More than Growing Pains: Physical Activity and Injury in Children

Niamh Fogarty

Feb 28, 20245 min read

Physical activity and sport contribute to the health and wellbeing of children during their initial stages of development (1). In the early years, sport is a source of enjoyment for them and has many benefits (see below). However, as children grow and mature overtime, so too does the dynamic of sport (i.e. it becomes more competitive and physically demanding which can increase the risk of injury) (1). This is something to be mindful of if you are a coach or a parent of a youth athlete.

Why is exercise important for children?

The percentage of children (in the Republic of Ireland) taking part in physical activity has increased by almost 10% since 2018, with 96% of primary and 84% of post-primary students participating in some form of sport at least once a week (2). This is positive given that regular exercise helps children maintain a healthy weight, builds strong bones and muscles, and improves cardiovascular health (3).

Other benefits of exercise for children include:

Building healthy habits: research shows that children who engage in regular physical activity during childhood are more likely to stay physical active during adulthood (4-5).
Physical development: physical activity plays a significant role in the development of motor skills, co-ordination and balance. It is through activities like running, jumping and climbing that children learn and develop these skills (6).
Psychological and social development: through sport, children can improve their cognitive function and develop many social skills like teamwork/leadership, co-operation, and communication (7-8).

How much exercise is too much?

The recommended physical activity guidelines for children and young people in Ireland (aged 5-17 years) is at least 60 minutes of daily moderate-to-vigorous activity (2), which only 15% currently meet (9). The World Health Organisation’s guidelines for vigorous-intensity aerobic activity and activities that strengthen muscle and bone at least 3 days a week is being met by 43% (10).

It is difficult to say how much exercise is ‘too much’, as many factors can impact this. However, coaches, parents and teachers should promote a balanced approach to physical activity that prioritises the enjoyment, safety and wellbeing of children. Like adults, children are at risk of burnout and developing overuse injuries like stress fractures and tendinopathies. Rest and recovery should therefore be promoted.

It’s more than just “growing pains”

In children, the growth plates are more vulnerable to injury during periods of rapid growth, making them susceptible to injuries/conditions like; Osgood-Schlatter disease, Severs disease, and Little League Elbow/Shoulder (more on these below!). Therefore, as a coach or a parent of youth athletes, it is important to be aware of the risk factors, signs and symptoms related to these common injuries/conditions to (1) minimise the chance of injury and (2) ensure that injuries/conditions are managed correctly.

At the age of 10, I was told by a physiotherapist that I had a condition called Osgood-Schlatter disease. This is a common condition among children and adolescents; usually those between the ages of 10 and 15 who are active in sports. Like many kids, Osgood-Schlatter’s affected me during my growth spurt (not that I grew that tall!), when my bones and muscles were rapidly developing. This caused pain and a lump to form just below my kneecap, at the top of my shinbone (tibia) where the patellar tendon inserts. As a child, it was difficult for me to understand why this was happening, but I now know that the repeated stress and tension on my knee and growth plate was caused by overactivity and inadequate rest.

While Osgood-Schlatter disease can be uncomfortable, it usually resolves on its own with the help of rest, ice, stretching and strengthening exercises (11). However, during the active phase of the condition, managing symptoms is important in order to prevent further discomfort. Usually, this involves (11):

Avoiding exercises and activities that make symptoms worse.
Applying ice to numb the pain.
Performing stretching and strengthening exercises to improve flexibility and muscle balance around the knee.
Getting sports massage on the quads and hamstrings to reduce the tension on the knee.
Wearing a supportive brace or strap during physical activity to reduce the stress on the patellar tendon during physical activity.

What other injuries are common for children and adolescents?

As a coach or parent of a youth athlete, you are not expected to make a diagnosis of these injuries/conditions, but it would help to know the signs and symptoms so that children can receive professional care and advice.

Sever’s Disease (Calcaneal Apophysitis): This condition also involves the growth plate, this time in the heel bone (calcaneus) (12). It is common in physically active children (between 8-15 years) who are involved in running and jumping sports (12). It occurs during periods of rapid growth when the Achilles tendon pulls on the heel’s growth plate.

Signs and Symptoms:

Typically causes heel pain/tenderness, especially during or after exercise.
Pain when either side if the heel is squeezed.
Children may complain of tight calf muscles and pain at the heel that worsens when running, jumping or walking barefoot.
They may limp or avoid weight bearing on the foot.

Little League Elbow/Shoulder: An injury that occurs in young children and adolescents (typically between 9-14 years) who are involved in overhead motion and/or throwing sports (e.g. rounders, cricket, javelin, tennis, volleyball) (14). The repetitive stress from overhead throwing motions places strain on the growth plate on the inside of the elbow and/or at the shoulder (13-14). Risk factors include poor throwing mechanics/technique, and excessive throwing velocity (14).