Practice makes perfect. In reality, too much practice can make a perfect recipe for overuse injury in children. Overuse injury is the result of repetitive motion and persistent stress on the musculoskeletal system. This constant stress causes micro-trauma in the bones, muscles, and connective tissues often only detectable by special imaging. Growing children have immature skeletons, which are more prone to stress injury.

Below are some common overuse injuries to watch for in the young athlete.

Shin splints: Pain over the shin area. Associated with improperly fitting shoes and running on hard surfaces.

Jumper’s knee: Pain coming from the patellar tendon located just below the knee. Aptly named for its association with repetitive jumping. This injury is very common in basketball players.

Sever disease: Pain where the Achilles tendon attaches to the heel that causes the athlete to walk with a limp. Seen with long distance running or repetitive jumping.

Little League shoulder: Pain in the shoulder caused by repetitive overhand motions such as baseball pitching or volleyball serving. Often an underlying cause of decreased throwing velocity.

Little League elbow: Pain in the elbow caused by repetitive overhand motions and golf swings. Pitch count limits in little league are designed to prevent this injury.

Spondylosis/spondylolisthesis: Presents as back pain at a specific level on the spine. Caused by repetitive bending of the back forwards and backwards. Often seen in football linemen and gymnasts. This is a stress fracture of the back (spondylosis) with possible slipping of the bones that form the spine (sponylolisthesis).

Osgood-Schlatter disease: A common cause of knee pain in runners. Often presents as a “bump” just below the kneecap at the top of the shin.

Stress Fracture: This is a generic term for a small crack in the bone caused by repetitive activity. Stress fractures are most common in the feet, as they receive the full impact of every step, jump and landing.


The general treatment for most overuse injuries is R.I.C.E. therapy: rest, ice, compress, elevate. If you believe your young athlete may have an overuse injury, please see your healthcare provider for evaluation and treatment recommendations.


Children are beginning organized sport activity at earlier ages. One study showed that organized team participation doubled in children age 6 and under from 1997 to 2008. While it is recommended that children ages 5 and up receive at least 60 minutes a day of exercise, practice hours per week should not exceed the child’s age in years.

Early specialization (defined as year-round focus on a specific sport before puberty) is associated with an 81 percent increase in risk for overuse injury compared to multisport athletes. The American Orthopaedic Society for Sports Medicine and International Olympic Committee advise young athletes to partake in diverse athletic activities to develop a wide range of physical skills and to avoid specialization until at least puberty.

Patrick Tansey is a medical student at Texas A&M Health Science Center College of Medicine.