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  • Writer's pictureCTPO Team

Overuse Injuries in Pediatrics

Causes of Overuse

Every summer brings an influx of new overuse injuries for us at Central Texas Pediatric Orthopedics (CTPO). Ankle sprains, growing pains, and back pain are all very commonly seen.

Many young athletes are enrolled in a variety of summer camps: from general fun camps, to speed and agility, and also sport specific camps. While camps are a great opportunity for the young athlete to grow and develop, they can be problematic for the young athlete due to the rapid increase in the number of hours, and also the intensity.

These summer camps are in addition to the normal workload of the young athlete, many of which specialize in sport from an early age or participate in sport all year round, further complicating the problem.

Overuse injuries are caused by too much load/stress on the muscles, tendons, ligaments and growth plates in the body. In kids, we are most concerned about the growth plates, as they have not fully developed and are susceptible to stress. Examples of common overuse types of diagnoses include apophysitis, tendinitis, muscle strains and stress fractures.

Excessive load can be caused by how long the athlete has been playing a sport, how frequently the athlete participates, and how intense they are playing. While these external loads are important, they can be complicated by internal factors such as heart rate, perceived effort, stress, and sleep.

Recognition and Treatment of Overuse Injuries

It is generally not too hard to spot an overuse injury. Most athletes will report a sharp increase in training a few weeks or months before the pain started, or participate with multiple teams across the calendar year. The athlete may be generally fatigued, may be growing rapidly, or be stressed out with school and homework.

We at CTPO generally recommend gentle stretching to the affected body parts, daily icing for pain control, and proper nutrition, hydration, and sleep. We may advocate for a few days of rest from the particular sport if the injury is severe.

Prevention of Overuse

Rapid changes to any of these types of load have been shown to place the athlete at higher risk of injury. Research has shown that athletes respond better to relatively small increases (and decreases) rather than larger load changes over a short period of time.

We also recommend changing only one variable or type of load at a time. For example, in baseball, recommended pitch counts and pitching distance increase with increasing age. We at CTPO recommend increasing either pitch count or distance, but not both at the same time to prevent risk of injury.

Calendar congestion is another problem we see for many of our patients. Too many matches/games in a short period of time, especially without proper rest, will increase the amount of playing time, increase the load demands on the body, and therefore increase the risk of injury.

Proper warm-up and stretching are vital for injury prevention. Growth related aches and pains are very common in our practice. As kids grow, their bones lengthen and the muscles that attach to the bones via tendons, pull away from the bone at the growth plate.

All too often we hear our athletes hold their stretches for 10 seconds and move on to another body part, with an average of 5 or less minutes for warm-up. This is NOT long enough! It is recommended that dynamic warm up be at least 10 minutes and that stretches be held for 30 seconds and repeated for 3 repetitions in one sitting in order to properly stretch a muscle. More frequent static stretching throughout the day is recommended if an area is particularly problematic

Young athletes are focusing on only one sport at too young of age. As a result, we are seeing an increase in overuse injuries in younger athletes. Without diversification of sport, athletes are taking the same kinds of blows to their bodies over and over again.

With year round competition, most young athletes are competing well beyond the recommended participation limits. We do recommend that your athlete play more than one sport, and diversify until at least 14 years of age.

As athletes change from sport to sport, they develop different muscles groups and improve skills sets specific to each sport. This will make them a better overall athlete, all while preventing the risk of overuse injury.


To make an appointment with one of our Doctors or Physical Therapists, please contact us at 512.478.8116 or visit our website at

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