Across the United States, more and more teenagers are focusing on a single, specialized sport or activity, much like the young gymnasts or other competitors at the Rio Olympics. Unfortunately, these adolescents also increasingly suffer from so-called overuse injuries.
New research has shown a link between sport specialization and an increase in overuse injuries among young people, many of whom train vigorously at the high school level or earlier, in some cases to get to the professional or Olympic level of competition.
Such a drive or ambition to become an elite athlete tends to leave out a crucial aspect of growing up: Bones and ligaments are not fully developed and are more vulnerable to injury, says Luis A. Rodriguez, M.D. [1], a primary care sports medicine physician with Miami Orthopedics & Sports Medicine Institute [2].
“We have to make sure that we are providing a healthy environment with proper guidance for these kids,” says Dr. Rodriguez. “The focus should not be just on winning. The young athletes’ health and safety should not be a secondary concern.”
An overuse injury occurs to a bone or muscle, developing over time as the tissue endures repetitive stress — and then is not provided sufficient time to heal and recover.
Adolescents More Susceptible to Injury
Adults who train for marathons or participate in triathlons are prone to overuse injuries. But adolescents are more susceptible to these injuries, and they can develop some injuries that are not commonly seen in adults in their 20s or older. About half of all sports injuries in young athletes are from overuse.
The ligaments in teenagers are not as flexible, resulting in more stretching and tearing injuries. Ligaments are the fibrous tissue, or bundles, that connect bones or cartilages together. An adolescent’s knee, for example, is more prone to inflammation because of repetitive stress on the joint from running and jumping sports or activities.
“When evaluating these young athletes, the parents and coaches need to be on the lookout for any swelling around the bone, any discoloration of the skin or any pain at rest or when moving,” says Dr. Rodriguez. “Pain during or after activity should be given special consideration and evaluated by a doctor.”
The problem is that sometimes young athletes will ignore their own pain. “There is so much pressure to keep playing that they will dismiss the pain as something basic and normal. But pain frequently requires special attention,” he said.
A recent study published in the American Journal of Sports Medicine [3] found that overuse injuries are on the rise, accounting for about half of visits by patients, ages 5 to 17, to a sports clinic over a 10-year study. Overuse injuries represented two-thirds of the 846 injuries sustained by kids ages 7 to 18 who were studied over three years at two other sports clinics. These figures are probably too low because kids often do not report overuse injuries.
The study’s authors concluded that: “There is an increased risk of serious overuse injury for athletes who spend numerically more hours per week participating in sports versus their age in years, as well as for those who spend more than twice as many hours per week participating in organized sports as in free play.”
Most overuse injuries occur in the lower leg, knee and shoulder. Boys are more apt to sustain injuries in their lower back and feet. Overuse injuries are most likely to strike in girls’ and boys’ track and field, and girls’ field hockey, lacrosse and gymnastics, the study says.
Girls are more susceptible because they typically enter adolescence earlier, putting more stress on their knees over time, compared to boys.
Ways of Preventing Overuse Injuries
There are some precautions that young people can take to help prevent overuse injuries:
Time off. Young athletes should take one to two days off per week to allow time for recovery. Any increases in training regiments should occur at a slow pace, allowing for rest periods. Time, intensity or distance covered in a particular sport or activity should not increase by more than 10 percent each week.
Diversify. Focusing too intently on one sport or activity is one of the primary factors behind overuse injuries and repetitive stress on a particular joint or extremity. Researchers found that activities that were not too structured, along with a variety of sports, before adolescence is the best formula for athletic success as teenagers mature into young adults.
Proper warm-ups and cool-downs. Proper conditioning exercises before and after any sport or activity can be very effective. However, proper technique is important. Parents should make sure that their kids’ coaches and trainers are helping prevent overuse injuries with the appropriate stretching routines for a particular sport.
Kids preparing to return to fall sports after taking the summer off may need to begin some training or conditioning on their own, with guidance from parents.
“There is no doubt that we’re sometimes overworking these kids so they can become great athletes,” says Dr. Rodriguez. “This may increase the risk of injury and the likelihood that they will drop out of a sport. First and foremost, we want to make sure they are enjoying their physical activity or sport and that they don’t feel pressured into winning at the expense of their safety.”