In the United States, more than 38 million youth and adolescents are involved in organized sports, according to Safe Kids USA. And while this participation provides kids many physical, psychological and social benefits, it also increases their chances of developing overuse injuries that traditionally have only been seen in high school and college athletes.

According to the Boston Children’s Hospital, 30 to 60 percent of student-athletes will experience an overuse injury, so it’s important to understand the causes and risk factors that lead to this condition, and also understand and implement preventative measures. 

Overuse Injuries Defined

Most people consider injuries to be traumatic in nature, which means that they are the result of sudden impact. However, overuse injuries—also known as stress injuries—occur over a period of time. They are actually “micro traumas” to the body’s muscles, tendons, bones or ligaments, which result from using the same body part over and over again.

“The human body was designed to take a certain level of punishment and once an individual’s threshold is reached, the body should be allowed to recover,” says Dr. Aaron Mares, associate professor at the University of Pittsburgh School of Medicine and a team physician for his school’s football team. “Unfortunately, in some circumstances it is not allowed to recover and an injury is the end result.”

Increase Among Young Athletes

The prevalence of this type of injury is due in part to the rise of organized sports. In previous generations, most children engaged in unstructured physical activities, which were performed on an irregular basis. However, organized sports involve repetitive and sometimes intensive drills, which place more stress on young, developing bodies, and don't provide sufficient time for rest and recuperation.

Risk Factors

Athletes who participate in sports that involve intense training using the same body parts on a recurring basis are at greatest risk of developing overuse injuries. These sports include:

  • Soccer
  • Football
  • Basketball
  • Baseball (pitchers)

Female athletes who participate in the following activities are also at higher risk:

  • Gymnastics
  • Running
  • Cheerleading

Susceptibility to overuse injuries is higher in athletes who:

  • Have experienced a prior injury to the same area
  • Are playing an intensive sport without proper conditioning

There are other factors that also increase susceptibility. According to Dr. Mares, who is also the lead physician for the Pittsburgh Marathon, “Children that have strength deficits, inflexibility and muscle imbalance seem particularly at risk."

He also notes that there are other physical conditions that can increase the chances of developing an overuse injury, such as “athletes with an abnormal gait, leg length discrepancy, knock knees, flat feet and are obese are also at risk.”

Common Types of Overuse Injuries

Some of the most common types of overuse injuries include the following self-explanatory conditions:

  • Golf elbow
  • Runner’s knee
  • Swimmer’s shoulder

Other common overuse injuries include:

  • Little Leaguer’s shoulder or elbow, which typically affects pitchers and is caused by overhead throwing motions
  • Sever’s disease, which causes pain in the heel and limping, and is a result of  jumping and running
  • Spondylolysis, which is back pain caused by intense flexing, and extending the lower back. It is common in gymnasts, football linemen and ice skaters
  • Sinding-Larsen-Johansson disease, which is a knee pain caused by jumping

Symptoms, Diagnosis and Treatment

Symptoms may include aches, pain, swelling, bruising and decreased performance, Dr. Mares says. Diagnosis includes a careful history and a complete physical. X-rays or an MRI may also be necessary.

While treatment varies depending on the type and severity of the injury, Dr. Mares says it should include some level of rest and backing off a particular activity. He notes that other treatment options may include the following:

  • Ice  
  • Anti-inflammatory medication
  • Compression  
  • Elevation
  • Possible bracing/immobilization
  • Eventual rehabilitation
  • Progressive return to activity when appropriate


Fortunately, overuse injuries can be prevented by adhering to the following guidelines furnished by the American Academy of Orthopaedic Surgeons:

  • Replace worn athletic shoes.
  • Make sure that clothes are light enough to release body heat. Wear removable layers when exercising in cold weather.
  • Always warm up, even before stretching, since this will loosen up muscles and joints.
  • Prevent dehydration and heat stroke by drinking a pint of water 15 minutes before exercising. Drink water every 20 minutes while exercising, and drink another pint after cooling down.
  • Cool down by lessening exercise intensity at least 10 minutes before stopping completely.
  • Don’t exercise every day. Give the body time to rest. Also, don’t exercise when fatigued, sore or in pain.

“Parents help their kids avoid overuse injuries by understanding what an overuse injury is and how it can be prevented,” says Dr. Mares. “They need to be an advocate for their child.” He also recommends STOP Sports Injuries and Safe Kids USA as two of the many campaigns that can serve as a valuable resource to parents, coaches and physicians.