On Call for All Kids: Overuse Injuries in Youth Sports

Posted on Mar 18, 2019

Now that Little League season is getting into full swing, parents have little time to worry about finding time to visit the doctor. Unfortunately, the sports that our children play to stay physically fit can land them in the doctor’s office. Injuries caused by year-round conditioning can lead to what are termed “overuse injuries.” In addition to being an Emergency Center doctor, Patrick Mularoni, M.D., is the medical director of Pediatric Sports Medicine at Johns Hopkins All Children’s Hospital.

What is an overuse injury and why does it happen?

An overuse injury is an injury caused by repetitive motion. This can happen anywhere from the workplace to the ball field. These types of injuries are on the rise and it often happens when an athlete is engaged in the same sport all year round. Many parents remember playing multiple sports and even a different sport each season, but today’s families are choosing a single sport and specializing at an early age. It is not odd to see children playing the same sport year round starting in the first grade. There is a thought that this makes the athletes more successful at a given sport and in some young athletes it does give them a leg up, but it also sets them up for joint injuries because of overuse without variation in sport or movement.

Is playing the same sport year round something that is unique to Florida?

Well the beautiful weather here in Florida does allow kids to play sports outdoor all year long but this is a trend that sports medicine doctors are seeing around the country. If we think about the northern states, you will see many athletes move from outdoor soccer, lacrosse and swimming to indoor arenas. For baseball, we are seeing a rise in throwing and hitting academies so even though the athletes may not be playing full-fledged baseball games in the winter, many are actually getting in greater reps than they would just playing in the summer.

Is there a reason why we are seeing children specialize at such a young age?

Much of it is media perception, many of us can remember seeing video of a toddler-aged Tiger Woods or a very young Wayne Gretzky working on their game before they were even old enough to enter kindergarten. This perception, unfortunately, fulfills itself because the young children that play year round do develop skills at a younger age but the problem is that many will either burn out or get injured because of the practice of year-round early specialization.

Since we are entering the spring season it seems like we should talk about Little League baseball. Now this sport has a unique diagnosis called Little League elbow. Could you tell us about that?

Little League elbow is another name for medial epicondylitis or apophysitis in the elbow. It is an overuse injury that is most often seen in children involved in throwing sports. The issue is most often seen in pitchers but can also be seen in catchers and other positions. In growing children the attachment of muscles to bone is relatively weak. Rather than tearing a ligament like the adult pitchers who require the famous Tommy John surgery, children will get pain and inflammation where the tendons and ligaments attach to the bone. This can be very painful and it usually hurts worse during and right after the athlete is throwing.

Can this apophysitis happen in other sports or is it unique to baseball?

We see different areas of apophysitis, and they can occur in baseball and in other sports as well. Depending upon the predominant movement in the sport, there will be different areas that are stressed. For example, we see an apophysitis called Osgood Schlatter near the knee of athletes in jumping sports like basketball and this is the area below the knee cap where the strong quadriceps muscles inset into the leg. We also can see this happen in the back of the heel, which happens most often in soccer players. This type of apophysitis at the heel area occurs where the calf muscle inserts just below the Achilles tendon.

What is the take-home message for parents? How do they know when a child should play through an injury or when they should be seen?

It is obvious when a child has an acute injury that it needs to be checked out. It’s the overuse injuries that create a nagging pain that are hard for parents. If you have concern, get it checked out. A few rules for parents:

  • Pain or swelling in a joint
  • If the pain is causing your child to play differently
  • If your child is limping or favoring an extremity after workouts

Overuse injuries are a serious problem for today’s youth and I think my best suggestion is to keep kids busy in a variety of sports and don’t be afraid to follow professional athletes’ lead by taking an offseason each year away from your child’s given sport.

On Call for All Kids is a weekly series featuring Johns Hopkins All Children’s Hospital medical experts. Visit each Monday for the latest report.

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