Preventing youth overuse injuries

with advice from Alison Barnett, PT, DPT;
Andrew J.M. Gregory, M.D., FAAP, FACSM;
and Mark Salandra, CSCS

Preventing youth overuse injuries

In recent years, a disturbing trend has been seen among younger athletes: Overuse injuries are becoming far more common.

Baseball in particular has been under intense scrutiny. A study of 481 youth pitchers between the ages of 9 and 14, published in the American Journal of Sports Medicine (subscription required) in February 2011, noted that 5% of the athletes suffered such a serious injury in the course of the study that they needed surgery, or, even worse, had to retire.

And in an article for the Los Angeles Times in 2008, Dr. E. Lyle Cain noted that at the turn of the millennium, younger athletes (mostly baseball players) were getting the Tommy John procedure, or reconstruction of the ulnar collateral ligament, at a much higher rate. Only about 12% of Tommy John cases were for patients under the age of 18 between 1991 and 1996; the number of cases had jumped to 30% by 2005.

But it’s not just baseball that’s at the root of the problem. Whether due to increased competition, the hope for college scholarships, or overambitious parents, many children and teens are specializing in sports at younger ages and playing much more than previous generations.

So what can parents do to help their kids stay healthy and avoid overuse injuries? First, be aware of your child and how he or she acts during and after physical activity. Dr. Andrew Gregory, a founding member of STOP Sports Injuries, says that the “main sign of overuse injury is pain. Any pain that is aggravated by activity should be taken seriously.” This means seeing a healthcare professional immediately to determine the source of the pain — the sooner, the better. Dr. Alison Barnett, a physical therapist in the Physiquality network of experts, notes that “early intervention is key to keeping your child active in the sport.” Waiting can often make the injury worse, leading to surgery rather than physical therapy and rehabilitation.

Personal training expert and champion powerlifter Mark Salandra also advises parents to learn about the specific sport movements and possible risk factors of your child’s sport. Knowing the proper posture required for swinging a bat or doing a back flip will help you be more aware of bad habits that can be corrected before an injury occurs. Dr. Barnett also says that poor posture can be a sign of muscle imbalance — “Is he looking rotated to one side? Are the muscles on one side of her back more developed than the other?” These imbalances can be easily corrected with cross-training, stretching and conditioning, which will help prevent injury.

Dr. Gregory also warns against doing too much too fast; he recommends limiting the increase of duration, intensity or frequency to no more than 10% per week. In baseball, that means limiting pitch counts, which has also been supported by the ASMI, the American Sports Medicine Institute. Salandra points out that this also goes for athletes who may train regularly in their field but try to increase their training for a specific event. He uses the example of a runner who normally runs several miles three times a week but decides to train for a marathon. “The runner begins advanced training, running a longer distance every day at a faster pace. Injury or break down is inevitable.”

All of our experts counsel a variety of activity, having children participate in more than one sport per year to develop multiple muscle groups. Salandra notes that adding resistance training to your child’s fitness regime will help strengthen muscles that may be overlooked in their athletic training, and it has been shown to “reduce the incidence of injuries in young and adult athletes.” They also advise plenty of rest to give the body a break; Dr. Gregory recommends one sport or team per season, at least one day off per week, and one month off every six months or so. If a child or teen is competing at a high level, Dr. Barnett also suggests consulting with a physical therapist: “A PT can assess their posture, body mechanics, and strengths and weaknesses in order to provide a comprehensive stretching and strengthening program to prevent musculoskeletal injury.”

In the end, parents need to make sure that their children are paying attention to their bodies and know when to stop. Salandra says that “youth athletes must be empowered by coaches and parents to communicate feelings of fatigue and pain.” Being pushed to compete through the pain will only lead to injury and heartbreak. It’s far better to show children how to listen to their bodies, and to respect pain as a sign that their body needs rest in order to be healthy and fit.

Alison Barnett, PT, DPT, is a physical therapist and the owner of Leaps and Bounds Therapy Services, a Physiquality network physical therapy clinic, with locations in Brighton and Whitmore Lake, Michigan.

Andrew J.M. Gregory, M.D., FAAP, FACSM, is an orthopedic surgeon at Vanderbilt Orthopaedics in Nashville, Tennessee. A member of the ACSM Youth Sports and Health Committee, he is also a founding member of STOP Sports Injuries, a medical coalition determined to increase awareness of and reduce the occurrence of youth sports injuries.

Mark Salandra, CSCS, is the founder of, one of Physiquality’s partner programs. Salandra educates and trains athletes young and old in strength and conditioning, with the goals of better fitness and lower rates of injury.

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For further reading:

Brody, Jane E. A warning on overuse injuries for youths. New York Times, April 4, 2011.

McLeod, Tamara C Valovich, Laura C. Decoster, Keith J. Loud, et al. National Athletic Trainers’ Association position statement: Prevention of pediatric overuse injuries. (PDF) Journal of Athletic Training, March-April 2011.

Deardorff, Julie. New pitching limit for youth baseball players: Study. Chicago Tribune, February 10, 2011.

Hyman, Mark. A children’s crusade: Pioneering sports surgeon James Andrews is again on the cutting edge — against overuse injuries in young athletes. Sports Illustrated, June 7, 2010.

Vedder, Steve. Young baseball players, coaches don’t always know or do what it takes to keep them healthy. Grand Rapids Press, May 2, 2010.

Overuse injury: How to prevent training injuries. Mayo Clinic, March 5, 2010.

Hyman, Mark. America’s obsession with youth sports and how it harms our kids. Sports Illustrated, April 7, 2009.

Stein, Jeannine. Youthful fling with surgery: More high school athletes are replacing elbow ligaments, raising concerns about overtraining. Los Angeles Times, July 21, 2008.

ACL Project Prevent: Working to reduce ACL injuries. USC Musculoskeletal Biomechanics Research Laboratory.

Neergaard, Lauren. Torn ACLs, other big injuries hit little athletes. USA Today, July 7, 2008.

The material and information contained on this Web site is for information only and is not intended to serve as medical advice or consultation.

Consult your personal physician before beginning any exercise program or self-treatment.