National Athletic Trainers' Association Position Statement: Prevention of Pediatric Overuse Injuries (Position Statement) (Report‪)‬

Overuse injuries in the pediatric population represent a significant health care concern. Some reports and clinical observations (l,2) indicate that 50% of pediatric patients present to sports medicine clinics for chronic injuries. In addition to their costs (direct and indirect medical expenditures), these injuries also result in lost participation time, numerous physician visits, and lengthy and often recurring rehabilitation. (3-5) Furthermore, athletes who sustain recurrent overuse injuries may stop participating in sports and recreational activities, thus potentially adding to the already increasing number of sedentary individuals and the obesity epidemic. In the pediatric population, overuse injuries can include growth-related disorders and those resulting from repeated microtrauma. (6) Growth-related disorders include Osgood-Schlatter disease, Sever disease, and other apophyseal injuries. Overuse injuries resulting from repetitive microtrauma and chronic submaximal loading of tissues include stress fractures, similar to those described in adult athletes. (6) However, overlap exists between broad classifications; some growth-related disorders may occur in sedentary children but much less often than in their active peers. (6) Regardless of the cause, these injuries can result in significant pain and disability. Although little research has identified causative factors for overuse injuries in children and adolescents, these injuries may be caused by training errors, improper technique, excessive sports training, inadequate rest, muscle weakness and imbalances, and early specialization. (6-10) More than half of all reported overuse injuries are speculated to be preventable, (5) but few empirical data support this statistic.