Overuse In Sports

Youth sports are booming here in Nashville. More and more children are becoming involved in travel and year round athletics. There also seems to be an evolving trend of young athletes specializing in a particular sport at a much earlier age. With the growing childhood obesity epidemic in America, I believe encouraging physical activity in young people is great. In addition to the physical benefits of athletics, there are many valuable lessons that can be learned by our children. However, there are some things that parents, coaches, and athletes need to understand about overuse and repetitive stress type injuries, particularly growth plate injuries, in order to keep our young athletes healthy and on the field or court as much as possible.

Most people have at least heard of the term growth plate. Simply put, growth plates are areas of cartilage at the end of a bone where the bone lengthens. Due to the fact that these areas of growth are not ossified (have not turned to solid bone) in young and early adolescent children, they can be particularly vulnerable to injury. As children are becoming more specialized at an earlier age this often results in more repetitive forces applied to a particular joint/piece of anatomy without adequate rest. These types of injuries can also occur in young people who are simply very active. An example would be a child who doesn’t play an “organized sport” but is always outside running or playing pick up games with friends. First, parents and coaches must understand that these athletes are not simply “little adults.” Their skeletons are different because they are growing and in some ways this makes them more vulnerable especially right before and during “growth spurts.” Injury occurs when the force that is applied through a particular joint/bone exceeds what the vulnerable physis (growth plate) can tolerate. Symptoms can involve various places throughout thebody, but are often seen in the shoulder, elbow, hip, knee, or foot.

One of the more common growth plate injuries occurs at the knee joint. This is commonly referred to as Osgood-Schlatter Disease. The injury occurs where the patellar tendon (tendon that runs from the bottom of the “knee cap” or patella to the top of the shin bone or tibia) pulls on its attachment to the growth plate at the top of the tibia. Pain associated with Osgood-Schlatter is typically located over the front of the knee. Often, athletes will notice localized swelling or a “bump” at this attachment known as the tibial tubercle. This type of injury can be seen in many sports, but is common where lots of jumping, landing, and/or explosive movements occur.

Growth plate injuries to the shoulder (often called Little Leaguer’s Shoulder) are most often seen in overhead type athletics. These sports include baseball and softball, but sports like volleyball and even tennis can apply the same forces to a young athlete’s shoulder. (Click here to read a post by Dr. Glattes on volleyball injuries and the shoulder.) Typically, the athlete will complain of pain on the outside of the arm over the deltoid or shoulder.

Sever’s Disease is a growth plate injury that occurs on the back of the calcaneus or “heel bone.” This area is where the Achilles tendon attaches to the back of the heel. Young athletes typically complain of pain over the heel, and the heel is often tender to touch. Excessive running, hard fields, cleats that have poor padding, and/or tight calf muscles may contribute to Sever’s. This can become painful enough that the child will complain of pain while walking and not just during sports.

Regardless of the location, the young athlete will often complain of pain that increases with activity. Diagnosis can typically be made with a good physical examination and x-rays to evaluate the growth plate and bone. Often the symptoms will resolve with rest, activity modification, anti-inflammatory medication (i.e. ibuprofen or naproxen), and sometimes physical therapy. If the symptoms are not treated, this can result in prolonged time away from activity or, in extreme cases, surgery. It is important to have your child evaluated by a healthcare provider who is familiar with treating these types of injuries in order to return your athlete to pain-fee participation as quickly and as safely as possible. The evaluation will also rule out any other cause of your athlete’s symptoms.

Children are not “little adults” and as our own Dr. Burton Elrod often says, “If it gets where the more you do, the more it hurts, you should back off.” When it comes to overuse and growth plate injuries “no pain, no gain” is not always the best strategy. Call us today at 615-342-0200 for evaluation if you have any concerns about your young athlete.

Stephen Hasselbring, PA-C, ATC

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