Stay in the Game: Avoiding Overuse Injuries in Teen Athletes

Dr. Lynn Pantuosco-Hensch, Westfield State University

For my fifth-grade boys’ soccer team, our last season was marked by many changes characteristic of typical adolescent transitions. Players on our team began to experience growth spurts, adolescent awkwardness, growing pains, social-emotional changes -- and overuse injuries. Although this is my oldest son’s team, I have prior experience as a soccer coach over the past 20 years at the youth, club, high school and collegiate levels. That experience combined with my research interests allowed me to make observations, track trends, and develop some useful advice for adolescent athletes and their families.

Essentially, many of the questionable habits that the players got away with more easily in elementary school (such as not eating or sleeping well, neglecting to warm up, juggling sports demands) began to catch up with them. As the physical and schedule demands of multiple sports or multiple teams in a single sport escalate, there is greater likelihood of negative issues such as injuries during adolescence. The hope is for adolescent athletes to reduce acute and overuse injuries – to stay healthy and stay in the game.

Adolescents More Prone to Injuries

Adolescence can impact athletic performance in many ways due to increases in body size, hormones, and muscular strength. Height and weight increases during a growth spurt can reduce balance and body control, resulting in adolescent awkwardness. In particular, longer legs and arms can have an impact on manipulative skills such as throwing and catching, swinging a bat or racquet, using a hockey or lacrosse stick, and kicking. Even basic locomotor patterns such as running or jumping may need to be relearned on a neuromuscular level.

Physical changes during adolescence combined with increasing demands of practice and game schedules can lead to injuries, many of which can be prevented. Adolescence is an especially important time to build good health and fitness habits. Between the ages of 11-13 years old, 70% of children will drop out of organized sport. A better understanding of overuse injuries in youth sports can enable parents to more effectively support their young athletic children.

Overuse Injuries

According to the Cleveland Clinic, up to half of all injuries seen in pediatric sports medicine are related to overuse. Overuse injuries occur when children repeatedly play the same sport, using the same muscle groups in similar ways without adequate rest and recovery.

These injuries can affect muscles, ligaments, tendons, bones, and growth plates. In children, these structures grow unevenly, increasing the likelihood of injury during adolescence. The most common overuse injuries involve feet, ankles, and knees.

Causes of Overuse Injuries

According to the American Academy of Pediatrics, “The risk of injury is multi-factorial, including training volume, competitive level, and pubertal maturation stage.” Some common causes of overuse injuries include:

Schedule: Too many practices and games without proper rest and recovery is a risk factor. Overscheduling can also lead to athletic burnout from mental and emotional fatigue.

Specialization: Early specialization in sport and lack of multisport participation leads to repetitive movements, lack of variety of movements, and reduced balance of muscle groups.

Multiple teams in the same sport: Playing on more than one team in the same sport increases the likelihood of schedule demands and repetitive movements.

Multiple teams in the same season: Playing two sports in a single season reduces the opportunity for rest and recovery, but it also offers a chance to vary movements.

Structured vs. unstructured play: Children who play more structured sports (teams and leagues) and less unstructured sports (pickup games) tend to be more susceptible to overuse injuries.

The shortfall of the research on long-term athletic development is that it addresses general trends more than practical strategies for individual athletes. This is where parents come in! By familiarizing ourselves with best practices, we can provide our children with a healthy youth sports atmosphere throughout adolescence.

As any good coach would do, I’ve broken down the game plan into preseason, in season and off season suggestions.


Fitness: One of my most significant observations from coaching is the lack of general fitness of many young athletes. When we were kids, it seemed like we could run all day and did. Lack of general fitness makes growing children and young adults more susceptible to injuries, especially overuse injuries. An unfit body will not hold up to the same demands as well as a fit body. Improving basic cardiovascular and muscular fitness before the sports season begins is key. This can be as simple as running sprints or doing push-ups, lunges, or squats at home.

Equipment: Proper equipment is essential, ranging from safety gear to foot wear. Parents should learn about and purchase proper safety equipment. When my children were new to ice hockey, I asked the coach for a tutorial on what to buy and how to dress appropriately. As adolescent athletes log more hours of play, a healthy body often starts from the bottom up. Recall that injuries to feet are among the most common. I recommend buying quality sneakers, cleats, and skates. Despite the reality that children go through shoes quickly (and the inevitable expense that goes with replacing them), the increase in use, body weight, and biomechanics warrants supportive, ergonomic footwear. Be sure to learn about sport-specific needs by asking coaches, experienced players, and some retailers. I often see adolescents wearing the wrong size or quality gear. There is also a tendency to forego safety equipment unless required by a parent or coach (for example, mouth guards).

Schedule: A well-organized schedule can help to avoid overuse injuries. This requires communication between coaches, parents, and players. When determining a schedule and routine for an adolescent athlete, be sure to include him or her in the process. A typical pattern is to prioritize the in-season sport and then club sports over recreational sports. Usually during adolescence, children begin to identify a primary sport which begins to dictate the schedule. I advise remaining a multi-sport athlete throughout the tween years if possible schedule-wise.

Goals: A child’s goals should be the focus of the preseason family game plan. As former athletes and now coaches, my husband and I are very careful not to impose our goals on our children (it’s not easy!). For example, last spring my son juggled lacrosse, club soccer, and town travel soccer teams. There is no doubt it was a lot. He really wanted to be on all three teams, so we made it work following many of the tips shared here. As parents, we can guide goal setting and athletic decision making.

In Season

Nutrition and Sleep: During a sport season the standard sleep and eat well advice applies more than ever. Well rested and nourished young athletes are more likely to outperform their less prepared counterparts. There is a plethora of nutritional advice available, but athletically, a focus on hydration and changing dietary needs is particularly helpful. For example, during peak growth phases iron and calcium consumption is especially important. Most young athletes learn too late to prioritize their sleeping and eating habits. Getting enough sleep and eating healthy require planning and discipline. It’s easy to forgo bedtimes and eat junk. It’s far more difficult to plan meals, pack snacks, and get to bed at a decent hour. These are prime examples of childhood habits that will no longer suffice during adolescence if a young athlete wishes to maximize performance and reduce injury rates. The biggest pitch here is to help a child view healthy habits as what athletes do in order to be successful. Eating and sleeping well should be part of the package deal.

Time limits: During a sport season, there are guidelines for how much time should be spent playing sports. Research by the American Orthopaedic Society for Sports Medicine (AOSSM) showed that “young athletes who participated in more hours of organized sports per week than their age in years also had an increased risk of an overuse injury.” Adolescent athletes are encouraged to stay under 16-20 hours of vigorous physical activity per week. In the 10-14 age range, organized sports time should be 75% training and 25% competition. Most youth leagues likely have a higher competition to training ratio than advised. Athletes are also advised to take 1-2 days off per week. Although not simple, balancing time commitments can reduce the likelihood of overuse injuries.

Healthy progression: Doing too much too fast can also increase susceptibility to injury. A basic rule of thumb is to increase training volume 10% per week over the course of a season. Mapping out a gradual progression over time is helpful for young athletes. As a parent, watch for overload or plateaus and adjust accordingly.

Warm ups: Warming up is an important safety component to competition. While most coaches have good intentions, team warm ups do not always meet individual needs. Figure out what helps your child feel physically prepared for competition. In our family, we go for walks or light jogs early on game days. My children sometimes go on our elliptical machine for a few minutes to get their blood flowing and then stretch. Any combination of cardiovascular exercise followed by dynamic stretching should be helpful preparation. When any of our children have sore muscles or other aches and pains, we use a microwavable corn filled heat pack to warm the area before moving. Warm muscles are less likely to sprain and strain. This is especially useful during road trips to avoid stiffness (also during those cold ice hockey  seasons).

Fortunately, there are some warm up programs specifically designed to prevent injuries. One of the best examples is the Prevent injury and Enhance Performance (PEP) program designed to address potential deficits in the strength and coordination of the stabilizing muscles around the knee joint. An added benefit of this 15-minute warm up routine is that athletes are also building all-purpose agility, balance, and coordination. A routine like PEP can be done at home or recommended to a coach for team use.

Proper technique: As training volume increases and competition levels rise, movement and sports skills really need to be done with proper form. Parents can help children learn proper form by demonstrating, watching videos, or reinforcing good habits. For example, when one of my sons wasn’t shooting a soccer ball correctly, we took a quick video so he could see himself and better understand the feedback he was given. Repeated, improper movements over time can lead to injury.

Neuromuscular training: Integrating sports skills training with motor skills can build a better athletic foundation for adolescent athletes. An improved foundation can also reduce the risk for future injury. Equipment such as ladders, hurdles, jump ropes, and plyometric boxes can be used for neuromuscular training. Exercises like squats, lunges, or toe raises can be done at home or with a friend.

Post-game: A proper cool down routine can speed up the recovery process. Adolescent athletes should be encouraged to stretch after games and practices. This is one of the tips we struggle with in our family. After racing from one sport to another, getting home to eat dinner and do homework, some nights there are not enough hours in the day. Helping our kids learn how to stretch independently has helped. We have some neat fitness products at home that are worth sharing. A stretch out strap helps with common stretches that could otherwise be partner assisted (and comes with an instruction booklet). Another of our favorites is a vibrating foam roller. The at-home options are becoming more affordable. Regular foam rollers also provide a deep tissue massage which helps to reduce muscle soreness and muscle pain. As would be expected, the vibrations add to the restorative experience. Lastly, the use of ice remains helpful for reducing swelling and pain as needed post-game. Young athletes should attend to post-game needs and build good habits during adolescence.

Mental Training: With all of the emphasis on physical preparation for sport it is easy to forget the mental aspects. Developing routines and setting goals are examples of the many mental skills that can be developed. The book Bring Your “A” Game: A Young Athlete’s Guide to Mental Toughness provides some valuable, step-by-step resources for young athletes to build their mental skill set. Especially important for reducing risk for injury are healthy pre-game and post-game routines that include nutrition, hydration, stretching, and personal reflection. A disciplined routine can help to stave off nagging injuries, as well.

Off Season

Time off: When the playoff run is over, the sports parenting doesn’t end there. Experts suggest that young athletes take a total of three months off from a primary sport (in one, two, or three month chunks of time). Let your children miss their favorite sports every now and then. Even professional athletes take time off to decompress and enjoy other aspects of life. Our children should too. Fight the temptation of year-round participation in a single sport.

Cross train: The postseason is an ideal opportunity to cross train through a variety of sports or non-traditional physical activities. If you’ve considered trying the new local ninja parkour course, now is the time! After a competitive sport season, it is also advantageous to play a recreational sport. Better yet, encourage your children to enjoy some unstructured pickup games with family or friends.