Playing It Safe: How to Help Your Kids and Grandchildren Avoid Overuse Sports Injuries.

July 05, 2013

The 12-year-old girl squints in the sun as she steels herself before delivering another serve. She eyes the volleyball in her hands, tosses it into the air, then reaches back and up with her serving arm to strike the ball over the net.

She’s done this at least 50 times in one practice, but with this serve, she feels a pinch radiate throughout her shoulder. It’s intense enough to concern her, but she’s used to playing with pain by now.

vball_news13Erin, who lives in Malibu (her parents have asked that the family’s names not be used) dedicates six to seven days a week to volleyball, varying year-round practice between a school team, two volleyball club teams and an occasional private coach. Saying she is dedicated to the sport is an understatement.

Like many young athletes, she is passionate and competitive. The continuous, repetitive motions from playing her sport year-round, however, led to a serious overuse injury that recently required medical attention, physical therapy and a break from the activity she loves so much.

Erin’s story is not unique. According to the National Center for Sports Safety, more than 3.5 million children ages 14 and younger receive medical treatment for sports injuries each year. And children ages 5 to 14 account for nearly 40% of all sports-related injuries in hospitals, estimates Half of the 3.5 million injuries are preventable because they are directly related to overuse.

Doctors have always seen youth injuries such as sprained ankles and wrists, broken bones and concussions from impact sports such as rugby, football, soccer and basketball. But overuse injuries are on a swift uptick. reports that in the past 13 years, serious shoulder and elbow injuries among youth baseball and softball players have increased fivefold.

Knee overuse injuries are up dramatically since 1999, according to American Academy of Pediatrics. Meniscal and anterior cruciate ligament (ACL) tears both rose significantly among children from 1999 to 2010— including a 400% surge in the frequency of ACL tears. A stable ACL allows a player to pivot, change direction and turn quickly—a must in many sports practiced at high levels of competition. A tear can require surgery and sometimes results in the early onset of arthritis, experts say.

Many sports medicine experts surmise that the rise in overuse injuries reflects the growing intensity and popularity of year-round competitive club teams. Three decades ago, organized recreational sports activities were mainly seasonal, giving children time off.

Today, kids can play their sport of choice year-round and often focus on just one sport, says Bert Mandelbaum, MD, an orthopedic surgeon with Santa Monica Orthopaedic and Sports Medicine Group, which is affiliated with Saint John’s Health Center. As a result, physicians are now treating serious shoulder, hip and knee injuries, with some children as young as 10 requiring surgery. In the recent past, the majority of these injuries occurred in high school or college.

No one wants kids to quit sports. After all, one of every three U.S. kids are overweight or obese, so it’s important that children and teens get off the couch and away from video games in order to stay healthy. But experts urge parents to not let them focus on one sport too soon or play it year-round if their bodies are not ready for it.

“When a young athlete participates in only one sport, they tend to use the same muscle groups over and over again without a break,” explains Dr. Mandelbaum, who has seen his share of overuse injuries. Formerly chief of orthopedic surgery for Saint John’s Health Center, he’s an expert at treating sports injuries for professional athletes and is the team physician for U.S. Soccer Federation teams, U.S. Gymnastics Federation and FIFA World Cup USA.


While doctors at Saint John’s Health Center treat a variety of sports-related injuries every year, the most common non-fracture injuries for children are knee injuries, with ACL tears becoming a larger percentage all the time. ACL tears are considered an acute, traumatic injury. However, there may be an overuse or fatigue component to injuries that could explain the alarming increase in ACL tears in young children seen recently, says James Lee Pace, MD, an orthopedic surgeon who provides pediatric and sports medicine orthopedic services at Santa Monica Orthopaedic and Sports Medicine Group.

Injury patterns can vary depending on where kids live. For example, in sunny Southern California where sports can take place year round, baseball reigns supreme, and shoulder and elbow injuries are very common, Dr. Pace says.

Some of the children who join club teams for baseball, soccer, basketball or volleyball at an early age are the same kids who dream of becoming college or professional athletes. But experts say their chances of making it to the loftiest levels of sports diminishes if they’re already undergoing medical treatments or surgery for ACL injuries or pitcher’s shoulder at 12 or 13 years of age.

“I’ve heard from baseball scouts that they no longer like to recruit pitchers from California schools,” Dr. Mandelbaum says. “The kids have too many overuse injuries from playing year-round.”

While sports injuries in young athletes are found all over the country, Southern California—with its near-perfect year-round weather and a focus on athleticism—is uniquely positioned to see high rates of injuries. Erin’s mother, Maria, says it’s hard to limit her daughter’s volleyball practice—with a school team, a beach club and an indoor club beckoning her to play week in and week out. And when coaches encourage more participation, it’s tough for a passionate child to realize she needs to rest.

“It’s common for her to do 60 serves in a practice—even with her private coach,” Maria explains. “She’s very determined.

Even if it hurts, she’ll practice a move over and over and over again to get better. The system of club teams is ‘win, win, win, win’— even with professionals and adults—but professionals take breaks. Our kids’ teams typically support the immediate win and not the long-term interests of kids.”

When the pain in Erin’s shoulder became excruciating last November, her parents took her to see Dr. Pace.

Ultimately, Erin was diagnosed with “Little Leaguer’s shoulder,” an overuse injury mainly seen in baseball players that involves the main growth plate of the shoulder. “It was caused by a tight shoulder capsule in the posterior part of her shoulder that she developed from repetitive overhead serving in volleyball,” Dr. Pace explains. “She ended up having two conditions—both from overuse.”

These conditions can become extreme in the bodies of prepubescent athletes. Fortunately, Erin’s bone did not start to bend, as her mother feared, but Dr. Pace told the family that her growth plate had widened a bit. If the condition had not been treated properly or in time, the bone on either end of the growth plate could “displace and cause long-term problems requiring surgery,” he explains.

Erin averted that crisis with eight weeks of physical therapy and rest from the game. Since her injury only creates pain when she is playing, the time off plus stretches and exercises to strengthen the area resolved the problem—for now. But Dr. Pace cautions that she needs to continue stretching and limit the number of serves per practice to avoid a recurrence.

Notes Dr. Mandelbaum: “Children, like professional athletes, need to take breaks from their focused sport as well as play a variety of sports to utilize and strengthen varying muscle groups.”