Child's play: Treating and preventing overuse injuries in kids

February 26th, 2019
By: Content Staff

A child is not just a small adult or a “mini-me,” and the physical therapy program used to treat his overuse injury should reflect that often-overlooked reality. That’s the message that physical therapist Julie Granger, who owns PRISM Wellness Center in Atlanta, wants her peers to keep in mind the next time a Little League pitcher shows up with a sore shoulder or a young figure skater has an ankle injury.

In an interview with the American Physical Therapy Association’s PT in Motion publication, Granger said that kids’ daily physical and cognitive growth changes their biomechanics, making it difficult for them to maintain consistency in the way they move. They will grow overnight, and then their brains will need time to adjust to those physical changes, she said.

“The body grows really fast, but the brain has less time to recalibrate everything else,” Granger told PT in Motion. “You see kids start to lose coordination, and there are more injuries. I equate them with puppies: They’ve got big feet and awkward bodies.”

Granger said physical therapists should make kids, parents, and coaches aware of how physical development can significantly affect biomechanics. By doing so, parents and coaches will be better prepared to identify changes in a child’s movement and help him avoid injury.

In another example cited by PT in Motion, a young golfer was experiencing neck pain, and by analyzing his swing on video, the physical therapist determined that the golfer was thrusting his hips at the ball too early, causing him to hyperflex his neck. Initially, the patient couldn’t understand why the physical therapist wanted to focus on his hips and glutes instead of his neck, but by reviewing the video with the child, the physical therapist was able to get the patient to buy into the treatment program.

Granger said overuse injuries are becoming more common in kids as they increasingly specialize in one sport year-round instead of varying their sports by the season. By performing the same skill set time and again instead of varying it up, children are making themselves more prone to overuse injuries.

According to PT in Motion, about 60 million children ages 6 to 18 play organized sports in the United States, including 44 million who participate in multiple sports. While the prevalence of overuse injuries can vary a great deal between sports, it is estimated that 45.9 percent to 54.1 percent of kids who play sports develop an overuse injury, and those injuries account for about half of pediatric sports-related injuries, PT in Motion reported.

Granger said the most common overuse injuries she sees are stress fractures and injuries of the growth plates, both apophysis, and epiphysis. She said unlike when treating adults, physical therapists shouldn’t assume that a kid’s tender ankle is just a sprain. “Physical therapists need to err on the side of assuming it’s a growth-plate injury until proven otherwise,” Granger told PT in Motion.

To combat overuse injuries, parents and coaches should encourage kids to play multiple sports that will help them develop their entire bodies instead of just the muscle groups necessary for one particular sport.

Often, parents and coaches will recognize that a child is outstanding in one sport and want her to devote herself entirely to that sport, but doing so increases the likelihood of injury, according to physical therapist Teresa Schuemann, who focuses on injury prevention in young athletes. This is especially true for athletes who play in more than one league and have many games and practices scheduled each week, she told PT in Motion. Research suggests that kids should play a single sport no more than eight months a year instead of year-round, PT in Motion reported.

To participate at the top level in sports such as gymnastics and figure skating, child athletes must specialize early because the most talented athletes will compete in elite-level competition before their bodies are fully mature. One key to preventing overuse injuries in these athletes is to develop an integrative neuromuscular training program for them.

INT programs are supplemental training programs aimed at helping child athletes develop their entire bodies, especially the muscle groups that get little attention in their sport of choice. This is done through exercises that require fundamental movements and target undeveloped areas of the body. The goal of INT programs is to improve the child athlete’s biomechanics and overall motor skills instead of just his sport-specific motor skills, according to PT in Motion.

“You need a solid base,” Schuemann told PT in Motion. “It's crucial for athletes to not develop compensatory patterns, as muscles they’re not using will weaken. A strong core helps prevent this.”

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