Grown-ups might hurt a bit after strenuous physical activity. That’s not unheard of—in fact, it happens as we age. “But kids shouldn’t hurt all the time,” says Dr. Heidi Prather, an orthopedic surgeon with Washington University Physicians.

“Sports are good,” Prather says. “Participating in sports can set up healthy habits that carry over to adulthood, but we do see some kids who are really pushed to excel in a particular sport from an early age,” When one joint or movement is repeated over and over, such as pitching a softball, even kids’ supple bodies can begin to break down.

“All sports can carry a risk of overuse injury. Young bodies are not any more protected from overuse injuries than adults’,” says Dr. Mark Halstead, a sports medicine physician with St. Louis Children's Hospital. “We certainly see plenty of overuse injuries in young athletes from either participation in multiple sports at once, or from playing in a single sport year-round without time for rest and recovery.”

Although children can be victims of overuse injuries, the nature of these injuries is somewhat different than the typical adult sports injury. “In adults, we tend to see most overuse problems related to tendons. In younger kids, especially those who are still growing, we commonly see overuse issues related to growth areas in the bone called the apophysis,” Halstead says. “These areas are where the tendons attach to the growing bone. The constant tension of the tendon tugging on these growing areas can stress the area and cause pain.”

Stress fractures are another overuse injury that can occur at any age, usually due to repeated impact to the bone without adequate recovery time between workouts. But whether impacting bones or overusing muscles and tendons, Prather notes that cross-training can help prevent injury.

“A lot of overuse injuries are because kids aren’t cross-training much, and it’s easier to develop an overuse injury because of training in the same way all the time,” Prather says. “For example, a gymnast who doesn’t cross-train can get compression-type injuries from the landings and jumps; and she’ll be more at risk for stress fractures, especially in the ankle, hand, wrist and back. On the other hand, a baseball pitcher who’s constantly throwing may have an overuse of the soft tissue around the elbow or shoulder.”

Prather emphasizes the importance of "loading joints in a balanced way." In other words, all joints and their supporting tissues should be trained for strength, endurance and flexibility. 

Overuse injuries generally present with pain during the physical activity. “Soreness after working out may be normal, but once it creeps into the actual act of doing the activity, that’s always cause for concern,” Halstead says. “It should not be acceptable to be told to just push through pain with activity in children. If the pain causes them to cry, limp, not be able to use an area or cause swelling, it should be evaluated.”

Ice, rest and over-the-counter pain remedies may be helpful, but any pain or soreness that persists beyond two weeks should be evaluated by a physician, Halstead adds.

Know what your kids’ workouts are like, Prather advises. “Are they balanced? Do they include a good cool-down? Remember, if your child needs Tylenol for pain after every practice, it’s time to get him or her checked out by a doctor.”

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