It is sobering to see any young athlete felled by injury. Friday-night crowds fall silent when a high school football player remains motionless on the field after the pile of players rises. Parents watch anxiously when a pitcher grabs his elbow after an inning and grimaces in pain. Audiences gasp when a gymnast falters on the high bars or when a competitive cheerleader loses balance and plunges to the mat below.

Dramatic injuries, though, do not outnumber the increasing overuse injuries that orthopedic physicians are seeing in young athletes. Parents, the ones most likely to Pediatric Pain Youth athletics may lead to adult chronic pain protect their children, may be pushing them to keep participating, playing and winning, as Dr. Mark Hyman discusses in his book Until It Hurts (Beacon, 2009). So when should an injury sideline a sports career to prevent the onset of lifelong pain?

When 51-year-old Kim King competed as gymnast over 30 years ago, she had no idea that she was damaging her body. She has since undergone three knee surgeries and hip surgery, and is scheduled for shoulder and back surgery to repair a ruptured disc. Not surprisingly, she also suffers from arthritis.

“If I knew then what I know now, would I still have done it? Probably. As a kid, you feel invincible,” says King, who was set to train for Olympic trials when she broke her ankle doing a back flip. The injury finished her career.

King, however, was an advanced athlete when most kids were playing in backyards. Gone are the days when kids meet for a spontaneous pick-up game. Today, sports are highly scheduled and specialized. The American Academy of Pediatrics advises against specialization before puberty, citing the possibility of an over-use injury as the top reason.

Dr. Lyle Micheli, pediatric orthopedic surgeon and director of sports medicine at Children’s Hospital Boston, estimates that out of the 30 million children playing organized sports in this country, approximately 10 percent will suffer injuries.

In 2008 ABC News produced a report that listed the top 11 injury-prone high school sports. Topping the list was football. Following was lacrosse, a fast-growing sport in which, the report speculated, coaches might not be fully trained. Third was baseball/softball. Cheer-leading and gymnastics rounded out the top five.

sports44Many sports injuries occur when young athletes are growing, notes Dr. Micheli, because muscles can tighten and cause injury. One injury that Dr. Micheli sees regularly is what is commonly known as “Little League elbow.” This affliction can occur at load-bearing joints. If a pitcher overloads his elbow, the damage can be irreparable and lead to arthritis. Dr. Micheli also is seeing in children a rise of complex regional pain syndrome (CRPS), a condition previously known as reflex sympathetic dystrophy (RSD) and associated only with adult patients. CRPS, a complication of injury, is very rare and can occur when an acute injury worsens and develops into a chronic pain issue. For example, an athlete may sprain an ankle that then continues to worsen instead of heal. If the patient develops CRPS, she may feel pain with the slightest provocation, like a light touch to the skin surrounding the ankle.

“[CRPS] is difficult to get rid of and difficult to treat. It’s as if the body says that the wrist or ankle causes pain so the body wants to slough off what is causing pain,” says Dr. Micheli. “It may be genetic or it may be psychological. We don’t know yet what happens when these patients become adults who experience this.”

sports33Another concern for young athletes is a rise in concussions. Children’s Hospital Boston opened a concussion clinic last year and often patients and families discover a full waiting room with standing room only, according to Dr. Micheli. In 2006 Pediatrics, the official journal of the American Academy of Pediatrics, recorded more than 300,000 high school sports-related mild to moderate concussions. Most were suffered by football players, cheerleaders and volleyball players. Data for pre-high school sports-related concussions was unavailable.

“People don’t realize how devastating concussions can be for young children. One symptom following a concussion can even be depression. Plus, [the students] are still in school. Concussions are a big problem,” says Dr. Micheli.

While parents may call their pediatrician for most childhood ailments, a sports injury is best treated by an orthopedic physician or sports medicine specialist. Treatment can range from rest to a physical therapy regimen. The goal is to allow the injury to heal before the athlete jumps back on the field or court. Doctors with sports medicine training will know specific ways to treat certain injuries or even diagnose sports injuries commonly missed. What may appear to be a sprained ankle might be an entirely different injury.

Some suggestions to avoid injury in young athletes vary. One is to play multiple sports until adolescence. Specialization in one sport can cause overuse injuries. For example, an athlete who excels in Little League may participate in travel ball in the fall, camps during spring break and regular ball in the spring. The body does not get a break from the same type of exercise. Injuries also can result from poorly trained coaches. Dr. Micheli cautions parents to be attentive to coaches’ credentials.

“We have no official certification for coaches in the United States. We have drivers’ licenses and teaching certificates but none for coaches. Usually they are well-meaning volunteers with little knowledge about sports safety,” says Dr. Micheli.

He recommends that parents keep sports fun and avoid pressuring children to perform, which can lead to psychosomatic issues. The purpose of sports should be to provide good basic exercise.


According to Safe Kids USA (, a nonprofit sports injury prevention organization based in Washington DC, children cannot adequately assess their risks and may have diminished coordination, making them at greater risk for injury. Children between the ages of five and 14 account for nearly 40 percent of sports-related injuries treated in emergency rooms across the country. Children new to a sport are at greater risk.

Children rely on the adults who care for and who coach them to make the best decisions for their safety. Attention to precautions may prevent a young person from becoming an adult living a life of chronic pain.


More than 30 million children participate in sports annually. Each year, approximately 3.5 million children under age 15 are treated in hospitals, doctors’ offices, clinics, ambulatory surgery centers and hospital emergency rooms in the United States for sporting injuries.




Estimated Number of Sports-Related Injuries in the U.S. among Children Ages 0-14

sports7One study estimated that sports-related injuries in children has caused a health care cost (both indirect and direct) of around 1.3 billion dollars.

Facts courtesy of Safe Kids USA, Washington D.C. (Fall 2005)