Lower extremity overuse injuries in the skeletally immature athlete

Sport participation is a leading cause of injury in children and adolescents. Although the focus often is on acute injuries, overuse injuries are extremely common and can cause lasting damage when not recognized early and treated appropriately. Overuse injuries result from the combination of repetitive microtrauma and inadequate healing time. Children are especially susceptible for many reasons, including muscle-tendon imbalance, improper technique, and difficulty identifying early signs of injury. In the last decades, not only have more children been participating in sporting activities, but the intensity of their participation has increased, with many participating year-round on multiple teams, often with professional or scholarship aspirations. As a consequence, overuse injuries have become even more prevalent. Bone, cartilage, tendon, physis, or apophysis may be affected, and the diagnosis can be challenging. In an effort to promote prevention, early recognition, and treatment of overuse injuries in children and adolescents, this article provides an overview of these injuries, describes vulnerabilities of the immature skeleton, and provides guidance andtalking points for physicians, parents, and coaches.