Sports & Overuse Injuries in Young Athletes

Sports and overuse injuries are among the most common reasons East Valley families bring a child to our pediatric orthopedic office, and many of them start with a complaint that sounds minor: a sore heel after soccer practice, a knee that aches after basketball, or an elbow that hurts only when pitching. Because a young athlete’s skeleton is still growing, these injuries behave differently than in adults, and they deserve evaluation from a team that treats children every day.

At Cactus Pediatric Orthopaedics, we care for young athletes from the first season of tee ball through the final year of high school competition. This page explains how sports injuries in children differ from adult injuries, the overuse conditions we see most often, the warning signs parents and coaches should not ignore, and how we help kids heal, get stronger, and return to the sports they love.

Why Young Athletes Get Hurt Differently Than Adults

A child is not a small adult, and that is especially true in sports medicine. The biggest difference is the growth plate, a layer of developing cartilage near the end of each long bone where new bone forms. Growth plates are softer than the surrounding bone and weaker than the nearby tendons and ligaments. When force or repeated stress is applied to a growing joint, the growth plate often gives way first.

Children also have apophyses, which are secondary growth centers where large tendons attach to bone. The heel of the foot, the bump just below the kneecap, and the inner side of the elbow are all apophyses. During a growth spurt, bones can lengthen faster than the muscles and tendons can stretch to keep up. That creates extra tension at these attachment points, and repetitive running, jumping, or throwing adds stress on top of it. This combination explains why several of the most common youth overuse conditions are injuries to growth centers rather than to muscles or ligaments.

A few other factors make young athletes more vulnerable:

• Growth spurts. Coordination, flexibility, and strength often lag behind rapid growth, which temporarily raises injury risk.
• Year-round play. Many kids now play one sport across several overlapping seasons, club teams, and tournaments, leaving little time for tissues to recover.
• Early specialization. Focusing on a single sport at a young age repeats the same movements and loads the same joints week after week.
• Reluctance to report pain. Children often do not want to miss a game or let a team down, so they keep playing through early warning signs.

In Arizona, the climate allows outdoor practice nearly every month of the year. Club baseball, softball, soccer, and volleyball seasons in the East Valley frequently overlap, and many of the young athletes we see have not had a true off-season in years. That pattern is one of the clearest drivers of the overuse injuries in our practice.

Acute Injuries vs. Overuse Injuries

Sports injuries in children fall into two broad groups. Understanding which type your child has helps explain the treatment plan and the timeline for returning to play.

Acute injuries happen in a single moment. A slide into second base, a collision on the soccer field, a bad landing in gymnastics, or a fall onto an outstretched hand can cause a fracture, sprain, dislocation, or ligament tear. The cause is obvious, and pain and swelling usually start right away.

Overuse injuries develop gradually from repetitive stress without enough recovery time. No single moment causes the injury. Instead, tiny amounts of damage build up faster than the body can repair them. Pain often begins as mild soreness after activity, then shows up during activity, and eventually may limit performance or appear even at rest. Because the onset is slow, overuse injuries are easy to dismiss as growing pains or normal soreness.

Overuse injuries are not rare. According to the Stop Sports Injuries campaign, an initiative of the American Orthopaedic Society for Sports Medicine, overuse accounts for nearly half of all sports injuries among middle and high school students. Research published in the American Journal of Sports Medicine found that overuse injuries made up about half of visits to a pediatric sports clinic, and investigators noted the true figure is likely higher because many kids never report their symptoms.

Common Overuse Injuries We Treat

The conditions below are the overuse injuries we diagnose most often in young athletes. Each one has its own dedicated page with more detail on symptoms, diagnosis, treatment, and recovery.

Sever’s Disease (Heel Pain)

Sever’s disease, also called calcaneal apophysitis, is irritation of the growth center at the back of the heel where the Achilles tendon attaches. It is one of the most common causes of heel pain in active children, typically between ages 8 and 14. Kids who play soccer, basketball, and other running sports on hard surfaces, or who wear cleats with little cushioning, are especially likely to develop it. A child with Sever’s disease often limps after practice, walks on tiptoes, or complains that the heel hurts first thing in the morning. Our page on Sever’s disease explains how stretching, heel cups, and activity changes usually resolve it.

Osgood-Schlatter Disease (Knee Pain)

Osgood-Schlatter disease affects the growth center just below the kneecap, where the patellar tendon attaches to the shinbone. Repeated running, jumping, and kneeling pull on this area during a growth spurt and cause a painful, sometimes visible bump. It is common in basketball, volleyball, soccer, and gymnastics, usually between ages 10 and 15. Most children recover fully once growth slows, and our Osgood-Schlatter disease page covers how we manage pain so kids can stay active in the meantime.

Little League Elbow

Little League elbow is an overuse injury to the growth plate on the inner side of the elbow, called the medial epicondyle. The repeated stress of throwing, especially pitching with high pitch counts or without enough rest, pulls on this growth center and can cause pain, swelling, and reduced throwing speed or accuracy. It appears most often in baseball and softball players between about 9 and 14. Left untreated, the injury can progress to a growth plate fracture or long-term elbow problems, so we take inner elbow pain in a young thrower seriously. Our Little League elbow page details rest periods, throwing programs, and prevention.

Little League Shoulder

Little League shoulder is a stress injury to the growth plate at the top of the upper arm bone, the proximal humerus. Like Little League elbow, it is caused by the high, repeated forces of overhead throwing, and it most often affects pitchers between 11 and 16. A child may describe pain at the side or front of the shoulder while throwing, and X-rays sometimes show widening of the growth plate compared with the other arm. Treatment centers on a period of no throwing followed by a structured return. Our Little League shoulder page explains what parents can expect.

Stress Fractures

A stress fracture is a small crack in a bone caused by repeated impact rather than a single injury. In young athletes, stress fractures occur most often in the shin, foot, and lower back, and they are common in running, cross country, basketball, gymnastics, and dance. Pain usually builds during activity and eases with rest, and the area may be tender to the touch. Sudden increases in training volume, poor footwear, and inadequate nutrition all raise the risk. Early stress fractures do not always appear on X-rays, so we sometimes use follow-up imaging to confirm the diagnosis. Our stress fractures page covers healing time and safe return to running.

Osteochondritis Dissecans (OCD)

Osteochondritis dissecans is a condition in which a small area of bone beneath the cartilage of a joint loses blood supply and begins to soften or separate. It most commonly affects the knee, followed by the elbow and ankle, and it is seen in active children and teens with open growth plates. Symptoms include joint pain with activity, swelling, and sometimes a catching or locking sensation. Many OCD lesions in younger children heal with prolonged rest and activity changes, while larger or unstable lesions may need surgical treatment. Our osteochondritis dissecans page explains how we monitor healing.

Spondylolysis (Low Back Stress Injury)

Spondylolysis is a stress fracture in a small bony bridge at the back of a lower spine vertebra. It is one of the most common causes of persistent low back pain in teen athletes and is linked to sports that involve repeated arching or twisting of the back, such as gymnastics, cheer, dance, football, diving, and volleyball. Back pain that lasts more than a couple of weeks in a young athlete is not normal and should be evaluated. Our spondylolysis page describes bracing, rest, and core strengthening.

Tendinitis and Other Repetitive Strain Injuries

Older teens whose growth plates are closing begin to develop more adult-style overuse injuries, including patellar tendinitis, sometimes called jumper’s knee, Achilles tendinitis, and rotator cuff irritation in swimmers and throwers. These problems usually respond well to rest, targeted stretching and strengthening, and corrections to technique or training load.

EVIDENCE / COMPARISON TABLE

Ages are approximate. Sources: AAOS OrthoInfo and Nemours KidsHealth condition overviews.

The overlap in this chart is one reason we ask about a child’s age, growth, and sport at every visit. A 12-year-old soccer player with heel pain, a 13-year-old basketball player with knee pain, and a 12-year-old pitcher with elbow pain are all in the age range when growth centers are most vulnerable, even though each injury involves a different joint.

We were very pleased with the care our child received. The team was calm, professional, and made a difficult situation much easier

Compassionate care during a stressful moment

After a long recovery elsewhere, we came here for another perspective. The provider offered a straightforward, helpful plan that finally moved our child forward

A second opinion that made all the difference

Our experience was excellent. The staff was attentive and made sure our child received the best care possible. We left feeling supported and informed.

We’re grateful for the thoughtful, professional approach

We felt confident in the treatment plan and appreciated how clearly everything was explained. The follow‑up care was just as thorough and reassuring.

Exceptional care and clear communication

The team made us feel supported from the moment we arrived. They were kind, patient, and focused on making sure our child felt comfortable throughout

They truly put children first

Had a visit for my 7 year old pitcher. He’s been complaining about his elbow. Everything about this visit was amazing. Every single staff member

Suzy Wade

Acute Sports Injuries in Children

Not every sports injury builds slowly. We also treat the acute injuries that happen during games and practices, including:

• Fractures. Broken wrists, forearms, fingers, collarbones, and ankles are common in contact sports, skating, and any activity with falls. Many of these involve the growth plate, which our growth plate injuries page covers in depth.
• Sprains and strains. Ankle sprains are among the most frequent injuries in basketball, soccer, and volleyball. In younger children, an injury that looks like a sprain may actually be a growth plate fracture, so a careful exam matters.
• Knee injuries. Twisting and cutting sports can injure the ligaments, meniscus, or kneecap. Teens, especially female athletes in soccer and basketball, are at higher risk for anterior cruciate ligament injuries.
• Avulsion fractures. A strong muscle contraction during sprinting or kicking can pull a small piece of bone away at a growth center, often around the hip or pelvis in teen athletes.
• Dislocations. Kneecap and shoulder dislocations occur in contact and collision sports and need prompt evaluation.

Our fracture care page explains how we treat broken bones in children, and having X-rays taken in the same office where your child is examined allows us to review images and discuss a plan in one visit.

Warning Signs Parents and Coaches Should Not Ignore

Children often downplay pain, so it helps to know what to watch for. Schedule an evaluation if your young athlete has any of the following:

• Pain that lasts more than a few days or keeps returning with the same activity
• Pain during activity, not just soreness afterward
• Pain at night or at rest
• Limping, favoring one side, or changing the way they run or throw
• Swelling, a visible bump, or tenderness over a joint or the end of a bone
• A drop in performance, such as slower throwing speed, less accuracy, or reduced jumping
• Stiffness, catching, locking, or a joint that gives way
• Low back pain that lasts more than two weeks

Seek emergency care right away for an obvious deformity, a bone breaking through the skin, numbness or tingling, a cold or pale hand or foot, or a head injury with confusion, vomiting, or loss of consciousness.

How We Diagnose Sports and Overuse Injuries

An accurate diagnosis starts with a detailed history. We ask which sports your child plays, how many teams they are on, how many hours a week they practice and compete, when the pain started, and what makes it better or worse. For throwers, we ask about pitch counts, positions played, and how many months of the year they throw. These details often point to the cause as clearly as any test.

Next, we perform a physical exam that checks tenderness, swelling, range of motion, strength, flexibility, and the way your child moves. We compare the injured side with the healthy side, which is especially useful in children because normal growth centers can look different at different ages.

X-rays are the first imaging test for most sports injuries in children. They show fractures, growth plate widening, and changes at growth centers. When X-rays are normal but symptoms suggest a stress fracture, an OCD lesion, or a soft tissue injury, an MRI or other advanced imaging may be recommended to see the bone and cartilage in more detail.

Treatment Options for Young Athletes

The goal of treatment is not only to heal the current injury but to help your child return to sport stronger and less likely to get hurt again. Most sports and overuse injuries in children heal without surgery.

Relative Rest and Activity Changes

Rest is the foundation of treating overuse injuries, but it rarely means complete inactivity. Relative rest means stopping or reducing the specific activity that causes pain while keeping your child active in other ways, such as swimming or cycling for a runner with a stress fracture. This protects the healing tissue while maintaining fitness and morale.

Bracing, Casting, and Supportive Devices

Depending on the injury, we may recommend heel cups for Sever’s disease, a strap for Osgood-Schlatter disease, a walking boot for a stress fracture, a back brace for spondylolysis, or a cast or splint for a fracture. These devices reduce stress on the injured area while it heals.

Physical Therapy and Strengthening

Many young athletes benefit from a structured program to improve flexibility, core and hip strength, balance, and movement patterns. Correcting tight muscles and muscle imbalances addresses the root cause of many overuse injuries and lowers the risk of recurrence.

Technique and Training Adjustments

We look at how much your child trains, how quickly training has increased, and whether technique contributes to the problem. For throwers, this often includes a gradual return-to-throwing program and attention to pitch counts and rest days. For runners, it may involve adjusting weekly mileage and footwear.

Surgery When It Is Needed

Surgery is reserved for injuries that will not heal reliably on their own, such as displaced fractures, unstable OCD lesions, and certain ligament injuries. When surgery is the right choice, we explain the procedure, recovery, and expected outcome clearly so your family can make an informed decision.

Writer note: align this subsection with Deric’s approved list of surgical and non-surgical procedures from the site outline.

Returning to Sports Safely

Returning too early is one of the most common reasons an overuse injury comes back. We clear young athletes to return to play when pain is gone during daily activities and sport-specific movements, strength and range of motion match the uninjured side, and any fracture has healed on X-ray. Return is usually gradual, starting with light practice and building toward full competition over several weeks. We share a clear plan with parents and, when helpful, with coaches and athletic trainers, so everyone knows what your child can and cannot do at each stage.

Preventing Overuse Injuries in Young Athletes

According to the Centers for Disease Control and Prevention, more than half of sports injuries in children are preventable. The American Academy of Pediatrics offers several practical guidelines for families, and we share them often:

• Take regular time off. Young athletes should have at least one to two days off from organized sports each week and two to three months off from their primary sport each year, ideally in one-month blocks.
• Delay specialization. Playing a variety of sports builds a wider range of skills and spreads stress across different muscles and joints. Many experts recommend waiting until mid to late adolescence before focusing on one sport.
• Watch weekly hours. A widely used guideline is that a child should not spend more hours per week in organized sports than their age in years.
• Increase training gradually. Sudden jumps in practice time, mileage, or intensity, such as the first week of a new season, are a common trigger for stress fractures and tendon injuries.
• Use proper equipment. Well-fitting, supportive shoes and sport-appropriate protective gear reduce stress on growing joints.
• Do not play through pain. Pain is a signal, not a test of toughness. Early evaluation usually means a shorter recovery.

Pitch Count Guidelines for Young Baseball Players

Throwing injuries are among the most preventable injuries in youth sports. MLB and USA Baseball’s Pitch Smart program sets daily pitch limits by age, along with required rest days based on pitches thrown. Pitch Smart also recommends that young pitchers avoid pitching on consecutive days, avoid playing catcher on days they pitch, and take at least four months off from competitive overhead throwing each year.

Limits like these only work when everyone keeps count. With overlapping club, school, and recreational teams, it is easy for a young pitcher to exceed safe limits across a single weekend. Keeping a shared log between teams is one of the simplest ways to protect your child’s arm.

Frequently Asked Questions About Youth Sports and Overuse Injuries