OrthoConnecticut

Michael M. Lynch, MD

Over the past ten years, it is estimated by some that the incidence of overuse sports injuries in youth has increased four or five fold. This is also reflected by a significant increase in surgeries directed at addressing these problems. The cause of this rise is primarily related to a dramatic rise in the number and duration of participants. Another major factor is a growing trend towards early commitment to single sport selection. Children that play a single sport year round, lose the necessary off season that is vital to bone, joint, muscle, and tendon recovery.

Many are familiar with the woes of the weekend warrior, often referred to as “Baby Boomeritis”. Children and teens are also very susceptible to overuse injuries, but for different reasons. Their immature bones are partly made of cartilage and that growing cartilage is very prone to repetitive stress. The growth factor alone is also a contributing element. As children hit growth spurts, their bones outpace the muscle and ligament units surrounding them rendering them relatively “tight” and inflexible. Inadequate conditioning, prior injury, and anatomic alignment are other intrinsic factors that lead to overuse injury.

Extrinsic influences on this phenomenon are equally important. These include training error (too rapid or too intense training progression, and inadequate rest), inappropriate equipment/footwear, athletic surfaces, and poor technique. Most of these factors can be influenced by appropriate intervention. It is most useful to intervene in a proactive and preventive manner.

Overuse injuries occur when structural breakdown follows repetitive loading of a bone or tendon. Macro trauma refers to demonstrable failure such as tendon rupture, or bone fracture. Micro trauma occurs at sub-clinical levels and is a cumulative phenomenon. A familiar demonstration would be the paper clip example. If you bend it back and forth one hundred times it breaks. At fifty times there is no visible breakage, but microscopically structural damage can be seen. When this occurs in a tendon for example, it stimulates a healing response involving the generation of enzymes and inflammatory cells. Without adequate rest, there is over stimulation of the healing process and it runs awry, inciting pain and dysfunction. Left unchecked this can turn into a degenerative process.

The vast majority of these conditions can be treated successfully with a regimen of rest, ice, and rehabilitation. The rest is vital, and with children often the most difficult to impart. Once the acute pain is controlled, rehabilitation through stretching and strengthening exercises can help to further resolve these issues, and more importantly, prevent their return. Only in certain cases is surgery necessary to bring about relief.

As with most medical conditions, when there is opportunity for prevention, this becomes the most effective strategy by far. Sensible participation levels, multi-sport involvement (NOT all in one season!), adequate rest, proper equipment all can be instituted prior to injury appearance. Peer pressure, coaching pressure and, most influentially, parental pressure should be minimized to allow healthy, unencumbered sports play. “No pain, no gain” is not an appropriate tenet for youth sports. Should an injury arise, prompt attention will make recovery more feasible.