Reduce Overuse Injury and Minimize Burn Out in Youth and Adolescent Athletes: Part 2

Overuse injury occurs due to submaximal repetitive loading of the body (muscle-tendon unit, ligaments, joints, bone, bursa, growth plate) when rest is not adequate to allow for those structures to adapt and recover. This incomplete recovery leads to poor athletic performance, reduced physical development, overuse injuries and burn out. Thus, competition and training errors are the most common cause of overuse injuries and burn out.

In my physical therapy clinics it is not uncommon to see an injured athlete playing for multiple sports teams with an excessive training or competition schedule. For example, a basketball player is on the school and travel basketball teams at the same time. They will have practice daily and 2 games per week on the school team and 2 practices per week and weekend tournaments (up to 5 games) on the travel team. In that given week he/she could have up to 15 basketball events. In each of those basketball events there will be normal amounts of body tissue overload and fatigue, however, there is not enough time for rest and recovery. Even when the season is over, the athlete moves into AAU basketball, more travel teams and the cycle continues throughout the year. No breaks, no opportunity for recovery leading to poor performance, reduced physical development, overuse injury, and potential burn out. This type of pattern is seen in all sports.

Now, contrast youth sports with professional sports. When was the last time you saw an NBA team playing multiple games in the same day? It is rare when NBA teams play more than 3 games per week. Remembering that the professional athlete is physically developed genetically gifted and optimally trained.

In professional sports there is a distinct competitive season followed by time off (off-season). During the off season; the athlete recovers from the competitive season, begins training for the next season and works on specific skills needed for their individual fundamental development and advancement. For example, in the NBA, it is not uncommon to hear of a player who has; increased upper body strength, improved ball handling ability and enhanced his shooting skill all in the off season.

The other issue facing the young athlete is burnout. Burnout is the part of a spectrum of conditions that include overreaching or over training. Burnout is a result of chronic stress that causes the young athlete to cease participation in previously enjoyable activities. It is estimated that by age 15, 70% of kids stop playing sports all together (National Center for Health Statistics). There are many reasons why the athlete stops playing sports; however, burnout is the most common theme. The young athlete is often bound by unreasonable time constraints and hectic schedules. Coaches at the youth level often misunderstand the athlete’s physical, mental, and emotional development treating the athlete like “little adults”. The youth athlete cannot be treated with the expectation of having adult level skill and emotional/mental maturity.

Prevention of Overuse Injuries and Burn out

  • Limiting weekly and yearly participation time
  • Schedule rest periods between seasons
  • Play multiple sports in youth and adolescence
  • Monitor training patterns during growth spurts
  • Perform preseason conditioning programs
  • Neuromuscular training (landing and deceleration techniques to improve lower extremity control)
  • Increase skill development training versus more competitions/games ( At ages less the 14 year of age, 60-70% of sports specific playing time should be spent of skill acquisition and development)
  • More focus on having fun and learning the sport (especially in youth sports)
  • Less negative performance evaluations (Less focus on results with more supportive focus on the mechanics of the activity and potential improvements seen).
  • Giving the athlete more control in sports decision making.

We can help!

Mishock Physical Therapy has 6 convenient locations in Gilbertsville, Skippack, Barto, Phoenixville, Limerick, and Stowe. Reach us via phone at (610)327-2600. Also, visit our website at to read more physical therapy related articles, learn more about our treatment philosophy, our physical therapy staff. Our mission is to exceed the expectations of our patients by providing excellence in care and service. We are here to serve you! Dr. Mishock is one of only a few clinicians with doctorate level degrees in both physical therapy and chiropractic in the state of Pennsylvania.

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