Dr. Shapiro completed his undergraduate education at UC San Diego, earning a B.S. in Biochemistry and Cell Biology, and a B.A. in Political Science. He furthered his education at UCLA where he earned a Masters Degree in Public…
5 Common Pediatric Overuse Injuries
Posted in Parenting 'Twee... by Dr. Jeremy F. Shapiro on Mar 21, 2013
I love this time of year when the weather encourages us to get outdoors and be physically active. And while baseball may be the first sport that comes to mind when we think of spring-time, in this day in age, pretty much all sports can now be played year round. So if a child or adolescent desires, they can play soccer, basketball, or even baseball all year long. And with this specialization of sports at an early age, pediatric overuse injuries are unfortunately becoming more and more commonplace.

So what I’d like to do is share 5 of the more common pediatric overuse injuries with my fellow DS members, so parents and adolescents know what to keep an eye out for. And I’d like to give a quick thanks to Dr. Tracy Zaslow (sports medicine physician) and Cora Maglaya (physical therapist) for inspiring me to write this after recently hearing their lecture on overuse injuries. So in no particular order:

1. Hip Apophysitis:
An apophysis is a growth plate where a muscle often attaches. An apophysitis is an irritation or inflammation of this growth plate often caused when the muscle that is attached is really tight or overused. This will often follow a sprinting exercise where there is a sudden-onset pain and a pop in the buttocks. Pain will also be noted when putting weight on the hip and even in the sitting position. Because the hip has quite a few apophyses, this condition can occur in different areas of the hip…often dependent on the type of athlete your child is. Gymnasts and soccer players are athletes commonly impacted by this condition. Treatment will often involve rest, icing, and gentle stretching (and even physical therapy) but depending on how severe the condition is, surgery might also be a possibility.

2. Shin Splints: Runners and jumpers are often sufferers of shin splints (AKA medial tibial stress syndrome.) Over a period of time, pain progressively worsens. Triggers included repetitive running downhill or on slanted surfaces. The young athlete will need to follow up with her physician as there can be a concern of a stress fracture. Treatment involves rest, ice compression, specific exercises (often under the guidance of a physical therapist,) and pain control. And in certain situations, orthotic shoe inserts may be helpful.

3. Sever’s Disease: AKA calcaneous apophysitis, I prefer saying condition rather than disease (just seems to have worse sounding implications.) This condition typically impacts children around 10 years of age (+/- 2 years) and presents with a few weeks’ history of heel pain…and specifically pain with activity and not necessarily walking. On exam, typically there will be tenderness to palpation along the heel. Treatment includes stretching the heel cord, resting, icing and even the use of full length shoe inserts. Unfortunately, the young athlete may need to take a break from a sport if the activity causes too much pain.

4. Osgood-Schlatter Disease: Again, I prefer saying condition rather than disease, but regardless, the typical presentation is of a 12 year-old soccer player with knee pain over the past few weeks. Pain is typically worse after playing sports and relieved by the usual rest, ice, and ibuprofen regimen. On exam, a “bump” might be seen just below the knee and about 25% of the time, it occurs in both knees. As with some of these overuse injuries, it can occur during periods of rapid growth. Depending upon how significant the symptoms are, treatment will involve routine stretching of the quads and hamstrings (upper leg muscles) and either include relative rest vs. full immobilization (not typically needed.)

5. Little League Elbow: AKA medial epicondyle apophysitis, this is typically seen in the younger age pitcher (‘tween years) who basically is just pitching too much. Other athletes who may experience this condition are those who play “overhead” sports…volleyball, water polo. The repetitive stress occurs on an apophysis in the elbow where pain is noted on the inner side of the throwing arm. Rest is key and that often involves not throwing for a few weeks (so be prepared, much of the baseball season will be missed.) When given clearance by your physician and/or physical therapist, stretching exercises will eventually lead to a gradual return to throwing.
But please remember that with any injury or unexplained pain, it is best to first see your child’s physician to accurately diagnose what is going on and determine the best course of action and treatment.

- Dr. Jeremy


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