Preventing Overuse Injuries in Young Athletes

Dr. Freehill examines 16-year-old pitcher, Patrick Ramsey

It stands to reason that young people who play organized sports are going to get injured.

But while young athletes are susceptible to the ankle sprains, wrist fractures and other acute injuries that are common among competitors of all ages, numerous studies indicate that approximately half of the sports-related injuries among children and adolescents in this country are caused by overuse.

These injuries - pitcher's elbow, swimmer's shoulder, runner's knee, tennis elbow, tendinitis - are the result of repetitive stress on tendons, bones and joints. Because they develop over time, they are not as obvious as bruises or breaks and can be more difficult to diagnose and treat. But they can also be avoided more easily.

"Overuse injuries in young people are definitely preventable," says Wake Forest Baptist Health orthopaedic surgeon David Martin, MD. "Athletes, especially kids, want to compete and don't necessarily recognize when something's wrong, so we have to be smarter than them."

Youth sports have boomed over the last 15 years, to the extent that an estimated 30 million children and adolescents in the United States now participate in organized athletic programs. But the incidence of overuse injuries in young athletes has increased at a much quicker rate across all sports, for reasons that are no mystery to sports medicine experts.

"Participation has increased overall and the sports have become more serious, more competitive at an earlier level, so there are many more year-round athletes than there used to be and many more single-sport athletes," says Martin, director of sports medicine for Wake Forest University athletics and team physician for the Winston-Salem Dash minor-league baseball team. "Kids playing the same sport year-round have no off-season, and this type of early specialization leads to more stresses and more overuse injuries than you normally would see."

Playing different sports, on the other hand, is good for young people on multiple levels, says Daryl Rosenbaum, MD, who specializes in family medicine and sports medicine at Wake Forest Baptist.

"You want to develop overall athleticism, even if you hope to excel in one sport, and playing different sports definitely helps with that," says Rosenbaum, who has been a team physician for the U.S. Soccer Federation's under-20 and under-17 men's and women's national teams and served as medical director of this year's Winston-Salem Open tennis tournament. "You also want to avoid an overuse type of injury. It's tough to go pro or be great in your sport if you injure yourself and fall behind everybody else.

"On the mental side of things, there's avoiding burnout," Rosenbaum adds. "If someone's pushed too hard too soon at one sport, they may get tired of it and then, if they don't enjoy exercise or sports in the future, that can negatively affect their long-term health."

That view is echoed by Michael Freehill, MD, a Wake Forest Baptist orthopaedic surgeon who specializes in shoulder injuries and assists as team physician for the Winston-Salem Dash.

"Playing multiple sports when you're young, up through high school, is actually beneficial for all your sports," says Freehill, who pitched in the minor leagues for six seasons before attending medical school, reaching the AAA level with two different organizations and making the 40-man roster of the Anaheim (now Los Angeles) Angels. "You're utilizing different muscles and performing different motions, resulting in a better athlete overall. Additionally, you're not over-taxing certain areas, such as the elbow or shoulder, as you would by playing the same sport all the time.

"The idea that you have to specialize in a sport at any early age to succeed is simply not true. You can excel to the highest level without being a one-sport athlete."

Proper rest is also a key factor in minimizing the risk of overuse injuries. The body needs time to recover from strenuous activity, especially when it's a young body with still-growing bones and still-developing muscles and tendons.

For a positive example of recovery time, Freehill points to major-league pitchers, who generally refrain from throwing for three months once the season ends.

"How can anybody argue that time off is not needed?" he says. "These are athletes who perform at the highest level, so it makes no sense to think that children who participate in sports can get by with anything less. The same rules apply to volleyball, swimming, tennis, basketball, all sports."

Freehill knows firsthand the importance of proper rest, or lack of it.

"The one regret I have from professional baseball was throwing year-round, which more than likely resulted in a surgery that altered the course of my baseball career," he says.

Rosenbaum recommends that young athletes take at least one day off per week and at least one season off, at least from organized competition in a specific sport, per year. He also emphasizes that both children and adults must realize that "pain is never normal, especially in kids."

"There's no such thing as 'just sore,'" he says. "It's never 'just part of the game.' Nobody, especially a child, should ever push through pain."

It's unlikely that the pursuit of victories, championships, varsity letters, college scholarships and pro contracts will fade from the youth sports scene anytime soon. But Martin, for one, believes that overuse injuries can be taken out of the picture.

"The key is education," he says. "And it can't be just, 'Well, the doctor says you can only throw so many pitches.' It has to be education for the family, the athletes, the coaches and the people who run the game. Little League baseball is one example - they've actually changed the game by putting in rules to protect the players' health - so inroads have been made.

"We also have to educate players, parents and coaches to recognize the signs of overuse, to catch things before they develop into real injury."

Perhaps the most important element, Martin says, is maintaining the proper perspective about sports.

"You have to attach importance to it, but you also have to be sensible," he says. "What I preach is that we have to get everybody involved to think not only about today's game, but about the season, about the player's athletic career, whatever that might be, and about the rest of their life - especially if the player is 10 years old.

"We're now doing that with concussions. We need to be doing it with overuse injuries, too, and I think that will come."

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Youth Sports: No Pain - Sports Medicine

Youth Sports: No Pain - Sports Medicine

Learn how sports medicine at Wake Forest Baptist Health in Winston-Salem treats sports injuries in youth and adolescents.

Last Updated: 04-09-2014
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