Young athletes today are more committed than ever, extra training sessions, weekend tournaments, strength sessions, school teams, club teams, academies… the list goes on. While this enthusiasm is fantastic to see, it also means we’re seeing more overuse injuries in children and teenagers than ever before. These aren’t sudden, dramatic injuries. They’re the slow-burning, nagging pains that build when training load outweighs the body’s ability to recover [1,2].
The upside? With early recognition and a sensible approach, these injuries are highly preventable and very treatable.
What Exactly Are Overuse Injuries?
Overuse injuries develop when a young athlete’s body is repeatedly stressed without enough recovery time in between [1].
Unlike adults, adolescents are still developing:
● Bones are softer and have open growth plates
● Tendons are less adaptable to repetitive load
● Muscles may not keep up with rapid changes in bone length
This means the same activity that feels “normal” in an adult can overload an adolescent’s tissues much more quickly [3].
Common examples include:
● Heel pain (Sever’s disease)
● Knee pain at the tibial tuberosity (Osgood–Schlatter)
● Patellar tendinopathy
● Shin splints
● Early stress reactions
● Shoulder pain in swimmers or throwers
● Lower-back pain in gymnasts, dancers or cricketers
Most of these injuries start mild — so early recognition is absolutely key.
Why Young Athletes Are More Likely to Develop Overuse Injuries
1. Growth Spurts: The Game-Changer
Growth spurts change everything. Bones lengthen rapidly, but muscles and tendons lag behind, creating extra tightness and tension across joints. This increases stress on growth plates and soft tissue structures [4].
This is why a child who was pain-free for years suddenly develops heel or knee pain “out of nowhere”.
2. Early Sport Specialisation
Children who specialise too early, particularly in sports with high repetitive loads like football, swimming, tennis, gymnastics, are significantly more likely to develop overuse injuries [5,6].
This happens because:
● The same movement patterns are repeated too often
● There’s no variation in tissue loading
● Recovery between seasons is reduced
Long-term, early specialisation also increases burnout risk.
3. High Training Volume
When match schedules, school PE, training sessions, and strength work all add up, load easily exceeds what a young body can recover from [2].
A simple rule:
If loads rise quickly but recovery doesn’t, tissues get irritated.
4. Not Enough Recovery (Sleep, Rest Days, Off-Seasons)
Children and teenagers need more sleep and more rest than adults. When school, homework, screens and sport combine, recovery becomes the first thing to slip [2].
Rest days protect young bodies from overload just as much as training builds strength.
5. Changing Coordination During Growth
When bones grow quickly, movement patterns temporarily become less smooth and less efficient. This change in biomechanics puts more stress on joints and soft tissues [4].
It’s not clumsiness, it’s physiology.
Warning Signs That Should NEVER Be Ignored
Parents and coaches should watch out for:
● Pain during activity that lingers afterwards
● Limping or avoiding certain movements
● Loss of speed or explosiveness
● Pain first thing in the morning
● Swelling, tenderness, or localised soreness
● A child repeatedly asking to “sit this one out”
These are early markers of tissue overload, not just “growing pains”.
How Physiotherapy Helps (Without Stopping Sport Completely)
Physiotherapy isn’t about telling kids to stop doing what they love. It’s about keeping them active safely.
1. Identifying the Real Cause
A physio will assess whether the issue is:
● Tendon overload
● Growth-plate irritation
● Bone stress
● Weakness or tightness linked to growth
● Technique inefficiencies
● Simply too much load too soon
Early clarity saves months of frustration [1].
2. Smart Load Management
We rarely pull a child out of sport unless absolutely necessary. Instead, we adjust:
● Training intensity
● Session frequency
● Pain-causing drills
● Running volume
● Jumping Exposure
Done well, this allows symptoms to settle while keeping the athlete moving [2].
3. Strength Training (Safe, Essential and Underused)
Supervised strength and conditioning improves:
● Joint control
● Load tolerance
● Balance and coordination
● Movement efficiency
● Injury resilience
And yes — it’s safe for children and adolescents when guided properly [7,8].
4. Mobility and Flexibility Work
Fast-growing athletes almost always have tight quads, calves or hamstrings [3].
Targeted stretches and mobility drills reduce stress at common injury sites like the heel and knee.
5. Movement Coaching
Correcting running mechanics, landing strategy, or change-of-direction technique significantly reduces joint load [9].
Small tweaks, big improvements.
6. Structured Return-to-Sport Progression
Once symptoms settle, we gradually reintroduce:
● Speed
● Jumping
● Cutting
● High-intensity drills
● Full training
● Match play
This prevents re-injury and ensures full confidence on return.
What Parents & Coaches Can Do
- Create an environment where pain can be reported
Kids often hide pain to avoid missing training [1]. - Protect recovery
Sleep + rest days = injury prevention [2]. - Avoid early specialisation
Multi-sport athletes have fewer injuries and better long-term performance [5,6]. - Follow sensible training guidelines
According to the AAP [2]:
● 1–2 rest days per week
● At least 3 months off per year from 1 sport
● Don’t exceed training hours per week > child’s age
These three rules alone prevent a huge number of overuse injuries.
- Use neuromuscular warm-ups
Warm-up programmes like FIFA 11+ reduce lower-limb injuries in young footballers by improving strength, landing mechanics and coordination [9,10]. - Seek help early
Prevention and early intervention always beat long-term rehab [1].
Our Barnet, Cockfosters & Enfield Physio’s have tons of experience and are specialists in treating adolescents . Have confidence that our specialist Physiotherapists will closely assess, diagnose & treat you in the correct & evidence-based way for all injuries. You can book an appointment here.
Blog By: Emre Oz (Musculoskeletal Physiotherapist at Crouch Physio).
References
- DiFiori, J.P. et al. (2014). Overuse injuries and burnout in youth sports. Br J Sports Med, 48(4), 287–288.
- AAP Council on Sports Medicine and Fitness. (2024). Overuse injuries, overtraining, and burnout in young athletes. Pediatrics, 153(1).
- PhysioPedia (2021). Injuries specific to children and teenagers.
- Parry, G.N. et al. (2024). Growth, maturation and injury risk in elite youth athletes. Br J Sports Med, 58(2), 88–95.
- Myer, G.D. et al. (2015). Early sport specialisation and injury risk. Sports Health, 7(5), 437–442.
- Jayanthi, N. et al. (2020). Sport specialisation and overuse injury risk. Am J Sports Med, 48(2), 325–332.
- Lloyd, R.S. et al. (2016). NSCA Position Statement: Long-Term Athletic Development. J Strength Cond Res, 30(6), 1491–1509.
- Lloyd, R.S. et al. (2015). Strength and conditioning in youth athletes. J Strength Cond Res, 29(5), 1439–1450.
- Kibler, W.B., Sciascia, A. & Uhl, T. (2017). Movement mechanics and youth sport injury. Sports Health, 9(2), 113–118.
- Hilska, M. et al. (2021). Neuromuscular warm-up and injury reduction in children’s football. Transl Sports Med, 4(3), 347–355.
