National Athletic Trainers' Association position statement: prevention of pediatric overuse injuries.

OBJECTIVE To provide certified athletic trainers, physicians, and other health care professionals with recommendations on best practices for the prevention of overuse sports injuries in pediatric athletes (aged 6-18 years). BACKGROUND Participation in sports by the pediatric population has grown tremendously over the years. Although the health benefits of participation in competitive and recreational athletic events are numerous, one adverse consequence is sport-related injury. Overuse or repetitive trauma injuries represent approximately 50% of all pediatric sport-related injuries. It is speculated that more than half of these injuries may be preventable with simple approaches. RECOMMENDATIONS Recommendations are provided based on current evidence regarding pediatric injury surveillance, identification of risk factors for injury, preparticipation physical examinations, proper supervision and education (coaching and medical), sport alterations, training and conditioning programs, and delayed specialization.

[1]  Phillip J Plisky,et al.  Can Serious Injury in Professional Football be Predicted by a Preseason Functional Movement Screen? , 2007, North American journal of sports physical therapy : NAJSPT.

[2]  Glenn S. Fleisig,et al.  Risk Factors for Shoulder and Elbow Injuries in Adolescent Baseball Pitchers , 2006, The American journal of sports medicine.

[3]  E. Collantes Estévez,et al.  Joint hyperlaxity and musculoligamentous lesions: study of a population of homogeneous age, sex and physical exertion. , 1993, British journal of rheumatology.

[4]  E. Giannini,et al.  Arthritis/arthralgia and hypermobility of the joints in schoolchildren. , 1988, The Journal of rheumatology.

[5]  C L Stanitski.  Management of sports injuries in children and adolescents. , 1988, The Orthopedic clinics of North America.

[6]  P. Beighton,et al.  Orthopaedic aspects of the Ehlers-Danlos syndrome. , 1969, The Journal of bone and joint surgery. British volume.

[7]  C. Carling,et al.  Incidence of Injuries in Elite French Youth Soccer Players , 2006, The American journal of sports medicine.

[8]  Tamara C. Valovich McLeod,et al.  Summary statement: appropriate medical care for the secondary school-aged athlete. , 2008, Journal of athletic training.

[9]  L. Decoster,et al.  Generalized Joint Hypermobility and Its Relationship to Injury Patterns Among NCAA Lacrosse Players. , 1999, Journal of athletic training.

[10]  A. Hreljac.  Etiology, prevention, and early intervention of overuse injuries in runners: a biomechanical perspective. , 2005, Physical medicine and rehabilitation clinics of North America.

[11]  R. Bahr,et al.  Low Risk of Injuries Among Children Playing Organized Soccer , 2009, The American journal of sports medicine.

[12]  R. Lysens,et al.  The accident-prone and overuse-prone profiles of the young athlete , 1989, The American journal of sports medicine.

[13]  L. Micheli,et al.  Overuse injuries in the young athlete. , 1988, Clinics in sports medicine.

[14]  Hal B. Jenson,et al.  Nelson Textbook of Pediatrics , 1965 .

[15]  J. Esdaile,et al.  Diagnostic associations with hypermobility in rheumatology patients. , 1995, British journal of rheumatology.

[16]  L. Remvig,et al.  Epidemiology of general joint hypermobility and basis for the proposed criteria for benign joint hypermobility syndrome: review of the literature. , 2007, The Journal of rheumatology.

[17]  Stephen Lyman,et al.  Effect of Pitch Type, Pitch Count, and Pitching Mechanics on Risk of Elbow and Shoulder Pain in Youth Baseball Pitchers , 2002, The American journal of sports medicine.

[18]  M. Seaton,et al.  Factors contributing to the development of medial tibial stress syndrome in high school runners. , 2001, The Journal of orthopaedic and sports physical therapy.

[19]  A. Ryan.  Prevention of sports injuries. , 1963, The New physician.

[20]  M. Kocher,et al.  Little League Elbow , 2002, Sports medicine.

[21]  S. Dalton.  Overuse Injuries in Adolescent Athletes , 1992, Sports medicine.

[22]  R. Grahame,et al.  Joint hypermobility syndrome in childhood. A not so benign multisystem disorder? , 2005, Rheumatology.

[23]  N Maffulli,et al.  Physeal injuries in children’s and youth sports: reasons for concern? , 2006, British Journal of Sports Medicine.

[24]  B. Sharkey.  Physiological and perceptual responses at submaximal and maximal capacity in six modes of exercise , 1993 .

[25]  J. Iwamoto,et al.  Stress fractures in athletes: review of 196 cases , 2003, Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association.

[26]  T. Gill,et al.  The immature athlete. Common injuries and overuse syndromes of the elbow and wrist. , 1996, Clinics in sports medicine.

[27]  J. Brenner,et al.  Overuse Injuries, Overtraining, and Burnout in Child and Adolescent Athletes , 2007, Pediatrics.

[28]  C J Hale,et al.  Little Leaguer's shoulder: a report of 23 cases. , 1999, The American journal of sports medicine.

[29]  C. Gordon,et al.  Family History Predicts Stress Fracture in Active Female Adolescents , 2007, Pediatrics.

[30]  C. Emery.  Risk Factors for Injury in Child and Adolescent Sport: A Systematic Review of the Literature , 2003, Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.

[31]  L. Micheli,et al.  The prevention of sports injuries in children. , 2000, Clinics in sports medicine.

[32]  J. White,et al.  Injury prediction in female gymnasts. , 1986, British journal of sports medicine.

[33]  Frederick Reed,et al.  Intensive Training and Sports Specialization in Young Athletes , 2000, Pediatrics.

[34]  G. Zimet,et al.  Parents' knowledge of the purposes and content of preparticipation physical examinations. , 1995, Archives of pediatrics & adolescent medicine.

[35]  P. Aichroth,et al.  Osteochondritis dissecans of the knee. A long-term study. , 1991, The Journal of bone and joint surgery. British volume.

[36]  B. Elliott,et al.  Do selected kinanthropometric and performance variables predict injuries in female netball players? , 1995, Journal of sports sciences.

[37]  C. Gordon,et al.  Correlates of Stress Fractures Among Preadolescent and Adolescent Girls , 2005, Pediatrics.

[38]  J. Difiori.  Overuse Injuries in Young Athletes: An Overview , 2002 .

[39]  Matthew Solomito,et al.  A Biomechanical Comparison of the Fastball and Curveball in Adolescent Baseball Pitchers , 2009, The American journal of sports medicine.

[40]  D. Gerrard.  Overuse injury and growing bones: the young athlete at risk. , 1993, British journal of sports medicine.

[41]  B. Heiderscheit,et al.  Medial tibial stress syndrome in high school cross-country runners: incidence and risk factors. , 2007, The Journal of orthopaedic and sports physical therapy.

[42]  A. Hodson.  Too much too soon? The risk of ‘overuse’ injuries in young football players , 1999 .

[43]  R Dawn Comstock,et al.  Epidemiology of Lower Extremity Injuries among U.S. High School Athletes , 2007, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[44]  S. Gasser,et al.  Little Leaguer's Shoulder , 1998, The American journal of sports medicine.

[45]  Dennis Caine,et al.  Does Repetitive Physical Loading Inhibit Radial Growth in Female Gymnasts , 1997, Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.

[46]  J. Simmonds,et al.  Hypermobility, injury rate and rehabilitation in a professional football squad--a preliminary study. , 2009, Physical therapy in sport : official journal of the Association of Chartered Physiotherapists in Sports Medicine.

[47]  J. Esdaile,et al.  The association of soft-tissue rheumatism and hypermobility. , 1998, British journal of rheumatology.

[48]  N. Maffulli,et al.  Overuse injuries of the olecranon in young gymnasts. , 1992, The Journal of bone and joint surgery. British volume.

[49]  K Bennell,et al.  Risk Factors for Stress Fractures , 1999, Sports medicine.

[50]  A. Junge,et al.  Prevention of Soccer Injuries: A Prospective Intervention Study in Youth Amateur Players , 2002, The American journal of sports medicine.

[51]  P. Kasten,et al.  Stress fractures in the juvenile skeletal system. , 2005, International journal of sports medicine.

[52]  A. J. Bianco,et al.  Osteochondritis dissecans of the elbow. , 1975, Clinical orthopaedics and related research.

[53]  J. Jupiter,et al.  Fractures of the distal end of the radius. , 1991, The Journal of bone and joint surgery. American volume.

[54]  C. Feudtner,et al.  Preparticipation physical evaluations for high school athletes: time for a new game plan. , 2004, Ambulatory pediatrics : the official journal of the Ambulatory Pediatric Association.

[55]  L. Micheli,et al.  Overuse injuries to tendons and apophyses in children and adolescents. , 1992, Clinics in sports medicine.

[56]  L. Barnsley,et al.  Hypermobility and sports injuries in junior netball players , 2005, British Journal of Sports Medicine.

[57]  G S Fleisig,et al.  Longitudinal study of elbow and shoulder pain in youth baseball pitchers. , 2001, Medicine and science in sports and exercise.

[58]  D. Ofluoğlu,et al.  Hypermobility in women with fibromyalgia syndrome , 2006, Clinical Rheumatology.

[59]  B. Rowe,et al.  Effectiveness of a home-based balance-training program in reducing sports-related injuries among healthy adolescents: a cluster randomized controlled trial , 2005, Canadian Medical Association Journal.

[60]  P. Z. Pearce.  Prehabilitation: Preparing young athletes for sports , 2006, Current sports medicine reports.

[61]  I. Learmonth,et al.  Hypermobility and injuries in a professional ballet company. , 1984, British journal of sports medicine.

[62]  Christopher M. Rausch,et al.  Adherence to guidelines for cardiovascular screening in current high school preparticipation evaluation forms. , 2009, The Journal of pediatrics.

[63]  D. Patel,et al.  Sports injuries in adolescents. , 2000, The Medical clinics of North America.

[64]  J Ransone,et al.  Assessment of first-aid knowledge and decision making of high school athletic coaches. , 1999, Journal of athletic training.

[65]  Stanitski Cl,et al.  Management of sports injuries in children and adolescents. , 1988 .

[66]  Allan J Ryan,et al.  American Orthopedic Society for Sports Medicine. , 1982, The Physician and sportsmedicine.

[67]  Christian N. Anderson,et al.  Management of Osteochondritis Dissecans of the Knee , 2005 .

[68]  C. Hirth.  Clinical Movement Analysis to Identify Muscle Imbalances and Guide Exercise , 2007 .

[69]  J. Press,et al.  Articular symptoms in hypermobile schoolchildren: a prospective study. , 1991, The Journal of pediatrics.

[70]  Neil Armstrong,et al.  IOC consensus statement on training the elite child athlete. , 2008, Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.

[71]  L. Micheli,et al.  Sports injuries in children and adolescents. Questions and controversies. , 1995, Clinics in sports medicine.

[72]  L. Engebretsen,et al.  Exercises to prevent lower limb injuries in youth sports: cluster randomised controlled trial , 2005, BMJ : British Medical Journal.

[73]  E. Collantes-Estévez,et al.  Joint hypermobility in patients with fibromyalgia syndrome. , 1998, Arthritis care and research : the official journal of the Arthritis Health Professions Association.

[74]  F. O’Connor,et al.  Managing overuse injuries: a systematic approach. , 1997, The Physician and sportsmedicine.

[75]  Harm Kuipers,et al.  The Incidence of Injuries in Elite Junior Figure Skaters , 2003, The American journal of sports medicine.

[76]  T. Rowland,et al.  Injuries in Youth Soccer: A Subject Review , 2000, Pediatrics.

[77]  D. Buskila,et al.  Joint hypermobility and fibromyalgia in schoolchildren. , 1993, Annals of the rheumatic diseases.

[78]  Pädagogik,et al.  National Federation of State High School Associations , 2010 .

[79]  E. Giannini,et al.  Hypermobility of the joints in juvenile episodic arthritis/arthralgia. , 1985, The Journal of pediatrics.

[80]  K. Cassas,et al.  Childhood and adolescent sports-related overuse injuries. , 2006, American family physician.

[81]  Thomas Reilly,et al.  Injuries in Young Elite Female Soccer Players , 2008, The American journal of sports medicine.

[82]  C CARTER,et al.  PERSISTENT JOINT LAXITY AND CONGENITAL DISLOCATION OF THE HIP. , 1964, The Journal of bone and joint surgery. British volume.

[83]  J. Stevens,et al.  A hypermobility study in ballet dancers. , 1984, The Journal of rheumatology.

[84]  J. Watkins,et al.  Sports injuries in children and adolescents treated at a sports injury clinic. , 1996, The Journal of sports medicine and physical fitness.

[85]  T. Rowland,et al.  A Biomechanical Comparison of Youth Baseball Pitches: Is the Curveball Potentially Harmful? , 2009 .

[86]  H. Iwata,et al.  Characteristics of stress fractures in young athletes under 20 years. , 2002, The Journal of sports medicine and physical fitness.