A growing issue of overuse injuries in young athletes

Authors

  • Teodor Trojner Clinical Department of Orthopedics, University Medical Centre Maribor, Slovenia
  • Robi Kelc Clinical Department of Orthopedics, University Medical Center Maribor, Slovenia

DOI:

https://doi.org/10.35469/ak.2023.419

Keywords:

Adolescent athletes, Early Sports specialization, Overuse syndromes, Preventive measures, Psychological well-being

Abstract

Over the past two decades, participation in professional sports among children and adolescents has surged despite the rising inactivity and obesity rates. Approximately 60 million young individuals in the USA are involved in organized sports. This increase has led to a concerning rise in overuse syndromes, which is becoming a primary concern in sports medicine.

Our review aims to examine common overuse syndromes in youth athletes and assess risk factors, pathophysiology, and preventive measures. Early sports specialization, societal pressures, and competitive demands lead to repetitive strain injuries. The young musculoskeletal system, though adaptable, is prone to injuries from intense training and insufficient recovery.

Prevention advocates against early sports specialization and promotes adequate rest. Diversifying sports, limiting training hours, and a robust support system are recommended to counteract the mental effects of intense specialization.

In summary, a holistic approach is needed to address overuse syndromes, emphasizing diversification, education, and a balanced approach to sports.

References

Abate, M., Silbernagel, K. G., Siljeholm, C., Di Iorio, A., De Amicis, D., Salini, V., … Paganelli, R. (2009). Pathogenesis of tendinopathies: inflammation or degeneration? Arthritis Research & Therapy 11, 235. https://doi.org/10.1186/ar2723

Aicale, R., Tarantino, D., & Maffulli, N. (2018). Overuse injuries in sport: a comprehensive overview. Journal of Orthopaedic Surgery and Research 13(309). 1-11. https://doi.org/10.1186/s13018-018-1017-5

Benjamin, M., Toumi, H., Ralphs, J. R., Bydder, G., Best, T. M., & Milz, S. (2006). Where tendons and ligaments meet bone: attachment sites (‘entheses’) in relation to exercise and/or mechanical load. Journal of Anatomy 208(4), 471–490. https://doi.org/10.1111/j.1469-7580.2006.00540.x

Bergeron, M. F., Mountjoy, M., Armstrong, N., Chia, M., Côté, J., Emery, C. A. … Engebretsen, L. (2015). International Olympic Committee consensus statement on youth athletic development. British Journal of Sports Medicine 49(13), 843-851. https://doi.org/10.1136/bjsports-2015-094962

Brenner, J. S., & American Academy of Pediatrics Council on Sports Medicine and Fitness (2007). Overuse injuries, overtraining, and burnout in child and adolescent athletes. Pediatrics 119(6), 1242–1245. https://doi.org/10.1542/peds.2007-0887

Brenner, J. S., & Watson, A., Council on Sports Medicine and Fitness, (2024). Overuse injuries, overtraining, and burnout in young athletes. Pediatrics 153(2), e2023065129. https://doi.org/10.1542/peds.2023-065129

Callaghan, M. J., & Selfe, J. (2007). Has the incidence or prevalence of patellofemoral pain in the general population in the United Kingdom been properly evaluated? Physical Therapy in Sport 8, 37–43. https://doi.org/10.1016/j.ptsp.2006.07.001

Calmbach, W. L., & Hutchens, M. (2003). Evaluation of patients presenting with knee pain: Part I. History, physical examination, radiographs, and laboratory tests. American Family Physician 68(5), 907–912.

Chéron, C., Le Scanff, C., & Leboeuf-Yde, C. (2017). Association between sports type and overuse injuries of extremities in adults: a systematic review. Chiropractic & Manual Therapies 25(4). https://doi.org/10.1186/s12998-017-0135-1

Circi, E., Atalay, Y., & Beyzadeoglu, T. (2017). Treatment of Osgood-Schlatter disease: review of the literature. Musculoskeletal Surgery 101, 195–200. https://doi.org/10.1007/s12306-017-0479-7

Congeni, J., McCulloch, J., & Swanson, K. (1997). Lumbar spondylolysis. A study of natural progression in athletes. American Journal of Sports Medicine 25(2), 248–253. https://doi.org/10.1177/036354659702500220

de Lucena, G. L., dos Santos Gomes, C., & Guerra, R. O. (2011). Prevalence and associated factors of Osgood-Schlatter syndrome in a population-based sample of Brazilian adolescents. American Journal of Sports Medicine 39(2), 415–420. https://doi.org/10.1177/0363546510383835

De Luigi, A. J. (2014). Low back pain in the adolescent athlete. Physical Medicine and Rehabilitation Clinics of North America, Sports Medicine 25(4), 763–788. https://doi.org/10.1016/j.pmr.2014.06.004

DiFiori, J. P., Benjamin, H. J., Brenner, J. S., Gregory, A., Jayanthi, N., Landry, G. L., & Luke, A. (2014). Overuse injuries and burnout in youth sports: a position statement from the American Medical Society for Sports Medicine. British Journal of Sports Medicine 48, 287–288. https://doi.org/10.1136/bjsports-2013-093299

Dixit, S., DiFiori, J. P., Burton, M., & Mines, B. (2007). Management of patellofemoral pain syndrome. American Family Physician 75(2), 194–202. Retrieved from https://www.aafp.org/pubs/afp/issues/2007/0115/p194.html

Elengard, T., Karlsson, J., & Silbernagel, K. G. (2010). Aspects of treatment for posterior heel pain in young athletes. Open Access Journal of Sports Medicine 1, 223–232. https://doi.org/10.2147/OAJSM.S15413

Ellis, S. J., Yu, J. C., Johnson, A. H., Elliott, A., O’Malley, M., & Deland, J. (2010). Plantar pressures in patients with and without lateral foot pain after lateral column lengthening. The Journal of Bone & Joint Surgery 92(1), 81–91. https://doi.org/10.2106/JBJS.H.01057

Emmonds, S., Till, K., Weaving, D., Burton, A., & Lara-Bercial, S., (2023). Youth sport participation trends across Europe: Implications for policy and practice. research Quarterly for Exercise and Sport. Advance online publication. https://doi.org/10.1080/02701367.2022.2148623

Fredericson, M., Jennings, F., Beaulieu, C., & Matheson, G. O. (2006). Stress fractures in athletes. Topics in Magnetic Resonance Imaging 17(5), 309-325. https://doi.org/10.1097/RMR.0b013e3180421c8c

Fullem, B. W. (2015). Overuse lower extremity injuries in sports. Clinics in Podiatric Medicine and Surgery 32(2), 239–251. https://doi.org/10.1016/j.cpm.2014.11.006

Gudelis, M., Perez, L. T., Cabello, J. T., Leal, D. M., Monaco, M., & Sugimoto, D., (2022). Apophysitis among male youth soccer players at an elite soccer academy over 7 seasons. Orthopaedic Journal of Sports Medicine10(1), 23259671211065063. https://doi.org/10.1177/23259671211065063

Halabchi, F., Abolhasani, M., Mirshahi, M., & Alizadeh, Z. (2017). Patellofemoral pain in athletes: clinical perspectives. Open Access Journal of Sports Medicine 8, 189–203. https://doi.org/10.2147/OAJSM.S127359

Hall, R., Barber Foss, K., Hewett, T. E., & Myer, G. D. (2015). Sport specialization’s association with an increased risk of developing anterior knee pain in adolescent female athletes. Journal of Sport Rehabilitation 24(1), 31–35. https://doi.org/10.1123/jsr.2013-0101

Harrast, M. A., & Colonno, D. (2010). Stress fractures in runners. Clinics in Sports Medicine 29(3), 399–416. https://doi.org/10.1016/j.csm.2010.03.001

Haws, B. E., Stone, A. V., Usoro, A. O., Marquez-Lara, A., Mannava, S., &Freehill, M. T. (2018). Optimal management of physeal elbow injuries in the skeletally immature athlete remains undefined: a systematic review. Journal of ISAKOS 3(1), 38–45. https://doi.org/10.1136/jisakos-2017-000155

Herman, M. J., Pizzutillo, P. D., & Cavalier, R. (2003). Spondylolysis and spondylolisthesis in the child and adolescent athlete. Orthopedic Clinics of North America 34(3), 461–467. https://doi.org/10.1016/s0030-5898(03)00034-8

Ishikawa, S. N. (2005). Conditions of the calcaneus in skeletally immature patients. Foot and Ankle Clinics 10(3), 503–513. https://doi.org/10.1016/j.fcl.2005.03.001

Itoh, G., Ishii, H., Kato, H., Nagano, Y., Hayashi, H., & Funasaki, H. (2018). Risk assessment of the onset of Osgood–Schlatter disease using kinetic analysis of various motions in sports. PLoS One 13(1), e0190503. https://doi.org/10.1371/journal.pone.0190503

James, A. M., Williams, C. M., & Haines, T. P. (2013). Effectiveness of interventions in reducing pain and maintaining physical activity in children and adolescents with calcaneal apophysitis (Sever’s disease): a systematic review. Journal of Foot and Ankle Research 6(1), 16. https://doi.org/10.1186/1757-1146-6-16

Jayanthi, N. A., LaBella, C. R., Fischer, D., Pasulka, J., & Dugas, L. R. (2015). Sports-specialized intensive training and the risk of injury in young athletes: a clinical case-control study. American Journal of Sports Medicine 43(4), 794–801. https://doi.org/10.1177/0363546514567298

Jayanthi, N. A., Post, E. G., Laury, T. C., & Fabricant, P. D. (2019). Health consequences of youth sport specialization. Journal of Athletic Training 54(10), 1040–1049. https://doi.org/10.4085/1062-6050-380-18

Johanson, M. A. (1992). Contributing factors in microtrauma injuries of the lower extremity. Journal of Back and Musculoskeletal Rehabilitation 2(4), 12–25. https://doi.org/10.3233/BMR-1992-2404

Kose, O. (2010). Do we really need radiographic assessment for the diagnosis of non-specific heel pain (calcaneal apophysitis) in children? Skeletal Radiology 39, 359–361. https://doi.org/10.1007/s00256-009-0774-y

Kreuz, P. C., Erggelet, C., Steinwachs, M. R., Krause, S. J., Lahm, A., Niemeyer, P., … Südkamp, N. (2006). Is microfracture of chondral defects in the knee associated with different results in patients aged 40 years or younger? Arthroscopy 22(11), 1180–1186. https://doi.org/10.1016/j.arthro.2006.06.020

Kumar, V., Bhatnagar, N., & Lodhi, J. S. (2018). Grade I Osteochondritis Dissecans in a young professional athlete. Indian Journal of Orthopaedics 52, 344–352. https://doi.org/10.4103/ortho.IJOrtho_322_17

LaPrade, R. F., Agel, J., Baker, J., Brenner, J. S., Cordasco, F. A., Côté, J., … Provencher, M. T. (2016). AOSSM Early Sport Specialization Consensus Statement. Orthopaedic Journal of Sports Medicine 4(4). https://doi.org/10.1177/2325967116644241

Launay, F. (2015). Sports-related overuse injuries in children. Orthopaedics & Traumatology: Surgery & Research 101(1), S139-147. https://doi.org/10.1016/j.otsr.2014.06.030

Leppänen, M., Pasanen, K., Kannus, P., Vasankari, T., Kujala, U. M., Heinonen, A., & Parkkari, J., (2017). Epidemiology of overuse injuries in youth team sports: A 3-year prospective study. International Journal of Sports Medicine 38(11), 847–856. https://doi.org/10.1055/s-0043-114864

Longo, U. G., Franceschi, F., Ruzzini, L., Rabitti, C., Morini, S., Maffulli, N., … Denaro, V, (2007). Light microscopic histology of supraspinatus tendon ruptures. Knee Surgery, Sports Traumatology, Arthroscopy 15, 1390–1394. https://doi.org/10.1007/s00167-007-0395-8

Longo, U. G., Ronga, M., & Maffulli, N. (2009). Achilles tendinopathy. Sports Medicine and Arthroscopy Review 17(2), 112–126. https://doi.org/10.1097/JSA.0b013e3181a3d625

Mari, L., & Jari, P. (n.d.) Recommendations for the prevention of physical activity-related injuries in adolescents. physical activity 2021. Retrieved from https://www.paripre.eu/wp-content/uploads/2022/02/2021_PARIPRE_Recommendations.pdf.

Martinelli, N., Spreafico, A., Tramacere, I., Marcolli, D., Valli, F., & Curci, D. (2019). Prevalence and associated factors of sever’s disease in an athletic population. Journal of the American Podiatric Medical Association 109(5), 351–356. https://doi.org/10.7547/17-105

Myer, G. D., Jayanthi, N., Difiori, J. P., Faigenbaum, A. D., Kiefer, A.W., Logerstedt, D., Micheli, L. J. (2015). Sport specialization, Part I: Does early sports specialization increase negative outcomes and reduce the opportunity for success in young athletes? Sports Health: A Multidisciplinary Approach 7(5), 437–442. https://doi.org/10.1177/1941738115598747

Norton, R., Honstad, C., Joshi, R., Silvis, M., Chinchilli, V., & Dhawan, A. (2019). Risk factors for elbow and shoulder injuries in adolescent baseball players: A systematic review. American Journal of Sports Medicine 47(4), 982–990. https://doi.org/10.1177/0363546518760573

Nutarelli, S., da Lodi, C. M. T., Cook, J. L., Deabate, L., & Filardo, G. (2023). Epidemiology of patellar tendinopathy in athletes and the general population: A systematic review and meta-analysis. Orthopaedic Journal of Sports Medicine 11(6), 23259671231173659. https://doi.org/10.1177/23259671231173659

Otoshi, K., Kikuchi, S., Kato, K., Sato, R., Igari, T., Kaga, T., & Konno, S. (2017). Age-specific prevalence and clinical characteristics of humeral medial epicondyle apophysitis and osteochondritis dissecans: ultrasonographic assessment of 4249 players. Orthopaedic Journal of Sports Medicine 5(5), 1-8. https://doi.org/10.1177/2325967117707703

Pascual-Garrido, C., Moran, C. J., Green, D. W., & Cole, B. J. (2013). Osteochondritis dissecans of the knee in children and adolescents. Current Opinion in Pediatrics 25(1), 46–51. https://doi.org/10.1097/MOP.0b013e32835adbf5

Patel, D. R., & Villalobos, A. (2017). Evaluation and management of knee pain in young athletes: overuse injuries of the knee. Translational Pediatrics 6(3), 190–198. https://doi.org/10.21037/tp.2017.04.05

Pavone, V., Vescio, A., Panvini, F. M. C., Lucenti, L., Caldaci, A., Sapienza, M., … Testa, G. (2022). Patellofemoral pain syndrome in young female athletes: A case-control study. Advances in Orthopedics 2022, 1907975. https://doi.org/10.1155/2022/1907975

Pohl, M. B., Mullineaux, D. R., Milner, C. E., Hamill, J., & Davis, I. S. (2008). Biomechanical predictors of retrospective tibial stress fractures in runners. Journal of Biomechanics 41(6), 1160–1165. https://doi.org/10.1016/j.jbiomech.2008.02.001

Popkin, C. A., Bayomy, A. F., & Ahmad, C. S., (2019). Early sport specialization. JAAOS - Journal of the American Academy of Orthopaedic Surgeons 27(22), e995-e1000. https://doi.org/10.5435/JAAOS-D-18-00187

Puzzitiello, R. N., Rizzo, C. F., Garvey, K. D., Matzkin, E. G., & Salzler, M. J., (2021). Early sports specialisation and the incidence of lower extremity injuries in youth athletes: current concepts. Journal of ISAKOS 6(6), 339–343. https://doi.org/10.1136/jisakos-2019-000288

Rio, E., Moseley, L., Purdam, C., Samiric, T., Kidgell, D., Pearce, A. J., … Cook, J. (2014). The pain of tendinopathy: physiological or pathophysiological? Sports Medicine 44, 9–23. https://doi.org/10.1007/s40279-013-0096-z

Rothermich, M. A., Glaviano, N. R., Li, J., & Hart, J. M. (2015). Patellofemoral pain: epidemiology, pathophysiology, and treatment options. Clinics in Sports Medicine 34(2), 313–327. https://doi.org/10.1016/j.csm.2014.12.011

Schulz, J. F., & Chambers, H. G. (2013). 41: Juvenile osteochondritis dissecans of the knee: current concepts in diagnosis and management. Instructional Course Lectures 62, 455–467. Retrieved from https://link.gale.com/apps/doc/A345694484/AONE?u=anon~2daf1d00&sid=googleScholar&xid=6129eb45

Shanmugam, C., & Maffulli, N. (2008). Sports injuries in children. British Medical Bulletin 86(1), 33–57. https://doi.org/10.1093/bmb/ldn001

Sharma, P., & Maffulli, N. (2006). Biology of tendon injury: healing, modeling and remodeling. Journal of Musculoskeletal and Neuronal Interactions 6(2), 181–190. Retrieved from https://www.ismni.org/jmni/pdf/download.php?file=24/14MAFFULLI.pdf

Shigematsu, R., Katoh, S., Suzuki, K., Nakata, Y., & Sasai, H., (2022). Risk factors of sports-related injury in school-aged children and adolescents: a retrospective questionnaire survey. International Journal of Environmental Research and Public Health 19(14), 8662. https://doi.org/10.3390/ijerph19148662

Soligard, T., Schwellnus, M., Alonso, J.-M., Bahr, R., Clarsen, B., Dijkstra, H. P., … Engebretsen, L. (2016). How much is too much? (Part 1) International Olympic Committee consensus statement on load in sport and risk of injury. British Journal of Sports Medicine 50, 1030–1041. https://doi.org/10.1136/bjsports-2016-096581

Sonneville, K. R., Gordon, C. M., Kocher, M. S., Pierce, L. M., Ramappa, A., & Field, A. E. (2012). Vitamin D, calcium, and dairy intakes and stress fractures among female adolescents. Archives of Pediatrics & Adolescent Medicine 166(7), 595–600. https://doi.org/10.1001/archpediatrics.2012.5

Sweeney, E., Rodenberg, R., & MacDonald, J. (2020). Overuse knee pain in the pediatric and adolescent athlete. Current Sports Medicine Reports 19(11), 479–485. https://doi.org/10.1249/JSR.0000000000000773

Valentino, M., Quiligotti, C., & Ruggirello, M. (2012). Sinding-Larsen-Johansson syndrome: A case report. Journal of Ultrasound 15(2), 127–129. https://doi.org/10.1016/j.jus.2012.03.001

Valovich McLeod, T. C., Decoster, L. C., Loud, K. J., Micheli, L. J., Parker, J. T., Sandrey, M. A., & White, C. (2011). National Athletic Trainers’ Association position statement: prevention of pediatric overuse injuries. Journal of Athletic Training 46(2), 206–220. https://doi.org/10.4085/1062-6050-46.2.206

van Poppel, D., van der Worp, M., Slabbekoorn, A., van den Heuvel, S. S. P., van Middelkoop, M., Koes, B. W. … Scholten-Peeters, G. G. M., (2021). Risk factors for overuse injuries in short- and long-distance running: A systematic review. Journal of Sport and Health Science10(1), 14–28. https://doi.org/10.1016/j.jshs.2020.06.006

Vora, A. M., Tien, T. R., Parks, B. G., & Schon, L. C. (2006). Correction of moderate and severe acquired flexible flatfoot with medializing calcaneal osteotomy and flexor digitorum longus transfer. Journal of Bone & Joint Surgery 88(8), 1726–1734. https://doi.org/10.2106/JBJS.E.00045

Warden, S. J., Gutschlag, F. R., Wajswelner, H., & Crossley, K. M. (2002). Aetiology of rib stress fractures in rowers. Sports Medicine 32, 819–836. https://doi.org/10.2165/00007256-200232130-00002

Wong, J. S., Lalam, R., Cassar-Pullicino, V. N., Tyrrell, P. N. M., & Singh, J. (2020). Stress injuries of the spine in sports. Seminars in Musculoskeletal Radiology 24(3), 262–276. https://doi.org/10.1055/s-0040-1709484

Yanagisawa, S., Osawa, T., Saito, K., Kobayashi, T., Tajika, T., Yamamoto, A., … Takagishi, K. (2014). Assessment of Osgood-Schlatter Disease and the skeletal maturation of the distal attachment of the patellar tendon in preadolescent males. Orthopaedic Journal of Sports Medicine 2(7), 2325967114542084. https://doi.org/10.1177/2325967114542084

Yen, Y.-M. (2014). Assessment and treatment of knee pain in the child and adolescent athlete. Pediatric Clinics of North America 61(6), 1155–1173. https://doi.org/10.1016/j.pcl.2014.08.003

Zaremski, J. L., Zeppieri, G., & Tripp, B. L. (2019). Sport specialization and overuse injuries in adolescent throwing athletes: A narrative review. Journal of Athletic Training 54(10), 1030–1039. https://doi.org/10.4085/1062-6050-333-18

Downloads

Published

28-03-2024

How to Cite

Trojner, T., & Kelc, R. (2024). A growing issue of overuse injuries in young athletes. Annales Kinesiologiae, 14(2), 157–173. https://doi.org/10.35469/ak.2023.419

Issue

Section

Technical notes