Overuse Injuries in Children and Adolescents
abstract & commentary
Synopsis: Several factors contribute to a number of overuse injuries in children and adolescents, including growth and inadequate conditioning.
Source: DiFiori JP. Overuse injuries in children and adolescents. Phys Sportsmed 1999;27(1):75-89.
Although there are many positive benefits from sports participation by our youth—increasing self-esteem, acquiring leadership skills and self-discipline, developing general fitness and motor skills, and enhancing peer socialization—DiFiori reminds us that these activities are not without the risk of injury. Commonly seen overuse injuries in children and adolescents include the following, in order of frequency: patellar pain, Achilles tendonitis, infrapatellar tendonitis, enthesopathies, Osgood-Schlatter’s disease, and osteochondritis. Factors contributing to such injuries include growth, prior injury, inadequate conditioning, anatomic malalignment, too rapid training, incorrect equipment or sport technique, and peer or adult pressure. Guidelines for evaluation and treatment of common overuse injuries in children and adolescents are suggested.
Comment by Letha Y. Griffin, MD, PhD
Unfortunately, the lack of participation in regular physical activity by our youth is impressive. Despite efforts to increase youth fitness, enrollment in high school physical educational classes between 1991 and 1995 dropped from 42% to 25%, and according to a report of the surgeon general on physical activity and health published in 1996,1 half of American youth are not vigorously active on a regular basis. Approximately 14% of young people participate in no physical activity.
Hence, an emphasis on youth fitness seems reasonable despite the potential risk of injury. Although DiFiori addresses a number of physical injuries that may occur to young athletes, he does not address the issue of sports "burnout" masquerading as sport injury. Young athletes may feel pressured by well-meaning parents and coaches to win. They may be forced to forgo participation in peer activities such as the school newspaper, yearbook, student government, and chorus as well as give up social times with friends. Occasionally, adolescents feel trapped in a sport in which they have lost interest or for which they feel their abilities or bodies are no longer suited. For example, a gymnast who grows six inches and gains 25 pounds during puberty may not be able to perform as effectively as when she had a smaller, leaner body. Young people, in order to avoid telling parents or coaches that they no longer wish to participate in a sport for which they have been groomed, may instead develop a series of overuse injuries that prevent sports participation. It is our job as sport physicians to look beyond the immediate injury and help these young people resolve the larger issue of their continued participation in a particular sport, emphasizing to them that giving up organized, competitive sports should not make one reject continued participation in recreational fitness activities.
Reference
1. US Department of Health and Human Services, National Centers for Chronic Disease Prevention and Health Protection. Physical Activity and Health: A Report of the Surgeon General. Pittsburgh, PA: Superintendent of Documents, 1996.
45. Commonly seen overuse injuries in youth sports include:
a. ACL tears, growth plate fractures, and ankle sprains.
b. cervical spine injuries, patella pain, and ankle sprains.
c. patella pain, Achilles tendonitis, and Osgood-Schlatter’s
disease.
d. ankle sprains, Salter fracture, and patella pain.
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