Sports Injuries: Is Your Child at Risk of Overuse?

adolescents running

The number of children who play competitive sports year-round continues to grow. As a result, the number of sports-related injuries is also rising. Physicians used to see mostly fractures, broken bones, sprained ankles and other trauma-related injuries. But in recent years, the ratio has shifted with 60 to 70 percent of sports-related injuries caused by repetitive stress.

Some common examples are tendinitis and other irritation of the knee; shin splints; and between the ages of 11 and 14, Osgood-Schlatter’s and Sever’s diseases, which occur when there is inflammation around the growth plate areas of the knee and ankle. In sports medicine clinics, we also see a lot of back and shoulder pain.

Our speculation is that more children are focusing at earlier ages on only one sport year-round, or they are trying to do multiple sports concurrently. This is overstressing their bodies and leading to more injuries. In the last 10 to 15 years, there has also been an increased emphasis on games and tournaments, which have a higher injury rate than practices.

When children show warning signs of overuse pain, I typically recommend a 36-hour rule. If the pain hasn’t improved after 36 hours of rest, using ice (20 minutes at a time, at least two to three times a day) and perhaps an over-the-counter anti-inflammatory like ibuprofen with parental supervision, then it’s time to call the doctor.

As a parent you can trust your own judgment. You know your child’s personality and how they should perform. If your gut is telling you that something isn’t right, it probably isn’t. As children get older and gain more competitive experience, I often talk to them about the importance of listening to their bodies, knowing what their pain thresholds are and recognizing when it’s time to slow down or stop.

Preventing sports injuries

Making sure that your child is getting plenty of sleep, proper nutrition and good hydration are all important. Some studies suggest that injury rates in weekend tournaments increase when children get fewer hours of sleep. One myth is that young athletes need high-protein diets. That’s not true; most American diets have more than enough protein for even the most strenuous activities.

I believe that year-round competition, practices and physical training is what drives overuse injury rates. Ideally, I recommend that children take off one season from highly competitive training every year. That doesn’t mean that they should be inactive—all children at all ages should be doing at least one hour of moderate to vigorous activity a day just for general health. This physical activity should increase the heart rate and breathing, but not be done to exhaustion—just enough where your child can only speak in short sentences. This daily hour of exercise doesn’t need to be done all at once; it can be done in several shorter periods such as on the playground, in gym class or during recess. Strength training three times a week—which can be as simple as sit-ups and push-ups—is also a good idea, as is maintaining general overall flexibility with gentle stretching.

During a sport season, it’s important that they have at least one rest day per week. A good rule of thumb for adolescents is to limit their sports time to one hour per week per age. So, for example, 11- or 12-year-olds should not train or play sports more than 11 or 12 hours per week in all activities combined. In high school, they can increase that time, but it shouldn’t be more than 15 to 16 hours per week—that’s where the risk of overuse injuries goes up.

Additionally, children should start a new activity gradually, increasing their training volume by no more than 10 percent each week. For example, runners might start running two miles, three times a week, and then they should increase by no more than a quarter mile per day each week. Or if your child is playing a sport where you can count the total time of physical activity and they are participating five hours per week, they should increase their time by half an hour each week.

An excellent resource for parents and children is, which includes sport-specific and issue-specific injury prevention tips and other resources for parents, athletes, coaches and health care providers.

Keith Loud, MD, MSc, is the Physician-in-Chief, and an adolescent sports medicine specialist at the Children’s Hospital at Dartmouth-Hitchcock (CHaD).