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  • Dori Nissenson

Back To School

All materials in this e-newsletter are written and distributed by Dori Nissenson

How can you tell when your athletes have had too much of a good thing?

With the end of summer vacation and the beginning of the school year, I am already starting to see an increase in sports-related injuries in children. As we all would agree, sports-related activity promotes physical and emotional well being in our children and the benefits of athletic activity are significant.

However, too much activity AND TOO MUCH OF THE SAME ACTIVITY, can lead to injury. The great thing about summer is that no matter where our children spend time... either at camp, in a far away place, or at home, their daily routine of physical activity and sports is much less intense and repetitive than it is throughout the school year.

It is this intensity and repetition that makes our children vulnerable to overuse injuries.


→ How do we know when our child's sport is too much for our children?

→ And, as parents, what are the complaints, signs and symptoms that we should be aware of so that we can prevent our children from developing an overuse injury?

→ What can we do to manage our athletes injuries and prevent them from recurring?

Overuse injuries happen over a period of time when an activity, in this case an athletic activity, is repeated frequently. This activity is repeated so frequently that the body part does not have time to heal between playing.

For example, overhead throwing in baseball is often associated with injuries in the elbow and swimming is associated with injuries to the shoulder. If your child swims or plays baseball multiple times a week, there is little opportunity for healing.

Because young athletes... our children... are still growing, they are at greater risk for developing injuries than adults athletes. Overdoing a sport can impair growth in a child and set the child up for long term health problems.

When your child complains of pain repeatedly, it is important to seek the help of a health professional in order to prevent a full-blown overuse injury from developing.

How Do Overuse Injuries Occur???

In generations past, children would play a different sport each season of the year.

However, now with the increased popularity of organized youth athletics, children tend to specialize in one sport only and play that sport all year round and in some instances, for more than one team at the same time.

Overuse injuries occur in a wide range of sports from baseball and basketball to track and soccer and gymnastics.

The most common overuse injuries involve the foot and ankle.

  • Overuse injuries affect the muscles, ligaments, tendons, bones and growth plates. Because the young athlete is still growing and growth in these structures is uneven, he or she becomes more susceptible to injury.

  • A child’s growth plates are weaker than the surrounding tendons and ligaments. As a result, repetitive stress to the ligaments and tendons pulls on the immature bone and growth plates and can disrupt the normal growth of the bone.

  • Continuous performance of the same athletic activity applies unchanging stress to specific areas of the body. This can lead to muscle imbalances. Muscle imbalances combined with the repetitive stress of overtraining and little rest put children at serious risk for overuse injuries.

What Should Coaches and Parents Be Awere Of?

Signs and symptoms of overuse injuries:

  • pain that is not the result of an injury such as a fall and pain that increases with activity

  • swelling

  • changes in form or technique

  • changes in walking or running

  • decreased in interest in practice

Common Overuse Injuries in Children and their symptoms

Sever's Disease: inflammation of the growth plate in the calcaneus or heel bone. The main symptom to be aware of is heel pain.

Osgood-Schlatter Disease: inflammation of the growth plate in the tibia or shin bone. The main symptom to be aware of is pain in the bony bump at the top of the shin with walking, running or jumping.

Jumper’s Knee: overuse of the patellar tendon and inflammation of the growth plate of the knee cap. The main symptom to be aware of is pain at the front of the knee with jumping.

Stress Fractures: Occur mostly in weight-bearing bones and usually occur with a sudden increase in activity.

Little Leaguer's Elbow or Medial Apophysitis: inflammation of the growth plate on the inside of the elbow. The main symptom to be aware of is pain on the inside of the elbow with overhand throwing.

Osteochondritis Dessicans: compression of the bones of the elbow. The main symptom to be aware of is pain on the outside of the elbow.

Stress Reaction of Growth Plates: common in gymnastics and overhand throwing

Strains and Sprains: soft tissue injury in muscles, tendons, bursa, and ligaments caused by overuse.

Treatment and Prevention

If you think that your child may be developing an overuse injury it is important to seek medical advice immediately.

Your doctor will recommend that your child take a break from the activity that is causing the pain or reduce participation in it and will recommend physical therapy to heal the injured structures.

He or she may even prescribe an anti-inflammatory,

A program of physical therapy for an overuse injury will depend on the specific injury. However, most overuse injuries are treated with:

1. RICE: Rest, Ice, Compression, Elevation

2. Manual Techniques: The physical therapist will perform manual work such as soft tissue massage and gentle joint work to calm the irritated structures and help facilitate healing.

3. Stretching: The physical therapist will identify tightness in the muscles that have resulted from the repetitive stress and will devise a stretching program for your child.

4. Strengthening: Repetitive stress injuries are caused by and cause weakness. The physical therapist will devise a strengthening program for your child that is sport-specific.

5. Activity Modification: Your physical therapist will make recommendations for proper form or technique that is sport-specific and will better protect your child from repetitive stress injuries.

6. Bracing and Orthotic Fabrication: If external support to the injured joint or muscle is necessary, your physical therapist will either recommend the appropriate support or will fabricate it.

What Can You Do To Help Your Child Avoid Developing An Overuse Injury?

1. Watch your child move on and off of the field so that you can detect a developing injury early.

2. Make sure your child stretches appropriately before and after practice and competitions.

3. When your child is done playing, don’t let him or her keep their sports gear on, especially cleats and shin guards.

4. Let your child rest when he or she is tired of playing or complains of pain.

If your child has been diagnosed with an overuse injury and is under the care of a physician or physical therapist, be compliant with the recommendations of the health care professional to avoid worsening of the injury and long term health issues.

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