Sports Injuries: Bring on the Pain

Quick facts!

Every year, 30 million children and teens participate in some form of organized sports, in which approximately 3.5 million injuries occur. Almost one-third of all injuries in childhood are sports-related injuries. 

Although death from a sports injury is rare, the leading cause of death from a sports-related injury is a brain injury. Almost 50% of head injuries sustained in sports or recreational activities occur during bicycling, skateboarding, or skating incidents.

In adolescents, sports accounts for 500,000 doctor visits and 30,000 hospitalizations every year!

The highest rates of injury occur in sports that involve contact and collisions, but more severe injuries occur during individual sports and recreational activities.


Are some sports more dangerous than others?

Injury rates vary by sport, but average around 2.32 per 1,000 athlete exposure.

Source: Comstock RD, et al. National High School Sports-related Injury Surveillance Study. National Center for Health Statistics, 2016;1-23.

Another issue is sports specialization, commonly defined as ‘‘year-round intensive training in a single sport at the exclusion of other sports” and associated with high-volume training that can result in psychological stress and overuse injuries.

Certain factors related to growth and body composition are of specific significance in adolescent athletes: 

Source: Comstock RD, et al. National High School Sports-related Injury Surveillance Study. National Center for Health Statistics, 2016;1-23.

There are also certain risk factors that contribute to overuse MSK injuries: 

  • Sudden increase in the intensity, duration, and volume of physical activity
  • Poor conditioning
  • Insufficient sport-specific training
  • Poor training technique
  • Inappropriate equipment for the sport

Case 1: “Angels in the Olecranon”

An 8yo baseball player presents with right elbow pain. He’s a right-handed pitcher who has been practicing for the past 8 months, saying “I just throw fastballs”.

  • Pain at medial aspect, increasing over the past 3 weeks. Transient swelling. No redness. No neurological symptoms. No prior trauma. 
  • Exam: RUE without any obvious deformity. No redness or swelling at elbow, but tender to medial aspect of elbow joint. Full ROM of elbow, noting pain on active flexion. Also has pain with valgus stress and wrist flexion. Unremarkable neurological exam. 
  • XR imaging shows “widening and cortical irregularities of the physis separating the epiphysis and metaphysis”

What’s the diagnosis?


Growing Bones…

The site of maturing bone is the physis (aka the growth plate), located between the epiphysis and metaphysis. 

  • One type of epiphysis is the apophysis, which is the insertion point on bones for tendons. 
    • Strong muscle contraction can cause a piece of bone to pull away from skeleton at the relatively weak apophysis (i.e., apophyseal avulsion injury.)
    • Apophyseal inflammation can arise from repetitive traction. This injury most famously occurs at the tibial tubercle, leading to Osgood-Schlatter disease. 
      • A similar process can occur at the patellar apophysis, known as Sinding-Larsen-Johansson disease. 

Case 2: Chariots of Fiery Shins

A 15yo cross country runner presents with left leg pain. 

  • Recently returned to cross country practice after summer vacation. On average he runs 5 miles a day, noting that he didn’t run much over the summer. 
  • Exam: Pain along the medial lower leg without focal tenderness. 

You suspect medial tibial stress syndrome (aka shin splints) vs tibial stress fracture. But what’s the difference?

  • Both occur frequently in runners, often with rapid increase in activity and/or overuse. 
  • Pain often differs: shin splints tends to be more diffuse whereas stress fractures are more focal. 
  • Shin splints (clinical diagnosis) may lead to stress fractures (possibly clinical, but more often requires XR imaging).
  • Similarly, treatment is more conservative for shin splints (reduction in activity, ice, NSAIDs, PT) than for stress fractures (cessation of activity, immobilization). 

General therapeutic approach to non-operative injuries

Inflammatory Phase (0 to 72hrs) – think “PRICE”

  • PROTECTION: crutches, padding, shock-absorbing insoles, external supports
  • RELATIVE REST: Should be encouraged to engage in activities of daily living
  • ICE: Ice packs directly over affected area, preferably immediately after injury (20 min continuously or 10 min episodes with 10 minute breaks in-between)
  • COMPRESSION & ELEVATION: Helps with venous return / lymphatic drainage, quicker reduction in inflammation

Reparative / fibroblastic phase (72hrs to 3wks): regarding strength, ROM, flexibility

Maturation Phase (3wks to 2yrs): goal-directed return to full activity


Take-Home Points!

  • Pediatric sports related injuries are common (and likely to continue to occur with earlier sports specialization)
  • Most are overuse injuries and non-operative
  • Differential is rooted in stage of MSK development
  • “PRICE” can go a long way in acute inflammatory phase

Blog post based on Med-Peds Forum talk by Fritz Siegert, PGY3