Overuse Injury in the Young Athlete: Reasons for Concern

In brief: More children are becoming intensely involved in competitive sports programs at younger ages. These children must cope with the psychological stress of competing as well as the physical stress of training during growth periods. A survey of the literature available on overuse injuries in children's sports showed few long-term studies on causes and prevention but isolated several factors that contribute to injury. Guidelines for people who direct youth sports programs emphasize adjustment of training to the child's physical and social development.     

Injury Patterns in Youth Sports

In brief: Millions of US children participate in recreational activities, organized youth leagues, and interscholastic sports programs. Although they enjoy and obtain health benefits from these activities, 3% to 11% of these children are injured while participating in sports programs each year. Epidemiologic studies show that different sports pose different types and degrees of risk and that injuries among children differ from those among adolescents. An awareness of injury patterns in youth sports helps physicians and others who care for children to identify variables associated with injury. Measures must be taken in all youth sports programs to modify such variables in an effort to prevent injuries.     

Training the child athlete: physical fitness, health and injury

The number of children and adolescents participating in organised athletic activities worldwide is increasing. However, physical fitness levels among youth are lower today than in previous decades. The combination of increased exposure and decreased preparedness for sports participation has led to an epidemic of both acute and chronic sports-related injuries in this population. Poor physical fitness, in addition to having negative health consequences, seems to be a risk factor for sports-related injury. Accurate injury surveillance data are required to better define the magnitude of the problem of injury in youth sports, as well as to identify specific risk factors for injury. From these data, targeted intervention strategies incorporating fitness training may be developed with the goal of preventing sports-related injury. Preliminary experience with several specific injury patterns--anterior cruciate ligament injuries and ankle sprains--has demonstrated the efficacy of such targeted prevention strategies.     

The young gymnast

Gymnastics training develops strength, flexibility, concentration, balance, grace, and speed in young athletes. In terms of hours per week and intensity of practice, the dedication to training at a young age, is unparalleled in most other youth sports. With this dedication comes the risk of injury to the immature musculoskeletal system, and it is our duty to ensure that these risks are minimized. Through adequate safety equipment, supervision, and spotting of difficult techniques, a number of acute injuries may be prevented. Maintenance of balanced flexibility and strength, modification of training to limit pain, and taping or splinting of wrists and ankles may reduce the risk of overuse injuries. Physician who deal with young gymnasts must have an understanding of the inherent risks of the sport to provide prompt diagnoses and appropriate management of injuries. The gymnasium can be a healthy environment as long as the health and safety of the child takes precedence over the success of the gymnast.     

Physeal injuries in children's and youth sports: reasons for concern?

A systematic review of the literature on the frequency and characteristics of sports related growth plate injuries affecting children and youth in organised sport was carried out. Both acute and chronic physeal injuries related to participation in sports have been reported to occur, although injury incidence data are somewhat limited. Of particular concern is the growing number of stress related physeal injuries, including those affecting the lower extremities. Although most physeal injuries appeared to resolve with treatment and rest, there is also evidence of growth disturbance and deformity. Possible injury risk factors and countermeasures are discussed, and suggestions for directing future research provided.     

Osteoarthritis as an outcome of paediatric sport: an epidemiological perspective

Recent data suggest that the risk of paediatric sport injury is high and constitutes a significant public health burden. A concern regarding long-term consequences of youth sports injury is the risk of developing osteoarthritis (OA) at a young age. Based on the available evidence, a link between youth sports injuries, particularly acute injury of the knee and ankle, and OA, is likely. Early OA development and intense participation in high-impact, high-stress elite sports at an early age also may be associated, but follow-up of elite athletes into the early adult years is needed to examine this relationship. Given that some antecedents of early adult-onset OA may be traced to child and adolescent sports injury and related surgery, and perhaps intense training regimens, it follows that efforts to prevent sports-related joint injury should begin during the childhood years. Based on the results of recent research evidence, programmes addressing prevention of youth sports injuries may provide the rewarding results of OA prevention.     

Prevention of pediatric sports injuries

With over 30 million children participating in sports each year across the United States, a number of significant injuries are to be expected. Although mild injuries such as strains, sprains, and contusions predominate, catastrophic injuries do occur. Young athletes are at an increased risk for growth plate and apophyseal injuries, overuse injuries, and heat illness. Many of these sports injuries can be prevented. Prevention strategies include protective equipment, rule changes, preseason and season prevention interventions, safety measures, better coaching, education, and a societal awareness of injury and prevention. This article discusses current injury prevention for children participating in baseball, football, soccer, and ice hockey.     

Strength training for children and adolescents

The potential benefits of youth strength training extend beyond an increase in muscular strength and may include favorable changes in selected health- and fitness-related measures. If appropriate training guidelines are followed, regular participation in a youth strength-training program has the potential to increase bone mineral density, improve motor performance skills, enhance sports performance, and better prepare our young athletes for the demands of practice and competition. Despite earlier concerns regarding the safety and efficacy of youth strength training, current public health objectives now aim to increase the number of boys and girls age 6 and older who regularly participate in physical activities that enhance and maintain muscular fitness. Parents, teachers, coaches, and healthcare providers should realize that youth strength training is a specialized method of conditioning that can offer enormous benefit but at the same time can result in serious injury if established guidelines are not followed. With qualified instruction, competent supervision, and an appropriate progression of the volume and intensity of training, children and adolescents cannot only learn advanced strength training exercises but can feel good about their performances, and have fun. Additional clinical trails involving children and adolescents are needed to further explore the acute and chronic effects of strength training on a variety of anatomical, physiological, and psychological parameters.     

Patellofemoral problems in runners

Unlike twisting and cutting sports, in which there are torsional forces placed on the knee, distance running involves straight line motion. The biomechanics of running usually insure a relatively smooth tracking of the patella in the femoral groove, so it is rare for a runner to experience an acute traumatic injury of the joint. Since such injuries are rare, this article concentrates on stress-related patellofemoral syndromes that are seen in runners.     

A review of epidemiology of paediatric elbow injuries in sports

The elbow is a common site of orthopaedic injury in the paediatric population. The number of these injuries continues to rise following increased levels of participation in paediatric recreational and competitive sport. Injuries to the paediatric elbow can be classified as either overuse or acute. Delineating injury patterns to the elbow in children can be challenging, given the cartilaginous composition of the distal humerus and the multiple secondary ossification centres that appear and unite with the epiphysis at defined ages. Pitching in baseball, serving in tennis, spiking in volleyball, passing in American football and launching in javelin-throwing can all produce elbow pathology by forceful valgus stress, with medial stretching, lateral compression and posterior impingement. In children and adolescents, the epiphyseal plate is weaker than the surrounding ligaments, predisposing them to epiphyseal plate injuries. On the other hand, post-pubescent or skeletally mature athletes are more prone to tendinous or ligamentous injury. Injuries may cause significant impact on the athlete, parents and healthcare system. With the exception of baseball, there are few prospective cohort studies on the epidemiological trends of childhood elbow injuries in other sports. This paper aims to describe the epidemiological trends in paediatric elbow injuries related to sports, suggests prevention strategies and discusses the scope for further research. A web-based search of existing articles pertaining to paediatric elbow injuries in sports was performed. The implications of acute and overuse injuries and the possibility of permanent damage should be understood by parents, coaches and the athletes. Proper understanding of the intrinsic and extrinsic risk factors that could lead to elbow injuries is thus required. Measures to prevent elbow injuries should include proper coaching, warm-up, officiation, legislation, medical expertise and protective gear. There are still many opportunities for prospective studies and other research projects among young athletes in various sports. Current studies will serve as a baseline for future research to assess the success of specific interventions in reducing the incidence of elbow injury in the paediatric athlete. Further epidemiological studies in various sports will help expand our knowledge and prevent potential disability and deformity in the paediatric elbow.     

Soccer injuries in Saudi Arabia

Soccer injuries which were seen at the King Fahd University Hospital over a period of 12 months were analyzed. The majority of the patients were under 20 years of age. Two-thirds of the injuries involved soft tissue, while those to the bone and joint comprised one-third. The lower extremity was involved in 59%. Sixteen percent of the injuries were considered severe enough to require inpatient treatment. We feel the high incidence of injuries can be reduced by better guidance and coaching at school and other training levels. At present, these patients are seen in the emergency room of our hospital and subsequently in the orthopaedic and fracture clinics. A specialized sports injury clinic staffed with medical and paramedical personnel with special interest in sports medicine would enable early and effective treatment returning athletes to play without undue delay.     

Closed head injuries in athletes

Nervous system sports-related injuries constitute a major source of serious morbidity and mortality in athletes. In particular, acute closed head injuries account for some 6000 potentially preventable deaths and literally millions of episodes of less severe head injuries each year. The long-term significance of chronic head injuries resulting from repetitive blows to the brain is only now being fully appreciated. Similarly subtle neuropsychological changes are being increasingly recognized resulting from milder head injuries. Although head injuries are almost inevitable and unavoidable sequelae of most contact and competitive sports, much can and should be done to reduce the serious acute and chronic neurologic complications inherent in these activities. Prevention of catastrophic sports injuries by careful preseason examination, education, training, and conditioning, and ongoing counseling of the athlete is of paramount importance. The use of carefully fitted protective headgear, and avoidance of maneuvers that may directly result in serious head injuries are also key. The immediate evaluation, evacuation, and triage of the injured athlete must take place carefully and expeditiously. Skillful, experienced, and compassionate definitive care must then ensue. In the long term, the complications and analysis of accurate statistical data on the magnitude of sports injuries in general, and nervous system involvement in particular, must be studied. Presently, only a few sports have accumulated such data, such as in the National Football Head and Neck Injury Registry. In the final analysis, it is the cooperative responsibility of the medical and athletic communities to strive to reduce these tragic injuries.     

Lower limb injuries in children in sports

This article presents an overview of sports-related injuries of the lower limb in children, with emphasis on the management. The special injury-related conditions of childhood, epidemiology, and the particular pattern of injuries are discussed. The increased participation of children in sports will continue. Permanent damage is a risk, and, as such, prevention should be the most important management in this age group. For example, stretching exercises should be performed with "warm" muscles. Excessive weight training has an unacceptable risk of injury. In endurance sports, the "10 percent rule," which consists of increasing activity by 10% each week, probably could be applied to prevent overuse injuries. A multifactorial approach may be helpful. The rationale for high performance, competitive sports for children is doubtful. The optimal levels of safe training will remain changeable and not predictable. It should be the responsibility of parents, coaches, and healthcare professionals to try and minimize the potential for injury and disability, and allow children to enjoy the benefits of sports.     

Epidemiology of injury in child and adolescent sports: injury rates, risk factors, and prevention

The epidemiology of sports injuries in children and youth is an important area of research that has been largely overlooked in the medical and sport science literature. This article presents an overview of the analytic aspects of pediatric sports injury epidemiology, focusing on injury risk factors and preventive measures. The review indicates that few modifiable injury risk factors have been statistically evaluated, and not many studies have been designed to determine the effect of injury prevention measures in pediatric sports. However, initial results are promising. Specific directions for further analytic research are presented.     

Déclaration de consensus sur l’entraînement de l’enfant au sport d’élite

Protecting the health of the athlete is the primary goal of the International Olympic Committee's Medical Commission. One of its main objectives is the promotion of safe practices in the training of the elite child athlete. The elite child athlete is one who has superior athletic talent, undergoes specialised training, receives expert coaching and is exposed to early competition. Sport provides a positive environment that may enhance the physical growth and psychological development of children. This unique athlete population has distinct social, emotional and physical needs, which vary depending on the athlete's particular stage of maturation. The elite child athlete requires appropriate training, coaching and competition that ensure a safe and healthy athletic career and promote future well-being. This document reviews the scientific basis of sports training in the child, the special challenges and unique features of training elite children and provides recommendations to parents, coaches, health care providers, sports governing bodies and significant other parties.     

Overuse injuries in youth sports: biomechanical considerations

Many children today participate in highly organized sports programs that involve regimented year-round repetitive training. This type of training has led to an increased incidence of overuse musculoskeletal injuries. Sports physicians have dealt with sports injuries in children for many years and, on the basis of their clinical experience, have developed guidelines to treat and to try and prevent these injuries. The purpose of this article is to provide a biomechanical perspective of sports injuries in young athletes and blend ideas from this perspective with more traditional clinical perspectives that dominate the literature relative to this topic. Basic tissue and gross movement mechanics principles are used to identify growth, morphological, and movement factors that may predispose a child to an overuse injury. Several biomechanical analyses of simple movement tasks are presented to quantify the forces developed in various tissues and to illustrate the effects that growth can have on these forces. Guidelines are given for developing injury prediction models that may be used in the future to establish safe and effective training guidelines for children.     

Overview of injuries in the young athlete

It is estimated that 30 million children in the US participate in organised sports programmes. As more and more children participate in sports and recreational activities, there has been an increase in acute and overuse injuries. Emergency department visits are highest among the school-age to young adult population. Over one-third of school-age children will sustain an injury severe enough to be treated by a doctor or nurse. The yearly costs have been estimated to be as high as 1.8 billion US dollars. There are physical and physiological differences between children and adults that may cause children to be more vulnerable to injury. Factors that contribute to this difference in vulnerability include: children have a larger surface area to mass ratio, children have larger heads proportionately, children may be too small for protective equipment, growing cartilage may be more vulnerable to stresses and children may not have the complex motor skills needed for certain sports until after puberty. The most commonly injured areas of the body include the ankle and knee followed by the hand, wrist, elbow, shin and calf, head, neck and clavicle. Contusions and strains are the most common injuries sustained by young athletes. In early adolescence, apophysitis or strains at the apophyses are common. The most common sites are at the knee (Osgood-Schlatter disease), at the heel (Sever's disease) and at the elbow (Little League Elbow). Non-traumatic knee pain is one of the most common complaints in the young athlete. Patellar Femoral Pain Syndrome (PFPS) has a constellation of causes that include overuse, poor tracking of the patellar, malalignment problems of the legs and foot problems, such as pes planus. In the child, hip pathology can present as knee pain so a careful hip exam is important in the child presenting with an insidious onset of knee pain. Other common injuries in young athletes discussed include anterior cruciate ligament injuries, ankle sprains and ankle fractures. Prevention of sports and recreation-related injuries is the ideal. There are six potential ways to prevent injuries in general: (i) the pre-season physical examination; (ii) medical coverage at sporting events; (iii) proper coaching; (iv) adequate hydration; (v) proper officiating; and (vi) proper equipment and field/surface playing conditions.     

Injuries in youth track and field are perceived to have multiple‐level causes that call for ecological (holistic‐developmental) interventions: A national sporting community perceptions and experiences

Engaging in competitive sports as a youth can have many health benefits, but recent studies also report a high risk for injury. The long‐term purpose of this Swedish research program is to develop a framework for safe track and field training for young athletes (aged 12‐15 years). The aim of this study was to establish what is perceived to contribute and cause injuries in youth track and field by compiling the best available experiential knowledge about the underlying factors and use this knowledge to identify appropriate areas to handle these in practical ways. Nine focus group interviews with in total 74 participants and confirming interviews with five individuals were performed in seven Swedish regions. Qualitative research methods were used for data analysis. Injuries in youth athletes were not considered to be strictly the result of individual factors but rather the result of the interactions between factors at different levels. Three major factors emerged as follows: Insufficient knowledge for athletic development in daily practice; shortsighted communities of practice and sports policies not adjusted to youth; and societal health behaviors. The experiential knowledge in the national sporting community suggests that if effective and sustainable injury prevention processes are to be implemented for youth track and field, an ecological (holistic‐developmental) approach to injury prevention is needed. Such an approach allows a longitudinal development‐focused strategy for prevention that spans an athlete's entire career.     

Injuries in badminton

Though badminton is one of the most widely played sports in the world, it has received little sports medical interest. Based on the few existing studies on injuries in badminton, compared to other sports it is of relatively low risk and dominated by overuse injuries. The injury duration is relatively long, but only a few working days are lost. Anatomically, most injuries are localised to the foot and ankle. The single most frequent injuries are Achilles tendinitis and tennis elbow. Rupture of the Achilles tendon is a rare injury, which is typically seen in older recreational players. When the time of exposure is taken into account men are found to have a higher injury risk than women, and recreational players a higher injury risk than elite players. In contrast to most other sports the relative injury risk is higher during training than in competition. Based on suggested causes of injury and injury mechanisms, together with the known injury pattern in badminton the following preventive matters are suggested: (a) changes in the badminton shoe, towards a higher heel, with shock absorption and a stiffer anatomically fitting heel counter; (b) adjustment of the friction between the individual shoe-soles and playing surfaces; and (c) specific badminton training including stretching and strengthening of the triceps surae and the muscles involved in the internal and external rotation of the shoulder and elbow during the badminton strokes.