Overuse Injuries —The Rising Epidemic of Child Sacrifice in Youth Sports

Paul Stricker, MD

Youth Sports Medicine Specialist & Olympic Physician

Scripps Clinic

San Diego, CA

In our “Super-Sized” society, more is always better—so it seems.  In youth sports, however, more is not always better, and in fact, can be harmful.  Almost 40 million youth are involved in sporting activities, and of those, it is estimated that approximately one-half of the millions of injuries that occur are due to overuse.  Overuse injuries should be preventable, because they involve overloading the body with too much activity too quickly.  Many of us are familiar with the “Terrible Twos” behavior that many toddlers (and parents) live through, but in the youth sports world, there exists the overuse injury phenomenon called the “Terrible Toos”—too much, too soon, too often.  These injuries can be worsened by incorrect technique, inappropriate gear, or situations that do not compensate for smaller and more vulnerable bodies.

Child obesity is a national health concern, with studies showing approximately a third of youth under 18 being overweight.  In an attempt to create healthy situations and controlled weight loss, these individuals can also be pushed to accomplish too much too quickly, and be subject to the same overuse problems that are becoming rampant in the athletic population.  We cannot ignore that both of these major issues need attention, and that repetitively throwing a baseball can be a problem just like repetitively reaching into a bag of chips.

Young athletes are training more intensely at younger and younger ages, and are often becoming “specialized” in one sport at an early age.  Often, adult training regimens are used to help accelerate a child’s performance.  Unfortunately, this often results in the reverse effect, and can cause overuse injuries such as tendonitis, stress fractures, and even growth plate injuries.

Adults assume injuries will occur in sports, and some injuries are unavoidable.  However, injuries due to the abuse of excessive repetition or pushing a young growing past the appropriate developmental skill level should not be acceptable at the rising frequency and rate of the current state of affairs.  My clinical practice has seen a substantial rise in overuse injuries over the past 10 years.  Part of this is certainly due to increased participation and increased youth sports opportunity, but we must also be aware that the increase in overuse injuries is substantial.  Year-round participation, earlier specialization, parental unrealistic expectations, and college (and middle school) recruitment pressures also contribute to this epidemic.

The “No Fame, No Gain” mindsets of many adults involved in youth sports places additional pressure on these youth to progress more quickly than they may be able.  Sports abuse becomes a sort of child sacrifice that is performed in the name of hopeful success.  Learning multiple foundational skills can help prepare the child for more adequate performance later on, and these early opportunities to learn such skills should not be missed.  Exposure to many different sports activities can help a child round out their abilities, and also see which activities they enjoy and feel a sense of accomplishment.

Parents and coaches should be encouraged for supporting exercise and sports participation in their children and teenagers.  Excessive involvement or pressure, on the other hand, contributes to physical and emotional overuse injuries.  Since society has ruthlessly narrowed the definition of sports “success” to nothing less than first place, we as adults must support a more realistic definition of success that includes outperforming oneself, or mastering a new skill.  Adults need to know that sports skills are developed in a sequential manner just as learning how to roll over, stand up, and walk.  Lack of this important knowledge can contribute to unrealistic expectations and begin an unhealthy spiral.

Solutions depend upon understanding the development and chemical nature of the young growing body, and that these children are not adults in small bodies.  Participation in sports should revolve around having fun, learning many skills, and choosing the activities the child enjoys.  Training regimens for young athletes and exercise programs for overweight children should be gradual in nature.  Education regarding development of skills and self-esteem is critical to avoid excessive pressures and unrealistic expectations of overly eager adults and a win-oriented society.  The goal is to redefine success, to maximize the youth sports experience, and to improve long-term performance for a lifetime of physical and emotional good health.