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Common Overuse Injuries in the Young Athlete

By Traci Toll-Griffin, MD | Pediatrics

Does your child love running or playing basketball? Do they enjoy soccer, football, or lacrosse? If your child plays any of these sports, there’s a chance that they will eventually complain of heel or knee pain.  Between the ages of 9 and 14 years old, children go through a major spurt in which the growth of their long bones can create tension where the muscle tendons insert into the bones. This can result in pain, especially when children are very physically active. However, these common overuse injuries respond well when given proper attention. They do not need to sideline your young athlete.

Pain in the front of the knee just below the kneecap is commonly called Osgood-Schlatter disease. It may result in a tangible bump on the tibia, or shinbone.  This is a result of the strong thigh muscles attached to the kneecap and the front of the tibia, also known as the tibial tuberosity.  The tension where the tendon inserts into the bone stimulates bone growth, which can produce discomfort in one or both knees. The pain tends to be worse with kneeling, jumping, running, climbing stairs, or going up hills.

Luckily, resting usually reduces the pain. Ice is also effective; I recommend applying it for 15 minutes, three times a day. If the pain persists, you can give your child acetaminophen or ibuprofen. It’s also important that your kiddo stretch before and after playing sports. This will help release tension at the insertion point.  Your child can continue their sport if the pain is not severe and improves with rest. However, they should see their pediatrician to confirm a diagnosis if the pain started abruptly, they are limping, or they have swelling around the knee itself. They should also go if the pain persists in only one knee. In these cases, your child may need further evaluation and physical therapy. However, this type of pain dissipates when growth stops and doesn’t indicate that your child will have knee issues in the future.

Another common overuse injury in the growing athlete is heel pain, called Sever’s disease.  This pain extends from the top of the heel down, towards the bottom of the foot. It is common in runners and those playing sports that involve cleats. On average, it presents in adolescents between the ages of 8-12 years old, and can occur intermittently for three to four years.  Children may complain of a pain that is persistent but worsens after exercise. It often occurs in both heels, though not always at the same time.

Like the previous condition, Sever’s disease is due to changes in the bones as they grow. In this case, the strong Achilles tendon attaches to the heel bone.  When the long bones in the lower leg grow, the muscle and tendon become tight, pulling on the heel bone. As noted above, your child should see their doctor if the pain started abruptly, they are unable to bear weight, or the pain continues despite interventions.

As with Osgood-Schlatter, stretching is the best treatment. It should be done with the calf muscles 3 times per day, especially before and after practice or games.  If the pain is tolerable, it’s fine to continue playing. Using a heel cup or cushion can also reduce this tension.  (If your child uses these devices, be sure that they accompany them with stretching.) Once again, ice the area for 15 minutes, at least three times per day. Ibuprofen can be useful as well. Lastly, have your child wear supportive shoes.  Though popular, flat- bottom sneakers (Converse or Van’s), flat boots (Uggs), and flip-flops aren’t good choices for footwear.

In summary, there is no doubt that both exercise and teamwork are important for your child’s growth and development. But too much of a good thing can have unintended effects.  By giving your child these tools and ways of listening to their body, you can help them stay as active and pain-free as possible.