Overview
Definition:
Overuse injuries in youth sports refer to musculoskeletal injuries that develop gradually due to repetitive stress without adequate recovery time
they are distinct from acute traumatic injuries.
Epidemiology:
Prevalence varies by sport, with an estimated 30-50% of all youth sports injuries being overuse injuries
common in sports involving repetitive motions like running, jumping, and throwing
incidence increases with higher training volumes and intensity.
Clinical Significance:
Overuse injuries can lead to chronic pain, functional limitations, premature athletic retirement, and psychological distress in young athletes
early recognition and prevention are crucial for long-term musculoskeletal health and continued participation in sports.
Risk Factors
Biomechanical Factors:
Poor technique
Inadequate flexibility or strength
Muscle imbalances
Foot deformities (e.g., pes planus, pes cavus).
Training Errors:
Sudden increases in training volume, intensity, or frequency
Insufficient rest and recovery
Overtraining syndrome
Poorly designed training programs.
Environmental Factors:
Inadequate warm-up and cool-down
Improper footwear
Playing surfaces (e.g., hard, uneven)
Playing in adverse weather conditions.
Individual Factors:
Rapid growth spurts (adolescent awkwardness)
Previous injury
Psychological factors (e.g., pressure to perform)
Nutritional deficiencies.
Common Overuse Injuries
Lower Extremity:
Osgood-Schlatter disease
Sinding-Larsen-Johansson syndrome
Sever's disease (calcaneal apophysitis)
Patellofemoral pain syndrome
Stress fractures (tibia, metatarsals)
Shin splints (medial tibial stress syndrome)
Achilles tendinopathy.
Upper Extremity:
Little League elbow (medial epicondylitis)
Little League shoulder (proximal humeral epiphysitis)
Rotator cuff tendinopathy
Wrist tendinopathy (e.g., De Quervain's tenosynovitis).
Spine:
Spondylolysis and spondylolisthesis
Pars interarticularis defects
Lumbar strain.
Prevention Programs
Structured Training Principles:
Gradual progression of training load (volume, intensity)
Periodization of training
Adequate rest and recovery periods between sessions and competitions
Cross-training to avoid over-reliance on one muscle group.
Neuromuscular Training:
Balance exercises
Plyometric training with proper technique
Agility drills
Strength training focusing on core and stabilizing muscles
Proprioception exercises.
Flexibility And Mobility:
Regular stretching of key muscle groups (hamstrings, quadriceps, hip flexors, calf muscles)
Dynamic warm-ups before activity
Static stretching post-activity.
Proper Technique And Equipment:
Coaches' education on sport-specific biomechanics
Use of appropriate, well-fitting footwear
Correct equipment maintenance and fitting
Regular equipment checks for wear and tear.
Education And Monitoring:
Educating athletes, parents, and coaches on early signs of overuse
Implementing pain monitoring systems (e.g., RPE, pain scales)
Establishing return-to-play protocols after injury.
Diagnostic Approach
History Taking:
Detailed history of pain onset, location, intensity, aggravating/relieving factors
Training history (volume, intensity, changes)
Previous injuries
Growth spurt assessment
Psychosocial factors.
Physical Examination:
Observation of posture and gait
Palpation for tenderness
Assessment of range of motion (active and passive)
Strength testing
Flexibility assessment
Special tests for specific injuries (e.g., anterior drawer for ACL, Thompson test for Achilles).
Investigations:
Plain radiographs (X-rays) for bony abnormalities, stress fractures, and apophysitis
MRI for soft tissue injuries (tendons, ligaments) and subtle stress fractures
Ultrasound for tendinopathy and soft tissue assessment
Bone scan for detecting stress fractures and inflammatory conditions.
Differential Diagnosis:
Acute traumatic injuries
Stress fractures vs
acute fractures
Growth plate injuries vs
fractures
Referred pain
Inflammatory conditions (e.g., juvenile idiopathic arthritis)
Tumors (rare but important to consider).
Management Principles
Relative Rest:
Modifying or temporarily ceasing the offending activity
Substituting with pain-free cross-training
Avoiding complete inactivity unless absolutely necessary.
Pain And Inflammation Control:
Ice application
NSAIDs (e.g., ibuprofen, naproxen) for short-term symptom relief, used judiciously
Physical therapy modalities (e.g., ultrasound, electrical stimulation).
Rehabilitation:
Gradual return to activity program
Progressive strengthening exercises
Flexibility and mobility exercises
Biomechanical correction
Proprioceptive training.
Return To Play Criteria:
Pain-free during daily activities and during sport-specific movements
Full range of motion and strength
Completion of a structured rehabilitation program
Psychological readiness.
Key Points
Exam Focus:
Understanding the distinction between acute and overuse injuries
Identifying common overuse injuries in pediatric athletes and their typical locations
Recognizing key risk factors for overuse injuries.
Clinical Pearls:
A gradual onset of pain, especially with increased activity, is highly suggestive of overuse
Always inquire about training volume and recent changes
Education of parents and coaches is paramount in prevention.
Common Mistakes:
Dismissing vague pain as "growing pains" without a thorough evaluation
Prescribing complete rest without considering modified activity or cross-training
Inadequate rehabilitation and premature return to play, leading to re-injury.