As parents, physicians and coaches, we all want our young athletes to succeed and do their best. However, sometimes this desire to help young athletes reach their full potential and athletic goals can result in over-training and overuse injuries of their growing muscles and bones. Over-training a child or adolescent athlete’s body may not only hurt their athletic career, but could also result in lasting health problems.
What is Over-Training and Overuse?
Over-training and overuse are two terms that go hand in hand. Over-training is, as it sounds, when an athlete trains for a certain sport in excess or performs a certain movement or activity too many times without enough recovery time in between. As a result, the athlete may develop an overuse injury from repetitive stress on a particular muscle, ligament or bone. The tissues may get inflamed, stretched or may even break. For example, a young gymnast who repeatedly performs hyper-extension activities may develop a stress fracture in their spine or a young, an over-trained swimmer may see signs of rotator cuff tendonitis. A relatively well-known overuse injury is Little League elbow – which occurs in young baseball players who are throwing or pitching too much.
An Unfortunate Trend
Over-training and overuse injuries in young athletes are not only becoming more common, but they are also being seen at younger ages. In fact, over 50 percent of all injuries seen in pediatric sports medicine are related to overuse. Many primary physicians are now seeing chronic tendonitis and stress fractures in athletes below the age of 10 – which was unheard of in the past.
The statistics are alarming. According to The Journal of Sports Science and Medicine, almost one-third of young athletes are over-training and putting unnecessary harm on their developing bodies.
Over-training in developing athletes can occur in males and females and in any sport. There is a higher incidence rate in individual sports (48 percent) compared with team sports (30 percent) and less physically demanding sports (18 percent). One of the major reasons for the increase in over-training and overuse injuries is that more children are participating in year-round training and competition in a single sport. However, even young athletes that play different sports in different seasons may still be at risk for overuse injuries, especially if their chosen sports emphasize the use of the same body part. For example, a young athlete who plays tennis, volleyball and swims may still be at risk for overuse injuries in their shoulder since all of these sports put a high demand on that body part.
The Importance of Growth Plates
The growth plate, or physis, is an area where bone growth occurs. They are usually located near the ends of the long bones in children and adolescents. The growth plates help determine the future length and shape of the mature bone. When growth is complete—usually during adolescence—the growth plates close and are replaced by solid bone.
Athletes are at risk of growth plate injuries when their growth plates are still open. For most girls, growth plates usually close from age 14 to 16; while for most boys they close from age 16 to 18. It is very important for parents and young athletes to understand that even though they might have the energy and stamina to push themselves, their bones may not be able to endure the stress like adult bones can. Growth plates are the “weak link in the chain” – weaker than the surrounding ligaments, tendons and bone – and therefore will often be where the injury occurs. If pushed too far, the athlete is at-risk for a growth plate injury.
Various factors can put young athletes at increased risk for injury. These include: poor coordination; open growth plates; muscle and tendon tightness secondary to growth spurts; and the fact that growing cartilage may be more vulnerable to stress.
The injury of growth plates might not just keep an athlete out for a season, but can cause long-term effects. If stressed or injured, growth plates can close prematurely, resulting in permanent developmental issues, such as crooked or uneven limbs. It is imperative for parents, coaches and primary physicians to protect their growing athlete’s growth plates by not over-training and pushing them too hard.
Wrist x-rays of a young fencer who developed left wrist pain while training for the national championships. Over-training had caused irritation of the growth plate in his left distal radius, which is seen as widening of the growth plate on this x-ray (arrow).
Signs and Symptoms
At first, an overuse injury will present as pain in the affected area after physical activity. If the young athlete continues to push through the pain, they may progress to also having pain in the affected area during activity, but initially this is not severe enough to restrict their performance. However, if they continue to perform the activity the pain may worsen to the point that it does limit their performance. The last, and most severe, stage in overuse injuries is when the athlete has pain that limits their performance and continues to bother them even at rest.
Although there are no scientifically determined guidelines, parents, coaches and physicians can take steps to help prevent over-training in young athletes. Rest is very important, and some sports, like baseball, have outlined specific guidelines like pitch counts that should be adhered to in order to minimize the risk of overuse injuries.
The American Academy of Pediatrics Council on Sports Medicine recommends the following:
- Limit any single sporting activity to a maximum of 5 days per week
- Take at least one day off per week from all sports and organized athletic activities
- Take at least three months off per year from any particular sport
Also, apply the 10% rule to training: Do not increase the amount or intensity of training by more than 10 percent per week. Additionally, coaches can incorporate drills that put less stress on the body, such as water running for a track athlete. Making sure that the athlete has proper form can also be critical. Lastly, it is important to keep workouts interesting and fun with age-appropriate games and training and to focus on wellness and teaching young athletes to be in tune with their bodies so they know when to slow down or alter their training methods.
By Sarah R. Gibson, MD
Sarah Gibson, MD is an expert in pediatric sports medicine. Before joining the Department of Orthopedics at Nemours Children’s Hospital in September 2013, she was in private practice in Fort Lauderdale, Fla. Dr. Gibson earned her medical degree at the University of South Alabama College of Medicine in Mobile. She completed a combined residency and internship in internal medicine at the Medical University of South Carolina in Charleston. Dr. Gibson then relocated to Boston for a residency in physical medicine and rehabilitation at Spaulding Rehabilitation Hospital, a teaching hospital of Harvard University, and a fellowship in primary care pediatric sports medicine at Harvard’s pediatric teaching institution: Boston Children’s Hospital. In addition to her clinical work with children, Dr. Gibson is a guest lecturer, researcher and published author. An athlete since childhood, she has provided medical care for a long list of teams and sporting events. Dr. Gibson is board-certified by the American Academy of Physical Medicine and Rehabilitation.