Youth Sports: No Pain - Sports Medicine

Sports Medicine - Pain-free Girl Playing Soccer

By Dr. Daryl Rosenbaum

When adults complain of pain after a pickup basketball game or a long bicycle ride I don’t worry immediately about an injury. Sometimes adults simply overdo it with the exercise and the next day they ache. That’s normal.

But when children and teenagers complain of pain after soccer practice or a tennis match I pay attention.

Pain is not normal in kids. So if your child is limping or tells you her shoulder hurts, there’s a good chance she’s injured herself.

I grew up playing tennis and soccer, so I know the joys sports give young athletes. In my family medicine practice at Wake Forest Baptist Medical Center, I run a sports medicine clinic and I supervise training for young doctors who want a career in sports medicine. I also work with the university’s athletic teams. I’m there on the sidelines at football and soccer games in case a player gets hurt. And I’m there in the training room too, advising coaches and athletes on how to prevent injury.

Sports injuries fall into two basic categories. There are injuries that result from repeating the same motion too many times. We call these overuse injuries. And there are injuries caused by some sort of sudden force, such as a twist or impact or fall. We call these acute injuries.

Youth Sports: Overuse Injuries

Think about a baseball pitcher who pitches nine innings two or three days in a row; or a dancer who practices on point for the star role in the Nutcracker every afternoon in December; or the basketball player jumping for rebounds and pivoting on the same knee every day after school.

The tendons and bones aren’t meant to endure that much strain. Children and teenagers have lines of dividing cells at the end of long bones called growth plates, which are also prone to injury. Repetitive motions can injure the tendons, bones or growth plates, especially in the shoulders, knees and ankles.

  • Tennis players and pitchers are prone to tendonitis in the shoulder.
  • Dancers are prone to stress fractures in their feet and shins. 
  • Football players who spend a lot of time in the weight room are at risk for stress fractures in the spine.

Treating Overuse Injuries

Treatment is similar for most overuse injuries – rest and rehabilitation. I like to talk with young athletes, their parents and their coaches about prevention, which boils down to a simple idea, and that is to give young athletes a break so that they don’t overuse their shoulders, ankles and knees.

Little League Baseball is catching on with limits on pitching. I’d like to see even more limits in youth sports. Few parents realize that when athletes play two or more games a day in a soccer tournament, they risk overuse injuries. Some athletes can reduce their risk of injury by refining their game. For example, a runner may be able to reduce the risk of injury by changing an awkward gait.

Also, be sure young athletes use equipment that fits their size. A tennis racket that’s too heavy strains the tendons in the elbow.

Finally, I’d like to see parents limit the number of months out of the year a child can play the same sport. Twelve months of soccer practice puts too much strain on the same set of tendons. Try soccer for nine months and something else for the rest of the year.

There’s no question that children and teenagers risk acute injury playing sports. They fall going for a rebound. They collide on the field. They hit their head against the goal post.

Youth Sports: Acute Injuries

Some acute injuries to the head and spine can be life threatening. When a player is unconscious or unable to move, call 911. Sports Medicine doctors also are just beginning to understand the full impact of head injuries, so I will save a full discussion of concussion for another time.

For now, remember that any blow to the head should be taken seriously, and if a child complains of a headache or nausea he needs to see a sports medicine doctor. Or think of it this way: when in doubt, sit them out.

Typical sports medicine injuries in young athletes include:

  • Sprains to the ligaments in their knees and ankles
  • Broken fingers, collarbones and ribs

When there’s pain and swelling it’s hard to tell whether it’s a sprained ligament or a fractured bone. That’s when it’s time to see your family doctor. A fracture may require a cast or, in some cases, surgery.

Treating Acute Injuries

A sprain can usually be treated with rest, ice, compression and elevation. Once the fracture or sprain has healed, it’s time for rehabilitation so that the young athlete regains strength and range of motion and prevents further injury. Some injuries may require formal physical therapy. But an ankle, for example, can be strengthened with simple exercises at home.

I cringe when I hear parents and coaches encouraging young athletes to push through the pain. Children and teenagers want to have fun. They want to run and jump and score. So when they walk off the field limping, pay attention. In most cases, pain means injury.

Rosenbaum Daryl ADr. Daryl Rosenbaum is the director of the Sports Medicine Fellowship in the Department of Family Medicine at Wake Forest Baptist Medical Center. Request an appointment online or by calling 888-716-WAKE.

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Last Updated: 08-25-2014
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