A Guide to Safety for Young Athletes
For young athletes, sports activities are more than play. Participation in athletics improves physical fitness, coordination, and self-discipline, and gives children valuable opportunities to learn teamwork.
Because young athletes are still growing, they are at a greater risk for injury than adults. The consequences of overdoing a sport can include injuries that impair growth and may lead to long-term health problems.
Fortunately, many youth sports injuries can be prevented. Some of the more effective ways to prevent these injuries include:
- Age-specific coaching
- Appropriate physical conditioning
- Proper use of equipment
In addition, coaches and parents can prevent injuries by fostering an atmosphere of healthy competition that emphasizes confidence, cooperation, and a positive self-image, rather than just winning.
Differences Between Child and Adult Athletes
Children Are Still Growing
The young athlete is not a smaller version of an adult. Children's bones, muscles, tendons, and ligaments are still growing, making them more susceptible to injury. In addition, there are significant differences in coordination, strength, and stamina between children and adults.
Children Vary in Size and Maturity
Young athletes of the same age can differ greatly in size and physical maturity.
- Grade school students are less likely to experience severe injuries during athletic activities because they are smaller and slower than older athletes.
- High school athletes, however, are bigger, faster, stronger, and capable of delivering tremendous forces in contact sports.
Children Can Injure Growth Plates
Growth plates are the areas of developing cartilage at the ends of long bones where bone growth occurs in children. The growth plates are weaker than the nearby ligaments and tendons. A twisted ankle that might result in a sprain in an adult, could result in a more serious growth plate fracture in a young athlete. Growth plate injuries have the potential to disrupt the normal growth of bone.
Common Youth Sports Injuries
Acute sports injuries are caused by a sudden trauma, such as a twist, fall, or collision. Common acute injuries include:
- Broken bones
- Sprains (ligament injuries)
- Strains (muscle and tendon injuries)
- Cuts or bruises
Most acute injuries should be evaluated by a doctor. Prompt first aid treatment should be provided by coaches and parents when the injury occurs. This usually consists of the RICE method:
- Rest. Avoid activities that involve the affected body part for the first few days after the injury.
- Ice. Apply ice immediately after the injury to keep the swelling down. Use cold packs for 20 minutes at a time, several times a day. Do not apply ice directly on the skin.
- Compression. To prevent additional swelling, lightly wrap the area in a soft bandage.
- Elevation. As often as possible, rest with the injured arm, hand, leg, or foot raised up higher than the heart.
This usually limits discomfort and reduces healing time. Proper first aid will minimize swelling and help the doctor establish an accurate diagnosis.
Overuse injuries occur gradually over time, when an athletic activity is repeated so often that parts of the body do not have enough time to heal between playing. Examples of overuse injuries include:
- Achilles tendinitis
- Osgood-Schlatter disease (knee pain)
- Jumper's knee
- Sever's disease
- Shin splints
- Stress fractures
- Throwing injuries in the elbow
Coaches may have more difficulty spotting less severe problems, however, because the pain is mild and the athlete often ignores it. Repeat injuries may turn into overuse conditions, which can put the athlete on the sidelines for the rest of the season.
To keep athletes in the game long-term, overuse injuries need to be diagnosed and treated by a physician as soon as possible. Parents and coaches should be aware of the more common signs of overuse injury. These include:
- Pain that increases with activity
- Changes in form or technique
- Decreased interest in practice
In the growing athlete's musculoskeletal system, pain from repetitive motion may appear somewhere besides the actual site of the injury. For instance, a knee ache in a child or adolescent may actually be pain caused by an injury to the hip.
Whether an injury is acute or due to overuse, a child who develops a symptom that persists or that affects their athletic performance should be examined by a doctor. A child should never be instructed or allowed to "work through the pain."
Concussions can occur in contact and non-contact sports with:
- A direct force to the head (e.g., helmet-to-helmet contact during football, or "heading" a soccer ball)
- A sudden, forced deceleration or direction change
Many concussions are not associated with a loss of consciousness. Common symptoms include headache, difficulty focusing, light sensitivity, fatigue, balance difficulty, and nausea.
After a concussion, the child should not practice or play until they are cleared to return to play by a health professional. A second head impact during the recovery phase from a prior concussion can put athletes at risk for serious neurological consequences.
Most people will be fully recovered by 10 days after a concussion, but some may recover sooner. Once symptoms resolve, the athlete can begin a gradual, guided progression of sports activity as long as they don’t experience symptoms with the progression. Helpful tips to resolve a concussion — aside from time alone — are to avoid bright screens, get plenty of sleep, and avoid activities that require significant mental focus or physical exertion.
Historically, concussions were not thought to be serious injuries (e.g., “they had their bell rung.”) But, in fact, concussions are significant injuries to the brain and require careful attention to prevent serious consequences. Any youth athlete with significant impact to the head and neck should be evaluated for concussion by an orthopaedic specialist.
Learn more: Sports Concussion
Strategies for Preventing Youth Sports Injuries
There are several strategies that coaches, parents, and athletes can follow to help prevent sports injuries. Most important, athletes should:
- Be in proper physical condition to play a sport (a pre-participation sports physical examination can be very useful in screening for potential problems)
- Know and abide by the rules of a sport
- Wear appropriate protective gear (for example, shin guards for soccer, a hard-shell helmet when facing a baseball pitcher, a helmet and body padding for ice hockey) and footwear
- Know how to correctly use athletic equipment (for example, correctly adjusting the bindings on snow skis)
- Always warm up before playing
- Stay hydrated
- Avoid playing when very tired or in pain
Young athletes need proper training for sports. They should be encouraged to train for the sport rather than expecting the sport itself to get them in shape.
Young athletes also should follow a regular conditioning program (in conjunction with their coach) with incorporated exercises designed specifically for their chosen sport. In addition, a well-structured, closely supervised weight-training regimen may help youngsters prepare for athletic activities.
STOP Sports Injuries
Many sports injuries in young athletes — particularly elbow and knee injuries — are caused by excessive, repetitive stress on immature muscle-tendon-bone units. Doctors are seeing an increase in overuse injuries because many young athletes are focusing on just one sport and are training year-round. The American Academy of Orthopaedic Surgeons has partnered with STOP Sports Injuries to help educate parents, coaches, and athletes about how to prevent overuse injuries. Specific tips to prevent overuse injuries include:
- Limit the number of teams on which your child plays in one season. Kids who play on more than one team are especially at risk for overuse injuries.
- Do not allow your child to play one sport year-round — taking regular breaks and playing other sports is essential to skill development and injury prevention.
Atmosphere of Healthy Competition
Coaches and parents are also responsible for creating an atmosphere that promotes teamwork and sportsmanship.
Youth sports should always be fun. The "win at all costs" attitude of many parents, coaches, professional athletes, and peers can lead to injuries. A young athlete striving to meet the unrealistic expectations of others may ignore warning signs of injury and continue to play with pain.
Young athletes must learn to deal with success and defeat to place events in a proper perspective. The promotion of the "win at all costs" ethic can have both short-term and long-term harmful effects on impressionable young athletes.
Sports and exercise are healthy activities for girls and women of all ages. The participation of girls and young women in sports has increased significantly since the passage of Title IX. Occasionally, a female athlete who focuses on being thin or lightweight may eat too little or exercise too much. Doing this can cause long-term health damage.
Three interrelated illnesses may develop when a girl or young woman goes to extremes in dieting or exercise. Together, these conditions are known as the "female athlete triad."
The three conditions are:
- Disordered eating
- Menstrual dysfunction
- Premature osteoporosis (low bone density for age)
Treatment for female athlete triad often requires help from a team of medical professionals, including your doctor, your athletic trainer, a nutritionist, and a psychological counselor.
More recently, concern for energy deficiency leading to poor training and risk for stress fractures has been expanding beyond the female sex to include REDS (relative energy deficiency syndrome). REDS can be experienced athletes of all genders — especially endurance athletes with high energy demands due to high energy expenditure during sport.
Many young athletes — boys and girls — use illegal anabolic steroids to improve their athletic performance. Steroids have been shown to increase muscle mass, but they can cause serious and potentially life-threatening complications and should be avoided. Most steroids are illegal and are banned by sports organizations.
Many athletes of all ages take sports supplements, such as creatine, because they think it will increase strength and improve sports performance.
The U.S. Food and Drug Administration does not regulate nutritional supplements. This means that the supplement products available in stores may vary in amount and quality, and there is no guarantee of safety or purity.
There is also not enough research on the long-term health effects of taking sports supplements, especially in adolescents and children who are still growing.
No matter what your age or health condition, always see your doctor for advice before taking nutritional supplements.
Benefits of Sports Participation
Athletic activity by young people is generally safe with low risks and high benefits. The major goal should be enjoyable participation. Exposure to competitive and noncompetitive sports encourages the development of fitness, motor skills, social skills, and a lifelong appreciation for sports.
Contributed and/or Updated by
AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS Find an Orthopaedist program on this website.