Key points

Introduction

Participation in organized sports is increasing in the United States. An estimated 30 to 45 million children participate in organized sports annually. Concurrent with this increase in participation is an upward trend in year-round participation in athletics in either one or multiple sports. The benefits of athletic participation in children as a means to stay active and physically fit are well documented ; however, an increased prevalence of athletic injury in young athletes has raised concern regarding the safety of intense athletic participation at a young age. Although many of these injuries may represent traumatic incidents, as many as one-third to more than 50% of these injuries are estimated to be a result of overuse.

Overuse injuries include a broad spectrum of injuries within sports medicine. Classically, they are defined as chronic injuries related to “constant levels of physiologic stress without sufficient recover time.” Globally, they can be perceived as the outcome of the difference between the volume of the stress or force applied to the body and the ability of the body to dissipate this stress or force. Injury may result from repetitive microtrauma imposed on otherwise healthy tissue or the repeated application of lesser magnitudes of force to pathologic tissue. Either scenario can lead to the sequelae of tissue breakdown. Unfortunately, the mechanism by which this stress ultimately leads to overuse injuries is not consistent among young athletes.

In the absence of a well-defined mechanism, the development of targeted intervention strategies is more difficult. Traumatic injuries, such as ligament tears, are typically the result of a single macrotrauma on otherwise healthy tissue, which results in tissue failure. Many injury-prevention programs attempt to develop the athlete’s neuromuscular control mechanisms to help dampen these external forces and reduce the likelihood of traumatic tissue failure. In the case of overuse injuries, there is significantly less evidence regarding the most efficacious program to reduce the incidence of these injuries. Therefore, current intervention programs that attempt to address potential underlying mechanisms or target specific risk factors that may contribute to abnormally high stress with repeated activities are still in development. The purpose of this article is to highlight the prevailing theories of overuse injury mechanisms as well as review the best available evidence for the implementation of prevention strategies designed to target overuse injuries in both endurance and pivoting/cutting sports.