Treating Sports Overuse Injuries

Overuse injuries are very common in children and teenagers, especially among kids who play sports throughout the year.

A high volume of sports puts your patients at higher risk for an overuse injury. Ask which sports they play, how often they play them, and how many teams they play for when taking the patient history. It is more and more common now that kids play on multiple teams at the same time or that sports seasons overlap. Here in the South, for example, baseball can start in January or February, while basketball – a winter sport – is still going on.

Year-round participation in multiple sports has an advantage as well – it becomes a form of built-in cross training. Your patients will be using the same muscles but developing them in different ways.

Encourage your athletic patients to play different sports and discourage “early specialization.” You can counsel patients regularly about sports diversification – during well-child visits and school or sports physical examinations. Patients who play football or soccer in the fall; basketball or wrestling in the winter; and then softball or lacrosse in the spring generally are at a lower risk for overuse injuries.

In contrast, specialization in the same sport throughout the year increases the risk for overuse injuries as well as “burnout.” For example, a child who starts at age 7 or 8 years and plays the same sport for years might find participation becomes less fun by age 13 or 14 years. In some cases, parents get enthusiastic, pay for private lessons to extend the “season” to 12 months, and the kids just never have a time to rest.

For some families, it seems like success of the team or success on the playing field becomes more important than the health of the child. You can face a dilemma if you recommend rest for a child about to play a big game or tournament. The best way I found around that is to spend sufficient time to explain why you are making your recommendations. If you just say, “His knee hurts, and he shouldn't play,” the patient and parents are less likely to be compliant.

We give advice. We rarely forbid a kid from playing. But you can explain what could happen if they don't follow recommendations. You might say something like, “Here is what I think you have, here is what I think you should do, and here's why. If you don't, the risk of making this a stress fracture is higher.” You can also explain that a nonsurgical elbow injury could become surgical if you continue to throw, play, or tumble.

Pediatricians can manage most overuse injuries. Watch for signs that can warrant referral, however, such as a swollen joint, limitation of joint movement, or symptoms of trauma/acute injury. Consider consulting a subspecialist when the child cannot completely bend or extend the elbow, for example. These findings suggest something worse than just overuse.

In general, the best way to treat an overuse injury is to underuse the affected area. Apply the PRICEMM techniques (protection, rest, ice, compression, elevation, medication, and [physical therapy] modalities) for 2 or 3 days. If there is no improvement, expand your differential diagnosis. Overuse injuries should improve quickly if patients start underusing the affected area in addition to modifying their workouts and using ice and anti-inflammatory medications.

Recommend the patient back off after you identify the likely source of pain. If a baseball player presents with elbow pain, for example, he might improve by pitching less or switching from shortstop to first base. Rarely do children need to stop playing altogether. Modification of the workout a little bit might be all it takes to give the body a chance to adapt. You could recommend a child play only part of the soccer game or avoid particular conditioning drills during practice, for example.

An overuse injury is defined as repetitive, submaximal stress applied to a tissue that occurs when the adaptive capability of the tissue is exceeded and injury results. A blister is a perfect example. If you put on a new shoe that starts rubbing your foot too much, eventually the skin breaks down. But if you wear the new shoes for a little bit, then switch to sandals, then boots, and finally put your new shoes back on, you slowly introduce those stresses. This way, the body has a chance to adapt, the skin will become callused, and you won't develop a blister.

Acute trauma is another reason to consider referring the child to a sports medicine specialist. If a child comes to you with instant pain from a jump off the monkey bars or a slide into home, she should be referred to rule out something more serious, such as a fracture or a cartilage or a ligament tear.

Another time to refer is anytime you feel uncomfortable. If you sense something isn't right, you will never be faulted for referring the patient to a specialist. So, when in doubt, go ahead and refer.

Typically, a good history and physical examination will be sufficient, with or without x-rays, for a pediatrician to determine the best recommendations for the patient.

Although x-rays are a necessity for evaluation of most orthopedic or sports injuries, it is preferable to refer the child and have the subspecialist order imaging tests. This avoids duplication of radiation exposure for the child and the unnecessary time and expense of repeated x-rays. In addition, laboratory assays typically do not help in the evaluation of a suspected overuse injury, unless you suspect a comorbid condition such as arthritis or joint infection.

Overuse injuries are very common in children and teenagers, especially among kids who play sports throughout the year.

A high volume of sports puts your patients at higher risk for an overuse injury. Ask which sports they play, how often they play them, and how many teams they play for when taking the patient history. It is more and more common now that kids play on multiple teams at the same time or that sports seasons overlap. Here in the South, for example, baseball can start in January or February, while basketball – a winter sport – is still going on.

Year-round participation in multiple sports has an advantage as well – it becomes a form of built-in cross training. Your patients will be using the same muscles but developing them in different ways.

Encourage your athletic patients to play different sports and discourage “early specialization.” You can counsel patients regularly about sports diversification – during well-child visits and school or sports physical examinations. Patients who play football or soccer in the fall; basketball or wrestling in the winter; and then softball or lacrosse in the spring generally are at a lower risk for overuse injuries.

In contrast, specialization in the same sport throughout the year increases the risk for overuse injuries as well as “burnout.” For example, a child who starts at age 7 or 8 years and plays the same sport for years might find participation becomes less fun by age 13 or 14 years. In some cases, parents get enthusiastic, pay for private lessons to extend the “season” to 12 months, and the kids just never have a time to rest.

For some families, it seems like success of the team or success on the playing field becomes more important than the health of the child. You can face a dilemma if you recommend rest for a child about to play a big game or tournament. The best way I found around that is to spend sufficient time to explain why you are making your recommendations. If you just say, “His knee hurts, and he shouldn't play,” the patient and parents are less likely to be compliant.

We give advice. We rarely forbid a kid from playing. But you can explain what could happen if they don't follow recommendations. You might say something like, “Here is what I think you have, here is what I think you should do, and here's why. If you don't, the risk of making this a stress fracture is higher.” You can also explain that a nonsurgical elbow injury could become surgical if you continue to throw, play, or tumble.

Pediatricians can manage most overuse injuries. Watch for signs that can warrant referral, however, such as a swollen joint, limitation of joint movement, or symptoms of trauma/acute injury. Consider consulting a subspecialist when the child cannot completely bend or extend the elbow, for example. These findings suggest something worse than just overuse.

In general, the best way to treat an overuse injury is to underuse the affected area. Apply the PRICEMM techniques (protection, rest, ice, compression, elevation, medication, and [physical therapy] modalities) for 2 or 3 days. If there is no improvement, expand your differential diagnosis. Overuse injuries should improve quickly if patients start underusing the affected area in addition to modifying their workouts and using ice and anti-inflammatory medications.

Recommend the patient back off after you identify the likely source of pain. If a baseball player presents with elbow pain, for example, he might improve by pitching less or switching from shortstop to first base. Rarely do children need to stop playing altogether. Modification of the workout a little bit might be all it takes to give the body a chance to adapt. You could recommend a child play only part of the soccer game or avoid particular conditioning drills during practice, for example.

An overuse injury is defined as repetitive, submaximal stress applied to a tissue that occurs when the adaptive capability of the tissue is exceeded and injury results. A blister is a perfect example. If you put on a new shoe that starts rubbing your foot too much, eventually the skin breaks down. But if you wear the new shoes for a little bit, then switch to sandals, then boots, and finally put your new shoes back on, you slowly introduce those stresses. This way, the body has a chance to adapt, the skin will become callused, and you won't develop a blister.

Acute trauma is another reason to consider referring the child to a sports medicine specialist. If a child comes to you with instant pain from a jump off the monkey bars or a slide into home, she should be referred to rule out something more serious, such as a fracture or a cartilage or a ligament tear.

Another time to refer is anytime you feel uncomfortable. If you sense something isn't right, you will never be faulted for referring the patient to a specialist. So, when in doubt, go ahead and refer.

Typically, a good history and physical examination will be sufficient, with or without x-rays, for a pediatrician to determine the best recommendations for the patient.

Although x-rays are a necessity for evaluation of most orthopedic or sports injuries, it is preferable to refer the child and have the subspecialist order imaging tests. This avoids duplication of radiation exposure for the child and the unnecessary time and expense of repeated x-rays. In addition, laboratory assays typically do not help in the evaluation of a suspected overuse injury, unless you suspect a comorbid condition such as arthritis or joint infection.

Overuse injuries are very common in children and teenagers, especially among kids who play sports throughout the year.

A high volume of sports puts your patients at higher risk for an overuse injury. Ask which sports they play, how often they play them, and how many teams they play for when taking the patient history. It is more and more common now that kids play on multiple teams at the same time or that sports seasons overlap. Here in the South, for example, baseball can start in January or February, while basketball – a winter sport – is still going on.

Year-round participation in multiple sports has an advantage as well – it becomes a form of built-in cross training. Your patients will be using the same muscles but developing them in different ways.

Encourage your athletic patients to play different sports and discourage “early specialization.” You can counsel patients regularly about sports diversification – during well-child visits and school or sports physical examinations. Patients who play football or soccer in the fall; basketball or wrestling in the winter; and then softball or lacrosse in the spring generally are at a lower risk for overuse injuries.

In contrast, specialization in the same sport throughout the year increases the risk for overuse injuries as well as “burnout.” For example, a child who starts at age 7 or 8 years and plays the same sport for years might find participation becomes less fun by age 13 or 14 years. In some cases, parents get enthusiastic, pay for private lessons to extend the “season” to 12 months, and the kids just never have a time to rest.

For some families, it seems like success of the team or success on the playing field becomes more important than the health of the child. You can face a dilemma if you recommend rest for a child about to play a big game or tournament. The best way I found around that is to spend sufficient time to explain why you are making your recommendations. If you just say, “His knee hurts, and he shouldn't play,” the patient and parents are less likely to be compliant.

We give advice. We rarely forbid a kid from playing. But you can explain what could happen if they don't follow recommendations. You might say something like, “Here is what I think you have, here is what I think you should do, and here's why. If you don't, the risk of making this a stress fracture is higher.” You can also explain that a nonsurgical elbow injury could become surgical if you continue to throw, play, or tumble.

Pediatricians can manage most overuse injuries. Watch for signs that can warrant referral, however, such as a swollen joint, limitation of joint movement, or symptoms of trauma/acute injury. Consider consulting a subspecialist when the child cannot completely bend or extend the elbow, for example. These findings suggest something worse than just overuse.

In general, the best way to treat an overuse injury is to underuse the affected area. Apply the PRICEMM techniques (protection, rest, ice, compression, elevation, medication, and [physical therapy] modalities) for 2 or 3 days. If there is no improvement, expand your differential diagnosis. Overuse injuries should improve quickly if patients start underusing the affected area in addition to modifying their workouts and using ice and anti-inflammatory medications.

Recommend the patient back off after you identify the likely source of pain. If a baseball player presents with elbow pain, for example, he might improve by pitching less or switching from shortstop to first base. Rarely do children need to stop playing altogether. Modification of the workout a little bit might be all it takes to give the body a chance to adapt. You could recommend a child play only part of the soccer game or avoid particular conditioning drills during practice, for example.

An overuse injury is defined as repetitive, submaximal stress applied to a tissue that occurs when the adaptive capability of the tissue is exceeded and injury results. A blister is a perfect example. If you put on a new shoe that starts rubbing your foot too much, eventually the skin breaks down. But if you wear the new shoes for a little bit, then switch to sandals, then boots, and finally put your new shoes back on, you slowly introduce those stresses. This way, the body has a chance to adapt, the skin will become callused, and you won't develop a blister.

Acute trauma is another reason to consider referring the child to a sports medicine specialist. If a child comes to you with instant pain from a jump off the monkey bars or a slide into home, she should be referred to rule out something more serious, such as a fracture or a cartilage or a ligament tear.

Another time to refer is anytime you feel uncomfortable. If you sense something isn't right, you will never be faulted for referring the patient to a specialist. So, when in doubt, go ahead and refer.

Typically, a good history and physical examination will be sufficient, with or without x-rays, for a pediatrician to determine the best recommendations for the patient.

Although x-rays are a necessity for evaluation of most orthopedic or sports injuries, it is preferable to refer the child and have the subspecialist order imaging tests. This avoids duplication of radiation exposure for the child and the unnecessary time and expense of repeated x-rays. In addition, laboratory assays typically do not help in the evaluation of a suspected overuse injury, unless you suspect a comorbid condition such as arthritis or joint infection.