Preventing overuse, not just acute and traumatic, injuries matters in youth sport

Cross Fertilising Injury Prevention (IP) and the British Journal of Sports Medicine (BJSM)

Readers of this journal would be fully aware of international definitions of injury based on the energy-exchange causation theory proposed by early injury researchers such as Haddon. Such definitions have led much prevention research to focus on acute traumatic injuries only. In this work, injury has been defined as any physical complaint that is caused by the inability of the body’s tissues to maintain its structural and/or function integrity following a transfer of energy to the body (e.g. from an impact, sudden movement, repeated force, etc.). For acute and traumatic injuries, this inability to withstand the energy transfer is manifested within a relatively short period following the inciting event. For this reason, studies analysing medical presentations for injury, especially at emergency departments and hospital settings, has provided a strong epidemiological basis to underpin preventive research, including in sport.

In the context of sports participation, however, injury prevention depends just as much upon the ability of the athlete’s body to tolerate repeated exposures to injury risks whilst remaining active in sport. Therefore, it is not just injuries associated with acute events that are problematic. Overuse injuries, that are not associated with a single inciting event and with symptom onset developing over time, also occur. As an example in other contexts, this has previously been reported in this journal by Wilkinson et al in the context of British infantry injury rates, for which only 83% of all injury diagnoses were associated with traumatic inciting events.

The British Journal of Sports Medicine (BJSM) Volume 48, Issue 4 recognises the importance of overuse injuries in youth sports, through its publication of a position statement from the American Medical Society for Sports Medicine on this important topic. There has been a general trend over recent years for increasing amounts of high-intensity training and competition in sport to be undertaken by youth, especially by those motivated to pursue careers in sport. However, such activities, when not balanced with appropriate physical load management and skill development, can lead to high rates of overuse injuries.

The Overuse Injuries and Burnout in Youth Sports position statement emphasises the following strategies to prevent overuse injuries:

  • Limit the amount of training undertaken, both in terms of actual time spent and its intensity. It is important that young athletes also have adequate periods of rest between sporting episodes, to allow their bodies to recover fully.
  • Preparation for sporting activity is important and both age-appropriate strength training and resistance training is important to help prepare the young athlete’s body for the physical challenges.
  • Proper supervision of training and sports preparation programs for young athletes should be provided.
  • As youth athletes are still maturing physically, it is possible that associated changes in their biomechanics could make them more prone to injury. When the sporting activity involves equipment, it is important that it is checked regularly to ensure it still fits properly and is of the right size.

There is sometimes the perception that overuse injuries are not very severe, because people with them rarely report to hospitals for treatment. However, even in children, they often take longer to recover from than acute injuries and they can significantly affect quality of life over some time. Importantly, they most certainly prevent children from participating in sport and other physical activities, thereby denying them the overall benefits of participating in an otherwise active lifestyle.


Caroline Finch is an injury prevention researcher and Head of the Australian Centre for Research into Injury in Sport and its Prevention (ACRISP) within the Federation University Australia located in Ballarat, Victoria, Australia. She specialises in two areas: (1) sports injury surveillance and research methodologies and (2) implementation and dissemination science applications for sports injury prevention. She is the Senior Associate Editor for Implementation & Dissemination for the British Journal of Sports Medicine and the Statistical Editor for Injury Prevention; both journals are published by the BMJ Group. Caroline can be followed on Twitter @CarolineFinch.

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