Understanding Common Overuse Injuries: A Guide for Student Athletes and Parents

For student athletes, staying active and injury-free is key to performing well in sports and enjoying the journey. For parents, knowing what to watch for can help you support your young athlete through the highs and lows of training and competition.

As a former high level gymnast, even with incredibly supportive coaches, teammates, and parents, I wish I’d had someone to advocate for me as a high-level athlete—someone to guide me on my journey and teach me how to care for my body.

It’s tempting to just push through challenges, hoping injuries will resolve on their own. But addressing issues head-on, rather than ignoring them, is essential for long-term success. Just as a young athlete’s dedication to training and practice brings you so far, maintaining your health and wellness requires that same focus and commitment.

My goal is to empower you (as a young athlete) with the knowledge to become your own best advocate, optimize your performance now, and keep you healthy and active for life.

Understanding the anatomy and common overuse injuries can empower both athletes and parents to take proactive steps to enhance athletic performance and maintain long-term health.

Acute versus Chronic Injuries

Recognizing the type of injury helps determine the best course of action.

Acute Injury:

This is a singular, traumatic incident.
These happen suddenly—think sprains, falls, or collisions during play.
However, having chronic injuries or increased stress levels can predispose an athlete to an acute injury.
If not properly treated, an acute injury can become chronic.

Chronic Injury:

This is an overuse injury.
These develop over time from repetitive stressful movements without enough recovery.
One or more chronic injuries can predispose an athlete to further injuries.

Risk Factors for Injuries in Youth Athletes

Certain factors make child and teenage athletes more prone to injuries, especially in the lower body:

Growth Spurts
Children’s bones can grow faster than muscle. Rapid bone growth during a growth spurt can put extra tension on the relatively shorter muscles. This suboptimal length-tension relationship can increase the risk of injury due to unbalanced stress forces.
Children have weaker spots within the bone at the growth plates. Until a child's growth plates close, these cartilaginous areas are more vulnerable to stress and injury from excessive repetitive activity.
Prior Injuries
Untreated injuries, even those from years ago, can lead to movement compensations throughout the body. Helping young athletes establish proper movement patterns sets a strong foundation for lifelong health and performance. Remember, time alone doesn’t heal all wounds.
A recent injury can increase the risk of a young athlete injuring another body part. While pain may subside within days, tissue healing typically takes six weeks. Returning to full play too soon can lead to a new injury or even reinjury.
Lack of Conditioning and Improper Load Management
Jumping into intense activity without proper preparation puts undue strain on all body tissues. Preseason sports activity should slowly ramp up.
Too much cyclical activity wears heavily on tissues and needs to be balanced with appropriate strength training. Contrary to popular belief, lifting weights for young athletes is not dangerous - it is actually necessary!
Inadequate Recovery and Energy Imbalances
Not enough of good quality rest and sleep, and insufficient nutrition can leave youth athletes vulnerable to injury. While a simple concept, these preventive and recovery techniques are essential for developing children and young adults. Don’t ignore the power of this low-hanging fruit!
Improving awareness and encouraging open communication about these risk factors can help prevent problems before they arise.

Anatomy of Common Overuse Injuries in Pediatric Athletes

Bone Injuries

Bone density changes throughout childhood and adolescence, with significant spikes around puberty. Building strong bone density early in life is essential for protecting bones over a lifetime. This is accomplished through proper nutrition and lifting weights.

Children are more susceptible to these types of injuries than adults and are prone to unique bone injuries because their bones are not fully ossified.

Let’s take a look at common pediatric bone injuries:

Avulsion Fractures: The muscle pulls a small piece of bone away from bone.
Stress Fractures: Tiny cracks (microfractures) in the bone that grow in size from overuse. Untreated stress fractures can progress to a traumatic break in the bone.
Growth Plate Stress Reactions: Overuse can damage growing bones. This can be dangerous, as injury to the growth plate can permanently stop the bone from growing further.

What to Do: Seek help immediately. Prevent these injuries by participating in strength training and eating a diet rich in calcium and magnesium; vitamins A, K, and D; and protein and collagen.

Muscle Strains

Muscle fibers are injured when an external load exceeds the capacity of the muscle. A strain can occur from repetitive motions or a sudden motion in which the load is too heavy for a muscle to control.

There are 3 grades of muscle strains:

Grade I:

Mild stretching of muscle fibers
Little to no damage
Mild loss of motion or strength
Feels better within a few days to a few weeks

Grade II:

Partial tear of muscle
May have swelling and bruising
Decreased range of motion and strength
Can take 2-3 months to fully recover

Grade III:

Complete tear (rupture)
Total loss of strength
Usually requires surgery to repair

What to Do:

Grade I:

Ice and/or heat
Foam rolling and massage
Gentle stretching and range of motion exercises
Neuromuscular re-education exercises

Grades II and III

See a healthcare provider immediately

Tendon Injuries (Tendinopathy and Rupture)

Tendons connect muscles to bones, serving as non-contractile "pulley ropes" that transmit muscle forces to create movement. Unlike muscles, which contract, tendons rely on their elasticity and rigidity for optimal function. Tendon health is influenced by collagen structure, which depends on proper nutrition and strength capacity.

The overarching term for a tendon injury is “tendinopathy”. More specifically:

Tendonitis:

Early-stage inflammation caused by overuse (0-3 weeks).

Tendinosis:

Chronic tendon damage from repeated stress (6+ weeks).
The tendon no longer has “inflammation” at the cellular level, but now the collagen structure starts to break down.

Tendon Rupture:

Severe case where the tendon tears completely.
This can occur from a sudden traumatic force or a tendon weakened by chronic tendinosis.

What to Do: Ice, rest, and strengthen the tendon gradually with good nutrition and strength training. Ask for help soon!

Ligament Sprains and Rupture

Ligaments connect bone to bone, providing stability and protection to joints. Ankle sprains are common in youth sports but often brushed under the rug, while “scarier” ACL knee injuries are widely recognized and frequently discussed among athletic communities.

Sprains can result from an acute traumatic incident, but they often occur due to overtraining when fatigued muscles fail to support proper joint mechanics.

Grade I:

Mild, some stretching of ligament
Little joint instability

Grade II:

Moderate, partial tear of ligament
Some swelling and bruising
Instability of the joint

Grade III:

Severe, complete tear of ligament (rupture)
Significant joint instability

What to Do:

Grades I and II:

Elevate to reduce swelling
Support with taping to reduce excessive motion at the joint, minimize pain, and improve joint proprioceptive (spatial) awareness
Maintain gentle range of motion to prevent joint stiffness caused by pain-related guarding
Neuromuscular re-education and strengthening of surrounding joint musculature

Grade III: Seek immediate medical attention—surgery may be required.

Common Lower Extremity Overuse Injuries in Youth Athletes

Ankles

1. Shin Splints

Medical term is tibial stress syndrome (anterior or medial). This is when there is inflammation of the muscle, tendon, or bone on around the shin bone (on the front or the inside of the shin bone).

This is common in kids who run a lot. If left untreated, shin splints can progress to a stress fracture.

2. Sprains

Ankles are usually sprained when the ankle turns in (inversion sprain) or the ankle turns out (eversion sprain). An athlete can sustain damage to the joint from stretching/tearing the ligaments or from compressive forces pinching the ligaments or bones.

Grade I and II sprains can be easy to rehab, but if left untreated, they can cause continued problems down the road.

3. Plantar Fasciitis

This occurs with repetitive loading to the foot and ankle. The connective tissue through the bottom of the foot gets irritated.

Maintain good mobility in the calf, ankle, and foot mobility to help treat and prevent plantar fasciitis.

Having adequate strength in the leg is important to help with force absorption with activities.

4. Calf Strains

Calf muscle strains occur when the muscle fibers in the calf are overstretched or torn, resulting in pain, swelling, and difficulty walking or running.

5. Achilles Tendinopathy

The Achilles tendon is the thick, ropey structure that attaches the calf muscles to the heel bone.

Achilles tendonitis can be caused by repetitive activities like running or jumping, rapid growth spurts, and poor footwear. If left untreated, the acute tendonitis can progress to a more chronic tendinosis, which takes longer to recover from.

Knees

1. Patellar Tendonitis (Jumper’s Knee)

The patellar tendon attaches the knee cap to the shin bone. When irritated with cyclical loading, the patellar tendon can become inflamed and painful just below the knee cap.

Patellar tendonitis is caused by repetitive activities like jumping (hence, the name Jump’s knee) and running.

Wearing a support strap below the knee can provide temporary relief, but it doesn't address the root cause and should not be relied upon as a primary solution.

2. Osgood-Schlatter Disease

This is irritation of the growth plate on the shin bone, just below the knee. This bone inflammation can produce a bump.

This condition is painful and again caused by excessive jumping and running.

As with patellar tendonitis, wearing a support strap below the knee can provide temporary relief, but it doesn't address the root cause and should not be relied upon as a primary solution.

3. Quadriceps and Hamstring Strains

Quadriceps are the muscles in the front of the thigh.

Hamstrings are the muscles in the back of the thigh.

Both muscle groups cross the hip and the knee joints, so strains can affect the function of the knee, hip, and back.

Quad and hamstring strains can result from overstretching or overloading the muscles, often during activities involving sprinting, jumping, or sudden directional changes.

Hips

1. Groin and Hip Flexor Strains

Groin and hip flexor strains can occur when the inner or front thigh muscles are overstretched or overloaded. This is often caused by sudden movements like twisting, sprinting, kicking, or sudden directional changes.

Suspected groin strains should not be disregarded because they can look similar to hernias, which require medical attention.

2. Internal Snapping Hip Syndrome

Internal snapping hip syndrome is when the hip flexor muscle/tendon creates a popping or snapping sensation during movement. It may or may not be painful.

This is often caused by tight and weak hip flexors rubbing against bony structures.

Internal snapping hip syndrome is common in gymnasts, dancers, and kicking athletes.

3. IT Band Syndrome

The iliotibial (IT) band is a thick band of fascia that runs from the hip, down the side of the leg, and attaches below the knee.

IT band syndrome is an overuse injury that can cause pain in the outer knee, hip, or thigh.

The quads, hamstrings, and gluteal muscles all attach into the IT band and can cause tightness.

IT band syndrome is often due to tightness of the IT band from repetitive activities like running or cycling, combined with hip and core weakness that compromises lower extremity stability.

Self-Advocacy and Communication

Key Points for Athletes: If you feel pain, take a moment to reflect and ask yourself:

What did I do differently today or yesterday?
Did I change my routine or increase my activity level?
Am I giving my body enough rest and recovery?

Athletes, learn to listen to your body and speak up about your concerns!

Key Points for Parents: Encourage your athlete to share how they’re feeling physically, mentally, and emotionally.

If your child experiences pain or unusual fatigue, reach out to their coach or physical therapist. Early intervention makes all the difference in recovery and future performance. Injury prevention starts with understanding the body and making informed decisions about training, recovery, and self-care.

In the next blog post, we’ll explore how youth athletes can minimize their injury risks, enhance recovery, and build resilience.

Disclaimer: This blog is intended for informational and educational purposes only and is not considered medical advice.