Overuse Injuries in Young Athletes

What is an overuse injury?

It is an injury to a bone, muscle, or tendon due to repetitive movements or stress. These structures become injured because they have not been able to rest and heal, as the title “overuse” implies. Often overuse injuries are more common if motion patterns or technique is also incorrect, or if there are natural alignment problems, such as flat feet in a runner.

What are the 4 stages of overuse injuries?

There are progressive and occur in the following pattern:

  1. Pain after physical activity
  2. Pain during physical activity (as well as after)
  3. Pain during physical activity that restricts performance (and often forces people to have to take time off)
  4. Chronic pain that doesn’t go away, even at or with rest

Who gets overuse injuries?

Anyone can get an overuse injury, but they are especially common in young and growing athletes.

How common are overuse injuries in young athletes?

50% of all pediatric sports medicine injuries are related to overuse.

Why are overuse injuries more serious in young athletes?

Children and adolescents have bones, muscles, and tendons that are still growing and developing. And while the growing body often adapts and heals quicker than an adult’s body, many young athletes may not recognize signs and symptoms of injury as early, which lead to a more serious injury. Often bad technique, such as pitching a baseball, if not corrected can also lead to more serious ligament injury as an adult, such as a “Tommy John” ligament (ulnar collateral ligament) tear.

What are risk factors for overuse injuries?

  • Previous injury
  • Adolescent growth spurt
    • Growing bone and joints are sensitive to tensile, shear, and compressive forces
    • Growing joints are hypermobile (“loose” ligaments)
  • Menstrual irregularity in female athletes (particularly bone stress injuries)
  • Overtraining, and not providing adequate rest and recovery after exercise

How much training is too much?

There is no “one size fits all” answer but there are a few points that are important to consider. Overtraining is common among young athletes specializing in a single sport and who train year-round without enough time off or rest.

What does a healthy training regimen look like?

  • Training regimens should include a variety of modalities, such as water running for track athletes, or “dry land” exercises for a swimmer.
  • Limiting sports-specific repetitive movements. Little League baseball has developed rules and guidelines for pitch counts, and time off after pitching.
  • The American Academy of Pediatrics recommends limiting one sporting activity to 5 days per week maximum with at least one day off to rest.
  • Single-sport athletes should schedule at least 2 to 3 months off per year from their primary sport during which the body can properly heal, the mind can refresh, and the athlete can focus on generalized strengthening, conditioning, and proprioception that help reduce injury risk. This also helps prevent athlete burnout.

What is burnout?

Also known as overtraining syndrome, burnout is defined as any combination of psychological, physiologic, or hormonal changes that result in decreased sports performance. Burnout is associated with overtraining, chronic stress, and sport specialization. Symptoms may include pain, fatigue, lack of enthusiasm about sports, and difficulty completing typical routines.

How can burnout be prevented?

  • Keep sports training interesting and fun
  • Take 1 to 2 days off from organized sports each week
  • Schedule breaks from training and competition every 2 to 3 months
  • Focus on wellness including body cues to slow down or make changes to training methods
  • Develop “periodization” of the training schedule, with periods of heavy and light training, and appropriately ramping up distance, time, and intensity during the season, and integrating a taper period in preparation for peaking at goal races or competitions
  • Promote good sleep hygiene practices, allowing enough sleep to feel rested in the morning, promoting brain and body recovery

What are some healthy goals for young athletes?

  • Promote sports participation as a means to lifelong fitness, recreation, team building, and motivation through healthy competition.
  • Discuss these healthy motivations with parents, medical providers, coaches, and teammates; consider providing workshops for all involved addressing nutrition, strengthening and sleep practices that align with these healthy motivations.
  • Becoming a well-rounded athlete involves diverse sports training and participation. This means being open to trying different sports and participating in moderation. This facilitates skill transfer to the primary sport and avoids pitfalls of overuse, overtraining, and burnout.


By Maryann Davies and Jon Minor, MD


1. https://www.amssm.org/Content/pdf%20files/2014_OverUse_Injuries-Burnout.pdf

2. http://pediatrics.aappublications.org/content/119/6/1242

1. https://www.healthychildren.org/English/health-issues/injuries-emergencies/sports-injuries/Pages/Preventing-Overuse-Injuries.aspx

2. http://www.jordantimes.com/news/features/overtraining-ups-injuries-and-burnout-kids-sports

3. https://blog.teamedgeathletics.com/girls-suffer-more-overuse-injuries-in-teen-sports