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Recommendations for Prevention of Pediatric Overuse lnjuries

Overuse Is A Problem

The CDC reports that over half of all sports injuries to children are preventable. Overuse injury patterns are responsible for nearly half of all sports injuries to middle and high school athletes. Up to fifty percent of all injuries seen in pediatric sports medicine are related to overuse. Injuries tend to be more common during periods of rapid bone growth, especially if underlying bio-mechanical problems are present. Injuries may be caused by training errors, improper technique, excessive training, inadequate rest, muscle weakness, imbalances and early specialization.

Prevention Programs Help

Programs that are successful in reducing the risk of overuse injuries include training for: strength, muscle control, flexibility, balance and sport technique. Preseason and in-season preventative training programs should include all of these plus strengthening for the core and legs, especially if there is a history of previous injury. Participation in a generalized fitness program for endurance, flexibility and strengthening at least two months prior to the sport season is vital for prevention of overuse injuries.

Guidelines to Prevent Overuse

Emerging evidence shows that the total volume of sport activity (either the number of repetitions or the quantity of time participating) is the most consistent predictor of overuse injury. Multi-sport athletes, those who participate in 2 or more sports with major emphasis on same body part, are at higher risk of overuse. Based on the literature, here are some guidelines to prevent injury:

  • Limit one sporting activity to a maximum of 5 days per week with at least 1 day off from any organized physical activity.
  • No more than 16-20 hours per week of vigorous physical activity. Take 2 days off each week from practices, competitions and sport-specific training.
  • Take at least 2 to 3 months off from the primary sport per year.
  • Participate in only one team of the same sport per season when participation in 2 or more teams of the same sport would involve practices and play for more than 5 days per week.
  • Progress training (intensity, load, time or distance) no more than 10% each week.
  • Do not ignore pain or try to play through it. Pain is the first indicator of an overuse problem. The most prominent risk factor for injury risk is a history of previous injury.
  • Prevent burnout by encouraging athlete to become well rounded and versed in a variety of activities rather than only one sport. Young athletes who participate in a variety of sports have fewer injuries and play sports longer than those who specialize before puberty.
  • Ensure that pediatric athletes play only 1 overhead throwing sport at a time and avoid playing year round.
  • Baseball:
    • Restrict use of “breaking pitches”. If throwing a breaking pitch hurts, stop!
    • Pitching limits: For 9-14 year olds, limit to 75 pitches per game/ 600 pitches per season/ 2000-3000 per year. For 15-18 year olds, limit to 90 pitches per game/ pitch no more than 2 games per week. (Note: Pitch limits rather than inning limits may be a better indicator of when pitchers should be removed to allow for rest.)

Recommendations from, American Academy of Pediatrics, National Athletic Trainer’s Association