Overuse Injuries

Overuse injuries can happen with repetitive motions and are often seen in athletes. The following are some common overuse injuries our team sees.

Jumper's Knee

What is jumper's knee?

Jumper's knee is an overuse injury that can be painful during activity. 

How to spot jumper's knee

The main symptom of jumper's knee is pain, although there may also be swelling. And if the condition is chronic, the tendon may tear or rupture. Your child will usually complain of pain below the kneecap, usually with running, jumping, climbing or squatting. Bending the knee and extending it against resistance may also be painful. In mild cases, pain occurs after strenuous activity. In more severe cases, pain continues even after the activity is complete.

How we treat jumper's knee

Most cases of jumper’s knee require:

  • Rest
  • Ice
  • Medicine to control pain and inflammation, such as ibuprofen
  • Physical therapy

In severe cases, athletes may need to stop their sport entirely until the pain is gone. A physical therapy program can then be used to gradually increase activity.

Osgood-Schlatter Disease

What is Osgood-Schlatter Disease?

Osgood-Schlatter Disease (OSD) is an overuse condition that causes swelling just below the knee on the upper part of the shin bone. It’s caused by repetitive, rigorous motion during sports that overworks the growth plate of the knee. Symptoms include pain, inflammation and a bump or knot at the top of the shin bone.

Risk factors for developing Osgood-Schlatter Disease

Rapid growth

When kids' bones grow in length, they tend to lose some flexibility as the muscles and tendons get stretched. A tight muscle-tendon unit, when contracting, will cause more stress at the anchor point compared to a flexible muscle-tendon unit.

Overlapping seasons

It is not uncommon for youth sports seasons to overlap, resulting in the athlete playing two sports at the same time. This increases the overuse stress on the growth plate, increasing the risk of injury.

Beginning of a season

The sudden increase in workouts that typically comes with a new season can put too much stress on growth plates. It’s better to ease into activity.

Year-round sports

Many sports are played year-round, not allowing time for young athletes’ bodies to rest, or "catch up" from the stress of a long season.

Summer sports camps

Often summer sports camps have kids play the same sport several hours a day for an entire week. This sudden increase in stress can lead to OSD.

How to spot Osgood-Schlatter Disease (OSD)

Symptoms include pain, inflammation and a bump or knot at the top of the shin bone. Boys ages 12 through 18 and girls ages 10 through 16 who are active in sports have the highest risk for this injury. This condition can occur with chronic repetitive tugging on the growth plate, or with one specific event such as fall or a sudden jump.

How we diagnose OSD

X-rays may be needed to rule out other conditions and may show an irregularity and fragmentation at the tibial tubercle.

Osgood Schlatter disease

 

How we treat OSD

  • Modify workouts by cutting back or eliminating unnecessary running or jumping drills during practice time. Limiting quadricep strengthening exercises and conditioning will lessen the irritation on the growth plate. Other activities such as push-ups, sit-ups and low-impact skill drills can be substituted until the pain subsides.
  • Ice can help with pain and swelling. Try an ice cup massage. Fill a Styrofoam cup with water and freeze it. When frozen, peel an inch of Styrofoam from the bottom of the cup and apply ice massage directly to the injured area for 10 to 15 minutes. This can be repeated every 60 to 90 minutes.
  • Anti-inflammatory medicine such as ibuprofen (Motrin, Advil) or naproxen (Aleve) can be taken on a regular basis to help relieve pain and inflammation.
  • Protective padding can be used to protect the knees from a direct hit or fall.
  • Supportive footwear including silicone gel pads and heel cups can provide shock absorption and pain relief during running and jumping.
  • Physical therapy may be useful to identify and address issues that may contribute to the risk of injury. Contributing factors that can be improved include weakness, lack of flexibility and poor core strength.

Return to play

If there is no limping or swelling and your young athlete has normal strength, they can continue to play. If the pain worsens or they start to limp or favor the injured leg, they should stop playing immediately.

Continuing to play despite worsening pain may increase the risk of a complete avulsion, or separation of the tendon from the growth plate. If this happens, your child may require surgical reattachment. If there is no improvement after three days of rest and ice, your child should see a doctor.

How to prevent OSD

Since OSD is an overuse injury, there are ways to prevent it, including:

  • Play only one sport (team) at a time
  • Start conditioning several weeks before the start of a new season to avoid the "too much too soon" trap
  • Tell someone, such as a parent or coach, if something hurts to prevent more severe injury

Prepatellar Bursitis

What is prepatellar bursitis?

A bursa is a sac that acts as a cushion between the bones, tendons and skin. If the bursa becomes inflamed it produces fluid and swells. Prepatellar bursitis is very common in wrestlers and can result from a direct hit to the front of the knee or from chronic friction caused by frequent kneeling.

Symptoms of prepatellar bursitis are painful swelling over the front of the knee. The swelling is not inside the knee, but rather between the kneecap and the skin. There may be pain and stiffness when bending the knee.

How we treat prepatellar bursitis

This condition is treated with:

  • Ice - Frequent application of ice packs for 20 or 30 minutes every three to four hours
  • Elevation – Elevating the knee may decrease swelling
  • Medicine - Anti-inflammatory medicine such as ibuprofen (Motrin, Advil) or naproxen (Aleve) can be taken on a regular basis to help relieve pain and inflammation
  • Draining - If the bursa is very swollen, the fluid may need to be drained

Sometimes the fluid inside the bursa becomes infected. In these cases, the knee becomes even more painful and is red and hot to the touch. With infected bursitis, the fluid must be drained and antibiotics are used to treat the infection.

How to prevent prepatellar bursitis

Prepatellar bursitis can be prevented by avoiding direct pressure or blows to the kneecap. Wearing proper knee pads can help.

Runner's Knee

What is runner’s knee?

Runner’s knee, or Patellofemoral Stress Syndrome (PFSS), is common in runners and kids who play sports like soccer, lacrosse and volleyball. This is an overuse injury that develops because of repetitive pressure between the kneecap (patella) and the thigh bone (femur). There are many contributing factors, including flat or pronated feet, knees that turn in while running, muscle imbalance, insufficient training and wearing shoes without enough support. Proper stretching and strengthening the muscles around the knee can reduce the risk for injury.

How we diagnose runner's knee

Symptoms of runner’s knee include:

  • Aching pain around or under the kneecap that worsens during activities like squatting, climbing stairs, jumping and running
  • A feeling of stiffness after sitting for a long time
  • Weakness
  • Occasional buckling

There usually is no swelling associated with runner’s knee. However, athletes with runner’s knee could end up with a dislocation injury, which can cause swelling.

An x-ray may be needed to confirm the diagnosis or rule out other causes of knee pain.

How we treat runner's knee

  • Modify workouts and avoid doing anything that worsens the pain. Runners may have to cut back on the distance they run or change their route to avoid hills or hard surfaces.
  • Adequate support is important in reducing injury-causing stress. Make sure shoes are not too worn and have adequate support. A brace, strap or sleeve may provide relief by stabilizing the kneecap.
  • Physical therapy can be very effective in eliminating pain and preventing further injury. Strengthening and stretching the quadriceps (front of thigh) and hamstring (back of thigh) muscles can help.
  • Ice can help with pain and swelling. Try an ice cup massage. Fill a Styrofoam cup with water and freeze it. When frozen, peel an inch of Styrofoam from the bottom of the cup and apply ice massage directly to the injured area for 10 to 15 minutes. This can be repeated every 60 to 90 minutes.
  • Anti-inflammatory medicine such as ibuprofen (Motrin, Advil) or naproxen (Aleve) can be taken on a regular basis to help relieve pain and inflammation.

Sinding-Larsen-Johansson Syndrome

What is Sinding-Larsen-Johansson Disease?

Sinding-Larsen-Johansson Disease (SLJ) is an injury that occurs near the bottom of the kneecap. And it’s a common injury in young athletes between the ages of seven and 13 who participate in sports requiring repetitive running and jumping.

SLJ involves the patellar tendon, which connects your kneecap (patella) to your shin bone (tibia). Repetitive stress can cause the growth plate at the bottom of the kneecap to become irritated and inflamed.

Symptoms

  • Pain at the front of the knee, near the bottom of the kneecap
  • Swelling and tenderness around the kneecap
  • Pain that increases with exercise or activities like running, climbing stairs or jumping
  • Pain that becomes more severe when kneeling or squatting
  • A swollen or bony bump at the bottom of the kneecap

Risk factors for developing SLJ

Rapid growth

When kid's bones grow in length, they tend to lose some flexibility as the muscles and tendons get stretched. A tight muscle-tendon unit, when contracting, will cause more stress at the anchor point compared to a flexible muscle-tendon unit.

Overlapping seasons

It is not uncommon for youth sports seasons to overlap, resulting in the athlete playing two sports at the same time. This increases the overuse stress on the growth plate, increasing the risk of injury.

Beginning of a season

The sudden increase in workouts that typically comes with a new season can put too much stress on growth plates. It’s better to ease into activity.

Year-round sports

Many sports are played year-round, not allowing time for young athletes’ bodies to rest, or "catch up" from the stress of a long season.

Summer sports camps

Often summer sports camps have kids play the same sport several hours a day for an entire week. This sudden increase in stress can lead to SLJ.

How we treat SLJ

  • Modify workouts by cutting back or eliminating unnecessary running or jumping drills during practice time. Limiting quadriceps strengthening exercises and conditioning will lessen the irritation on the growth plate. Other activities such as push-ups, sit-ups and low-impact skill drills can be substituted until the pain subsides.
  • Ice can help with pain and swelling. Try an ice cup massage. Fill a Styrofoam cup with water and freeze it. When frozen, peel an inch of Styrofoam from the bottom of the cup and apply ice massage directly to the injured area for 10 to 15 minutes. This can be repeated every 60 to 90 minutes.
  • Anti-inflammatory medicine such as ibuprofen (Motrin, Advil) or naproxen (Aleve) can be taken on a regular basis to help relieve pain and inflammation.
  • Protective padding can be used to protect the knees from a direct hit or fall.
  • Supportive footwear including silicone gel pads and heel cups can provide shock absorption and pain relief during running and jumping.
  • Physical therapy may be useful to identify and address issues that may contribute to the risk of injury. Contributing factors that can be improved include weakness, lack of flexibility and poor core strength.

Return to play
If there is no limping or swelling, and your child has normal strength, they can continue to play. If the pain worsens or they start to limp or favor the injured leg, they should stop playing immediately.

Continuing to play despite worsening pain may increase the risk of a complete avulsion, or separation of the tendon from the growth plate, possibly requiring surgical reattachment. If there is no improvement after three days of rest and ice, the athlete should see a doctor.

How to prevent SLJ

Since SLJ is an overuse injury, there are ways to prevent it, including:

  • Play only one sport (team) at a time
  • Stretch to maintain and improve flexibility, especially during growth spurts
  • Start conditioning several weeks before the start of a new season to avoid the "too much too soon" trap

Tell someone, such as a parent or coach, if something hurts to prevent more severe injury.