Overuse injuries in high school athletes: who, what, and why?

Important considerations for coaches and parents

Overuse injuries can be a huge problem in any athlete, because they take a long time to develop and an even longer time to get resolved. Young athletes are more susceptible to overuse injuries than adults because of their developing bodies. Among youth, overuse injuries are the most common in 13-17 year olds.

While bones get longer in puberty, they don’t achieve their greatest density until a few years later. Growing cartilage, muscle and tendon tightness from growth spurts, and lack of awareness of pain are all proposed mechanisms that contribute to overuse injuries in teens. Combine the physiological changes with the horrible, awful, no-good trend of sports specialization and overtraining, and it’s no surprise rates of overuse injuries are increasing every year.

Understanding the patterns of overuse injury among young athletes is critical to develop effective, targeted prevention efforts. To that end, one recent study examined injury data from over 3000 high school athletes from across the country over a six year period. Here’s what they found:

  • Girls were 50% more likely to suffer an overuse injury than boys. This shouldn’t be surprising: girls are thought to have a higher pain tolerance than boys, and they mature faster, which means they have less time to adapt to physical changes. It also may explain why…
  • Girls were more likely to be injured early in their high school careers, while boys were the opposite. In girls, injury rates decreased from 30 – 20% from freshman to senior years, while boys’ rates increased from 20 – 30%
  • The sports with the highest risks of overuse injuries were in girls track and field, girls lacrosse, girls field hockey, and boys swimming. The authors of the study speculated that “these girls’ sports have larger teams with younger, skeletally immature girls who were not physically ready to handle the repetitive motion associated with these sports.” Whether or not that’s true, athletes in these sports will definitely benefit most from overuse injury assessment and prevention. Football, baseball, and wrestling actually had the lowest risks of overuse injuries.
  • The lower leg (shin splints, stress fractures) was the most common site of overuse injury, except in sports like swimming and volleyball which require more upper body movements.

So how can high school athletes avoid overuse injuries?

For starters, track their training volume, by multiplying duration by session RPE. It’s absolutely critical to do so. Injury prevention is a major reason for data tracking, and it’s another reason that perceived ratings of intensity are superior to heart rates and math: as far as I know, there isn’t a math equation that can tell you how much your shins hurt. Training volume tells you a lot about an athlete, and it can be calculated in every single type of sport. Pro athletes average around 3000 training volume units per week in peak training periods. So unless your kids are pros (they’re not), it should be much lower. It will help them in the long run.

Kids also need to play more than one sport! Specialization not only makes kids worse athletes, but those who play only one sport year round are almost twice as likely to suffer an overuse injury. Most data suggests that kids from higher income families or those that spend twice as much time playing organized sports vs. unorganized sports are more likely to get injured.

Cross training should be a component of weekly practice schedules. There are more ways to improve fitness than running. Try a game of ultimate frisbee, or my favorite tailgating-turned-PE-sport, trashcan football (sorry, no internet links because I invented it). It also includes strength training and agility exercises. Strength training develops neuromuscular coordination, joint stability and bone density, and change of direction exercises improve proprioception – the ability to know where your body is in space.

Taking a day off once in a while couldn’t hurt either!

Photo credit: Matt Hintsa/flickr creative commons