Young Athletes and Overuse Injuries: A Physical Therapist’s Warning Signs

Overuse injuries rarely begin with one dramatic moment. There may be no fall, collision, pop, or immediate swelling.

Instead, a young athlete notices soreness after practice. The discomfort goes away with rest, so the athlete continues playing. Several days later, the pain begins earlier in practice. Eventually, it affects performance or continues after the activity has ended.

This gradual progression makes overuse injuries in young athletes easy to overlook. Parents and coaches may assume the child is dealing with normal soreness. Athletes may hide the symptoms because they are afraid of losing playing time. [1]

A physical therapist looks for more than the location of the pain. Changes in movement, balance, strength, flexibility, and athletic performance can reveal that a young athlete’s body is no longer recovering from the demands being placed on it.

What Is an Overuse Injury?

An overuse injury develops when repeated physical stress exceeds the body’s ability to recover and adapt. Every practice creates small amounts of stress in muscles, tendons, bones, and other tissue; with appropriate rest and nutrition, the body repairs that tissue and becomes better prepared for the activity. Problems begin when the athlete repeatedly trains before recovery is complete. [2][5]

This can happen because of a sudden increase in practice time, playing on more than one team, year-round participation in one sport, repeating the same movement too frequently, returning after a break without rebuilding conditioning, poor technique, inadequate strength or mobility, insufficient rest, or continuing to play through pain. [1][3]

Young athletes may be particularly vulnerable during periods of rapid growth. Bones can lengthen faster than muscles and tendons adapt, temporarily changing flexibility, coordination, and the way force moves through the body. [2]

The Four Stages of an Overuse Injury

Stage 1: Pain after activity

What it looks like: Discomfort after practice, a game, or a workout that resolves with rest and does not affect performance. The easiest stage to dismiss — and the cheapest place to intervene.

What to do: Reduce training load before symptoms become disruptive

Stage 2: Pain during activity

What it looks like: Pain begins during practice or competition, but the athlete can still participate. Parents may notice repeated stretching, rubbing a joint, or changed technique.

What to do: Modify the aggravating activity; assess movement and load

Stage 3: Pain affects performance

What it looks like: Symptoms limit speed, strength, accuracy, endurance, or normal movement. The athlete may limp, avoid a movement, or ask to leave practice early.

What to do: Stop the aggravating activity; structured evaluation

Stage 4: Pain at rest

What it looks like: Pain during ordinary activities or at rest.

What to do: Medical evaluation required before returning to participation

Warning Signs a Physical Therapist Watches For

A change in movement. Limping, shortening one stride, landing more heavily on one leg, avoiding full knee or hip motion, turning one foot outward, dropping one shoulder while throwing, or shifting weight away from a painful side. These compensations allow an athlete to continue temporarily — while placing additional stress on other areas of the body.

A decline in performance. Reduced throwing speed, loss of accuracy, slower running times, decreased jump height, difficulty changing direction, earlier fatigue, reduced endurance, or trouble completing previously comfortable skills. A performance decline despite increased training is not always a sign the athlete needs to work harder — it may mean the body needs recovery. [5]

Pain in the same location after every practice. General soreness spreads across a muscle group and improves as the body adjusts. Overuse pain is more specific — it repeatedly appears in the same location and becomes easier to trigger over time. Pinpoint bone tenderness, pain near a growth plate, or joint pain that returns with every practice should not be ignored. [2]

Swelling or stiffness. Visible swelling suggests irritated tissue. Morning stiffness or difficulty moving normally after sitting can indicate the area is not recovering fully between sessions.

Loss of interest or motivation. A child who normally enjoys a sport may begin dreading practice or looking for reasons not to participate. This may reflect pain, fatigue, emotional burnout, or a combination — parents should avoid assuming the athlete has suddenly become lazy or uncommitted. [1]

Common Overuse Injuries in Young Athletes

Osgood-Schlatter disease

What it is: Pain and tenderness where the patellar tendon attaches near the growth plate at the top of the shinbone. Worse with sprinting, stairs, squatting, or jumping. [4]

Typical athletes: Growing athletes in running and jumping sports

Sever’s disease

What it is: Heel pain from repeated Achilles tendon pull on the growth area at the back of the heel. Running, jumping, and cleated shoes aggravate symptoms.

Typical athletes: Growing children in field and court sports

Stress reactions & stress fractures

What it is: Repeated impact irritates an area of bone until a small crack develops. Localized pain during activity that progresses to pain while walking or at rest.

Typical athletes: Distance runners; athletes with sudden volume increases

Throwing-related shoulder & elbow injuries

What it is: Repeated overhead stress near the growth plates of the shoulder or elbow. Warning signs: pain, lost velocity, reduced accuracy, difficulty warming up, changed mechanics. [2]

Typical athletes: Baseball, softball, volleyball, swimming

Patellofemoral pain

What it is: Pain around or behind the kneecap with running, jumping, squatting, or stairs. Contributors include rapid activity increases, hip weakness, and limited ankle mobility.

Typical athletes: Running and jumping sports

Tendon overload

What it is: A sudden increase in running, jumping, or repetitive arm activity exceeds the tendon’s current capacity — Achilles, patellar, rotator cuff, and other heavily used tendons. [5]

Typical athletes: Sport-specific; follows load spikes

Why Playing Through Pain Can Make the Problem Worse

Young athletes often believe that ignoring discomfort proves they are tough. However, continuing to repeat the aggravating movement may turn a manageable irritation into a more significant injury — and it teaches the athlete to move around the pain rather than correcting the problem.

Compensation creates a chain reaction: an athlete with heel pain stops pushing through the foot normally, and that change can affect the ankle, knee, hip, and even the opposite leg. Rest alone may calm the symptoms, but it does not always correct the strength, mobility, or movement deficit that contributed to the problem. Parents can learn more about acute injuries, growth plate concerns, and when orthopedic care may be necessary in our companion article, Pediatric Sports Injuries: What Parents Should Know Before Fall Season.

What a Physical Therapy Evaluation Includes

A physical therapy assessment is based on the athlete’s symptoms, sport, position, training schedule, and stage of development. The therapist may evaluate joint range of motion, muscle flexibility, strength, balance, coordination, walking and running mechanics, squatting, jumping and landing, sport-specific movements, and differences between the right and left sides.

The therapist also reviews how the training load has changed: How many teams is the athlete playing for? How many days per week? When did symptoms begin? Was there a recent camp, tournament, or mileage increase? A recent growth spurt? Does pain improve on days off? Has performance changed? [5] This information helps determine whether rehabilitation is appropriate or whether the athlete should first be evaluated by a physician.

How Physical Therapy Addresses Overuse Injuries

The first goal is to reduce the stress that keeps the injured area irritated — which does not always require complete inactivity. The athlete may temporarily modify practice duration, running distance, throwing volume, jumping, high-impact drills, or competition schedule.

The rehabilitation program then addresses the deficits contributing to the symptoms. Treatment may include mobility exercises, progressive strengthening, balance and coordination training, manual therapy when appropriate, walking or running retraining, jumping and landing instruction, sport-specific movement correction, and a gradual return-to-practice plan. All Sports Physical Therapy provides individualized sports medicine and physical therapy services for athletes recovering from acute and overuse injuries.

Training Load Matters

Rehabilitation is not only about selecting the right exercises — it also involves managing how much stress the athlete experiences throughout the week. An athlete may tolerate a school practice schedule but develop pain after adding a travel team, private lessons, and weekend tournaments. Each activity may appear reasonable on its own; together, they may exceed the athlete’s current capacity. Research on training load shows that rapid spikes in workload — not high workload itself — are the strongest predictor of injury. [5]

Parents should consider the complete workload rather than focusing on one team. Helpful strategies include:

• Schedule at least one full rest day each week. [1]
• Avoid playing the same sport year-round without meaningful breaks. [3]
• Limit participation on overlapping teams.
• Increase mileage, throwing, and practice intensity gradually. [5]
• Allow more recovery during growth spurts or after illness.
• Treat pain as useful information rather than an inconvenience.
• Prioritize sleep, hydration, and adequate nutrition.

Rest should be built into the training plan before an injury occurs. [1]

When Should the Athlete Stop and Be Evaluated?

A young athlete should stop the aggravating activity and be evaluated when pain is becoming more frequent or intense, pain changes the way the athlete moves, symptoms continue at rest, there is swelling, the athlete cannot bear weight normally, pain is located directly over a bone, a joint catches, locks, or gives way, performance continues to decline, symptoms are not improving after a reduction in activity, or the athlete has numbness, tingling, or weakness.

A physical therapist can identify many movement and training factors contributing to an overuse injury. When symptoms suggest a fracture, growth plate injury, significant joint condition, or another problem requiring medical diagnosis, the therapist refers the athlete for orthopedic evaluation — at ASPT, directly to the sports medicine physicians at NY Bone & Joint Specialists.

Help Young Athletes Build Durable Bodies

The goal of youth sports is not simply to finish the current season — it is to help children develop skills, confidence, and a healthy relationship with physical activity that lasts for years. Early overuse symptoms are often easier to address than advanced injuries. Parents, coaches, therapists, and athletes should work together to create a training environment where reporting pain is viewed as responsible rather than weak. [1] At All Sports Physical Therapy, our therapists help young athletes understand how their bodies move and recover. We develop personalized programs that address pain, restore strength and mobility, and prepare athletes for a safe return to their sport.

FAQ's

What are the early warning signs of an overuse injury in a young athlete?

The earliest signs are usually not complaints of pain — they are soreness after every practice in the same spot, movement changes (a limp, shortened stride, dropped throwing arm), declining performance, swelling or morning stiffness, and fading enthusiasm for the sport. Kids compensate before they complain. Pinpoint bone tenderness or pain near a growth plate deserves particular attention in a growing athlete. [1][2]

What are the four stages of an overuse injury?

Stage 1 is pain after activity; stage 2 is pain during activity that doesn’t limit play; stage 3 is pain that affects performance; stage 4 is pain at rest — which requires medical evaluation before returning to sport. Intervening at stage 1 usually costs a week of reduced load. Waiting until stage 3 or 4 can cost a season, because the athlete has been reinforcing compensations the entire time.

Why are growing athletes more vulnerable to overuse injuries?

Growth plates — the areas of developing cartilage near the ends of growing bones — are weaker than mature bone and can be injured by repetitive stress that an adult’s skeleton would tolerate. During growth spurts, bones can also lengthen faster than muscles and tendons adapt, temporarily reducing flexibility and coordination. Conditions like Osgood-Schlatter disease and Sever’s disease are growth-plate-related by definition. [2][4]

Is it bad for kids to play one sport year-round?

Year-round single-sport play without meaningful breaks is associated with higher rates of overuse injury and burnout — pediatric sports medicine organizations recommend rest days, off-seasons, and sampling multiple sports. Total workload is what matters: school team plus travel team plus lessons plus tournaments can quietly exceed a young body’s capacity even when each looks reasonable alone. [1][3]

When should a young athlete see a physical therapist vs. a doctor?

A physical therapist is the right starting point for gradually developing pain with movement or performance changes; a physician should evaluate first when there is pinpoint bone tenderness, suspected growth plate injury, pain at rest, swelling, catching or locking, numbness, or an inability to bear weight. ASPT screens for exactly these red flags and refers directly to the sports medicine physicians at NY Bone & Joint Specialists when a medical diagnosis is needed — then rehabilitates the athlete once the diagnosis is confirmed.

How can overuse injuries be prevented?

The best-evidenced prevention is load management: at least one full rest day per week, gradual increases in training volume and intensity, breaks between seasons, limits on overlapping teams, extra recovery during growth spurts, and prioritizing sleep and nutrition. Research shows rapid spikes in workload — not high workload itself — are the strongest injury predictor, which is why sudden additions (a new travel team, a tournament weekend) are the moments to watch. [1][3][5]

Peer-Reviewed Clinical References

[1] Brenner JS; AAP Council on Sports Medicine and Fitness. Overuse Injuries, Overtraining, and Burnout in Child and Adolescent Athletes. Pediatrics. 2007. pubmed.ncbi.nlm.nih.gov/17545378

[2] DiFiori JP et al. Overuse Injuries and Burnout in Youth Sports: AMSSM Position Statement. Clin J Sport Med. 2014. pubmed.ncbi.nlm.nih.gov/24366013

[3] Jayanthi N et al. Sports Specialization in Young Athletes: Evidence-Based Recommendations. Sports Health. 2013. pubmed.ncbi.nlm.nih.gov/24427397

[4] AAOS. Osgood-Schlatter Disease (Knee Pain). OrthoInfo. orthoinfo.aaos.org/en/diseases--conditions/osgood-schlatter-disease-knee-pain

[5] Gabbett TJ. The Training-Injury Prevention Paradox: Should Athletes Be Training Smarter and Harder? Br J Sports Med. 2016. pubmed.ncbi.nlm.nih.gov/26758673