What Exactly are ‘Overuse’ Injuries? Inside the Epidemic Sidelining Youth Athletes

By Nancy Justis, Iowa Youth Sports Initiative

Overuse injury.

The term itself seems fairly self-explanatory. Something in the body was used too much, and it led to injury. But with overuse injuries at an all-time high among youth athletes, you deserve to know more.

In ESPN Staff Writer Baxter Holmes' essential two-part series on overuse injuries in basketball, Dr. Nirav Pandya, a noted orthopedic surgeon at UCSF Benioff Children's Hospital, estimates that the number of pediatric sports injuries he now sees annually is quadruple what it was five years ago. Pandya says more than half of all surgeries he currently performs are on patients under the age of 14.

And what causes overuse injuries?

"All injuries stem from the body's inability to absorb force. Period. Force is constantly coming into the body, (and it) should be absorbed by the muscles," says Dr. Tommy John, chiropractor and author of the book Minimize Injury, Maximize Performance: A Sports Parent's Survival Guide. "If it's not fully absorbed by the muscles, it will go into tissues not designed to absorb that amount of force for that amount of time for that amount of reps. That could be a ligament, meniscus, tendon, cartilage, bone, etc."

"The force comes in and chips away at those areas. Constantly chips, chip, chips. (But) it only chips away if we're not able to adapt to the forces we're talking about. It's a relative term—overuse injury, it's all relative. What might be overuse for one person isn't for somebody else."

If an injury is not an overuse injury, it can typically be categorized as a traumatic injury. This refers to an injury caused by a one-time exposure to a tremendous, overwhelming amount of force. Think of falling from a high tree branch and breaking your arm, or a football player having the side of their knee barreled into by a lineman and suffering torn ligaments.

According to the Mayo Clinic, overuse injuries are generally more likely to occur as you get older, which makes the rise in overuse injuries among youth athletes all the more startling.

"This is 10, 12 years ago, and the kids coming into my baseball lessons, they were starting to come in more and more injured," says John, who was previously a baseball performance trainer. "The injury cases I was seeing in these kids, they were the things that 40-, 50-, 60-year-olds were experiencing. I'm like, wait a second, something's not right."

Early specialization is a driving cause of overuse injuries among youth athletes. Early specialization refers to the act of exclusively playing one sport from an early age. It's generally recommended that kids wait until at least their early teens until they start specializing, yet more children and pre-teens are playing one sport year-round than ever before. The schedules for these specializers are often packed with so many organized games and training sessions you'd think they were a professional.

When you only play one sport and engage in few other physical activities, you're bound to repeat many of the same motions over and over again. Maybe it's jumping up for a rebound. Maybe it's throwing a fastball. Maybe it's racing up and down the field in soccer. But eventually, all that repetition can take a toll. And when your body isn't strong enough to handle it—a fact which often ties into the poor posture many modern humans have due to our technology addiction—something's gotta give.

A 2017 study from the University of Wisconsin found that high school athletes with a "high specialization classification" had an 85-percent higher incidence of lower extremity injuries than high school athletes with a "low specialization classification." Essentially, athletes who specialized were found to be at a much higher risk of lower extremity injury than athletes who play and train in multiple sports.

An overlooked aspect of overuse injuries is that there are almost always warning signs leading up to the more severe incidents. John calls them "breadcrumbs."

"There's always something beforehand that leads to the big stuff. There's always some precursor to that point. There's always some sort of warning system the body gives. It's so rare (when there isn't)," John says."Somebody walks in—'My 12-year-old tore their meniscus.' How unfortunate—any injury history? 'Oh, yeah. History of rolled ankles, we've had orthotics in since she was 8, we've been playing the same sport (year-round). She's had swelling in her knee for three years. She's had shin splints forever. She's had tape and therapy and she does oils every night.' It's like there's this whole list of things, (and) it was only a matter of time before the body can't warn anymore. Then comes the catastrophic injury."

The professionalization of youth sports has also put parents and kids in a position where they often feel pressured to miss as little time as possible, lest other youth athletes "pass them by." The No. 1 priority after an injury is often reducing the pain as quickly as possible so the young athlete can return to their travel or AAU team, while the underlying causes of that pain go largely unaddressed.

"Pain is one of the last things to show up in dysfunction and injury, but the first to go away. And we use it as the greatest marker—which is sad. People aren't allowed to feel pain anymore. They're constantly icing, they're taking anti-inflammatories...They'll take off or do certain therapies or modes that have them come back. 'Well, you're 80 percent or so of where you were at when you came in, and we have to exit you because your insurance won't pay for this anymore. You've taken 2-3 weeks off, you're good!' Actually, you're worse off than you were before. Because you didn't take the time to level up to a person higher than the person who got injured. That person was not ideally-equipped—because you got injured, let's be honest," John says.

"We're applying that pro sport mentality to kids, and in addition to many other factors, it's almost impossible for anyone to heal in the current system of any sport because of the way it's set up. The time frame and the guilt that's laid on them. Well, if you take three months off, or you take six months off, or you take a year off of throwing—which might be best for some cases—they're like, 'What?' Because they're being sold this idea if you miss anything, you will be left behind."

The overuse injury epidemic in youth sports is the result of many convergent factors. Kids growing up with very little unstructured outdoor play, parents treating their kids like miniature pros, shady club teams looking to squeeze every dollar out of families, constant use of iPhones destroying posture—these all play a role. Yet past generations of kids played for hours upon hours each day, and their bodies rarely broke down. Thus, it boils down to one big question—how is the way kids play today different than it was then?