitive coaching drills, as well as the recent trend toward sports specialization in young athletes. Patellar pain syndrome - an alignment problem in the knee caused by overtraining - is the number-one diagnosis in my clinic today, even though it had never been seen in kids until the growth in organized sports. Talk of stress fractures, tendinitis, and bursitis is no longer confined to pro athletes; it now can be heard in high school locker rooms.
Certain overuse sports injuries, such as Little League elbow - which refers to damage to the growth cartilage in the elbow joint caused by repetitive whipping motions of the arm - are seen exclusively in child athletes because of the softness of their growing bones and relative tightness of their ligaments and tendons during growth spurts.
Other overuse sports injuries seen mostly in children include osteochondritis dissecans of the knee and ankle (repetitive grinding together of bones that causes damage to the growing surface cartilage and may result in pieces of dead bone and cartilage dropping into the joint and wreaking havoc), Osgood Schlatter's syndrome (inflammation at the point where the tendon connects the kneecap to the very top of the shinbone) and os calcis apophysitis (inflammation at the point where the Achilles tendon attaches to the heel).
Unlike acute sports injuries such as sprains, strains, bruises, and breaks (which the Consumer Products Safety Commission tells us result in four million emergency room visits every year), the exact prevalence of overuse injuries is difficult to ascertain. That's because the symptoms of overuse injuries develop over time, and do not require immediate emergency care. Suffice it to say, overuse injuries in kids sports are so common that pediatric sports medicine clinics have opened to respond to the problem.
One of the most disturbing aspects of overuse injuries is their insidiousness. Often kids won't admit to being sore - they just drop out of sports, often for life. When these injuries go undetected, the damage to a growing child's hard and soft tissues can be permanent. Evidence suggests that overuse injuries sustained in childhood may continue to cause problems in later life, such as arthritis.
As overtraining is the most common cause of overuse injury, the most effective way to prevent overuse injuries is to make sure that qualified personnel are coaching kids. The American Red Cross teaches a sports safety course that I and other members of the U.S. Olympic Committee's panel of experts on youth sports helped design. I urge you to have the coaches in your local youth sports program contact their local Red Cross chapter for information. Another important measure is to make sure kids have a proper pre-season physical every year to rule out underlying conditions that might predispose them to overuse injury - anatomical abnormalities such as knock knees, flat feet, and swayback, for instance. Finally, if kids want to participate in strenuous sports, they should be fit enough to do so; a properly performed pre-season physical should rule out fitness deficiencies and recommend an exercise program.
Every day I see happy, healthy, confident youngsters with a glint in their eye that tells me they're hooked on sports for life. By reducing overuse injuries we can make sports a safer and even more rewarding environment for their young participants.
The Children's Hospital Boston is a 396-bed comprehensive center for pediatric health care. As one of the largest pediatric medical centers in the United States, Children's offers a complete range of health care services for children from birth through 21 years of age. Children's records approximately 22,600 inpatient admissions each year, and our 204 specialized clinical programs schedule more than 527,500 visits annually. Additionally, the hospital performs 23,000 surgical procedures and 200,000 radiological examinations every year.
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