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Published on June 14, 2012

overuse injuries

Less Really is More—Overuse Injuries in Kids, Part One

The number of children who participate in sports has been growing for the last several decades, due to both the increased access and the large number of different athletic activities available to children. It is estimated that somewhere between 30 and 45 million children participate in some form of athletic activity every year. So is there anything to be concerned about with kids playing all these sports? Can too much of a good thing [exercise] turn into a bad thing?

There are two common questions I get in my office.

  1. “How many sports can my child play and still be safe?”
  2. “Is it even possible for kids to do too much?”

While the answer to the second question is yes, the answer to the first is a little harder to answer. There is no scientific research that tells us for certain how much physical activity for children is too much for their growing bodies. The reality is that the answer to that question is unique to every child.

How Overuse Injuries Develop

Overuse injuries represent one half of all the injuries seen in pediatric sports medicine clinics. These types of injuries occur because every time we exercise, there is micro-traumatic damage that occurs in our bones, tendons, and muscles. This microscopic damage is repaired by the body when we rest, resulting in stronger tissues. However, if that period of rest is inadequate for complete repair, the body starts to get behind and the effect of that damage starts to accumulate over time. The bones of children are especially vulnerable to these types of injuries because they are still growing and remodeling as they mature, and are less able to handle stress compared to adult bones.

Four Stages of Overuse Injuries

  1. The pain is present after physical activity.
  2. The pain is present during the physical activity, but does not limit the athlete’s performance.
  3. The pain does begin to restrict the athlete’s performance.
  4. The pain occurs both with the activity and during rest.

Treating an Overuse Injury

Overuse injuries include a spectrum of problems from simple sprains and strains to stress fractures. Depending on the nature of the injury, treatment can include everything from rest, to physical therapy, or to immobilization of the area in a cast. If your child’s pain is lasting longer than a week or two, or if it seems to be getting worse over time, they should be seen by their pediatrician to determine if there is a serious injury present.

Risk Factors for Overuse Injuries

  • Repetition of a specific activity.
    • If possible, try to introduce different drills or a variety of activities into the practice regimen. Many sports have their own recommendations to help prevent known overuse injury patterns such as the ‘pitch count’ in Little League Baseball, which helps young pitchers avoid damage to their arm.
  • Doing too much, too soon.
    • To help avoid this issue, follow the 10 percent rule – increase the level of activity by 10 percent each week. For example, if a young soccer player at the start of his season can run for 20 minutes during practices before he needs to rest, the following week he can be allowed to run for 22 minutes during practices (an increase of 10 percent).

The Best Way to Avoid Overuse Injuries

Try to limit kids to 18 – 20 hours / week of their sports activity – this includes both games and practices. Limiting the amount of time spent exercising is the number one way to prevent an overuse injury.

Overuse injuries are just one type of problem that kids who are doing too much can encounter. In my next post, I’ll talk about over-training and burnout specifically, and some signs to watch out for. Stay tuned!

See: Overuse Injuries Part 2

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