As a pediatric orthopaedic surgeon, the most common complaints I am asked to evaluate involve overuse syndromes. Theses syndromes cause pain in many areas of the body including the knee, foot, heel, hip, elbow and shoulder--commonly where muscle and tendon units attach to bone via growth centers. Often there is no specific trauma, just progressively worsening pain with activity which usually improves with rest.
These kinds of injuries stem from our children doing more sports, at a higher intensity with fewer or no breaks between seasons. Our society has placed an increased emphasis on competition over recreation and I think this is largely to blame. Little league, youth soccer, football, cheerleading and dance, are all now associated with regional, state and national competitions, rather than just exercise and fun. The kids feel an increased pressure to perform when they are hurting to not miss the big event, or let the team down.
Even in gym class, with new programs to combat childhood obesity and the ever growing tendency for our children to sit in front of a computer or play video games, kids are being asked more frequently to run the mile, the pacer, and lift weights. Often these activities are without the appropriate shoe wear, stretching, safety and individualizing of what is most appropriate for each particular child.
It is important to note that most of these overuse/repetitive stress injuries carry little to no long term detriments to the child. To some degree, they can “play through the pain” but it is not going to go away and if the child is truly limping, it has gone too far. Not to mention that a child “playing through the pain” often changes their mechanics and can risk another injury. It is always important to differentiate between minor achiness that progresses over time and the acute onset of pain.
So you may ask, what is the best way for a parent to help their child avoid or minimize the chance of getting these types of injuries? First encourage and teach appropriate stretching both before and after activities of all major muscle groups. Next encourage light off season training, stretching, light running and swimming. Don’t go from no running, to soccer tryouts where kids are running several miles a practice.
The best advice for parents is to know that each child is different. Participating through pain is okay in some, but not all circumstances and it is hard to know as a parent how to differentiate. It is also sometimes impossible to convince your child to take a break when not coming from the voice of someone other than the parent. Any pain that is persistent, does not go away with a few days rest, is associated with swelling or bruising or starts fairly abruptly should be evaluated. There are no specific time frames for these injuries to go away. The longer the symptoms have been around, the longer they take to go away. Your child can safely return to sports when they can do light jogging, demonstrate equal strength and improved flexibility – all without pain. This can be 3 weeks, it can be 6 weeks or it can be 12.
My best advice to the athlete, “No pain no gain” is not always okay. Be honest with yourself and your coaches/teachers when you are hurting. Often a brief break or avoidance of only certain activities for a short while will help. Every visit to the doctor does not necessarily mean a complete break from sports. Often we can just help ease the symptoms until the big game is over. STRETCH! And remember, performing on an injured or painful limb can often leave you at risk for worse injuries that could be season or even career ending.
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