Developing Physically Active and Sporty Kids - Overuse Injuries and Burnout

Original Editor - Jess Bell based on the course by Tracy Prowse
Top Contributors - Jess Bell, Kim Jackson and Naomi O'Reilly

This article or area is currently under construction and may only be partially complete. Please come back soon to see the finished work! (7/11/2021)

Introduction

A large number of children participate in organised sports every year. In the US alone, more than 46.5 million children play sports. While the benefits of physical activity are clear, involvement in organised sport can also lead to injuries and burnout. There were, for instance, 1.2 million injuries recorded for high school athletes in the US in 2015 to 2-16.

Each year, more than 10 percent of children aged under 14 are treated for sports injuries in the US. Half of all sports injuries in children aged over 10 years are overuse injuries.

However, despite these high rates, 70 percent of children who participate in sports will drop out by the age of 13. The reasons for this are explored here, but they may be partly due to the influence of pushy parents and coaches.

Growing Need For Intervention

Children may be at more risk of injury for several reasons. These are discussed in more detail here LINK, but the following factors should be considered:

• Immature bones
• Insufficient rest after an injury
• Poor training or conditioning / muscle strength
• Specialisation in just one sport
  • Young athletes are specialising in sports (and positions) at earlier ages, which is known to increase injury risk
  • It has been found that diversified sports training during early and middle adolescence may be more effective in developing elite-level skills
  • Specialisation can be delayed until late adolescence
• Year-round participation
  • Training schedules are often regimented and repetitive, which has increased the number of overuse injuries in children
• Changes in society
  • Shrinking backyard
  • Perceived danger
  • Technology
  • Less play time, more drill time

Overuse Injury and Burnout Prevention

A child’s history of injury is:

• A risk factor for future injury (during both adolescence and adulthood)
• A contributor to long-term degenerative diseases, such as osteoarthritis

As shown in Table 1, which is based on the work of DiFiori and colleagues, risk factors can be divided into intrinsic and extrinsic risk factors.

Table 1. Intrinsice and extrinsic risk factors. Key: +++ = strong predictor of future injury / burnout; ++ = moderate predictor; + = mild predictor; 0 = poor evidence, not considered a predictor of injury

Intrinsic Risk Factors	Extrinsic Risk Factors
Prior injury +++	Higher training volumes ++
Growth spurt +++	Overscheduling+ (recovery time ++)
History of amenorrhea +++	Poor-fitting equipment +
Joint hypermobility + (especially during adolescence)	Sport specialisation +
Readiness + (physical and psycho-social, not age)
Anatomic malalignment, flexibility, functional control of movement 0
Sufficient strength to withstand forces and range of motion +

Jayanthi and colleagues found that the following factors had an increased odds of serious overuse injury:

• Young athletes participating in more hours of sports per week than their age in years (i.e. > 9 hours for 9 years)
• Young athletes whose ratio of organised sport to free play was >2:1 hours per week

Recommendations

An intervention programme for overuse injuries should:

• Focus on preventable risk factors first (education and communication)
• Aim for proper technique / basic skills
• Strength and ability training should be part of the child’s part routine
• 10 percent rule:
  • Children should not increase their training volume by more than 10 percent a week
• Training workload and growth rates during growth spurts should be monitored, especially during early adolescence

For acute injuries, intervention programmes should include:

• One or two strength-training sessions a week, perhaps at the end of practice sessions
  • Children should exercise their whole body, including core work and specific muscles
• Include agility and proprioception exercises twice a week
• Make sure to include an adequate warm-up:
  • Prepare the neuromuscular system for competition
• Specific joint and muscle strengthening (particularly for hypermobility / low connective tissue tone)

Strength and agility training should be promoted in school sport:

• Use a variety of strengthening techniques
  • Therabands
  • Weights
  • Medicine balls
  • Swiss balls
  • Bodyweight
  • Gravity
• Agility and proprioception exercises should be sport-specific
• Connect with a health professional as to what muscles to focus on for which sports

Warm-up sessions should include:

• Half to three-quarter speed jogging and backwards jogging
• Mild jog with high knees, skipping, butt kicks and toe reaching
• Crawling calf stretch
• Lunges with twist and walking quadriceps stretch
• Warm-up with active, dynamic mobility exercises
  • Move through the range of motion necessary for a specific sport
  • If the athlete’s sport requires a range that they are yet to achieve, it is important to stretch (in the cool-down or at home)
• Three-quarter speed sport-specific coordination training
  • This includes any activity that challenges balance, stability and agility, such as:
    • Bounding
    • Hopping
    • Diagonal cutting
• Include a few strengthening exercises for muscles that tend to become strained in the relevant sport (often the hamstrings and groin muscles)

NB: The cool-down should include static stretches, and time should be given to drink fluid.