Table of contents, injuries that can occur in:
This section provides information on some of the most common injuries that afflict young athletes, i.e. athletes between the ages of 12 and 15 (the website is being updated for age groups 16-19 years). It also provides information about some injuries that can occasionally occur in growing athletes that it is beneficial to be aware of.
At these ages, it is relatively unusual to have overload injuries in the shoulder or elbow regions. If a young athlete has persistent discomfort in these areas, i.e. for more than 4 to 6 weeks, a Doctor should be consulted.
Acute, traumatic injuries in athletics are relatively rare. Young athletes that sustain painful, acute (suddenly occurring) injuries should seek medical advice in order to get a diagnosis. These types of injuries are not covered on this page as they should be managed by medical professionals.
Coaches! Pay attention to, and collect information on, the injuries, illnesses and medications that the young athletes in your training group have!
Parents / Guardians! Inform the coach if your child is unwell, has pain, and if they take any medication!
Young athletes should not use pain-relieving treatments in order to train or compete!
Injuries that may occur in growing children and young people.
Slipped upper femoral epiphysis (SUFE): ‘Slipping’ in the thigh bone growth plate
This affects growing children around the ages of 11 to 16 years old. This condition is caused by a disorder in the growth plates. It is more common in black people than white people and 2 to 5 times more common in boys than girls. The disorder rarely occurs in girls who have had their first period and occurs significantly more often in overweight children, but it can also be triggered by sports. It is possible that an endocrine (hormonal) influence may be the cause of weakening in the growth plates.
Symptoms: Pain in the groin, the front of the thigh and around the knee joint. Limping. Atrophy of the thigh muscles, i.e. muscle wasting. Reduced range of motion in the hip joint, in particular inward rotation.
It is very important that young people who notice the above-mentioned symptoms do not continue training but visit a doctor so that an x-ray can be taken!
Diagnosis: By a Doctor. Clinical examination and x-ray, plus other investigations as necessary.
Stress fracture-stress reaction in the groin
Stress fractures occur as a result of recurrent, non-maximal, overloading. The muscles do not recover sufficiently, become exhausted and cannot dampen the loading they are exposed to. This means that the bones end up loaded instead. A small crack occurs in the outer hard (cortical) surface of the bone. This is preceded, in many cases, by an inflammation of the femur in the thigh and / or pelvic bone (so-called periostitis). Common locations of stress fractures in the groin region are the femoral neck and the area around the pubic bone (os pubis). Stress fractures can occur at any age, but are very rare in children under the age of 10.
Symptoms: Groin pain exacerbated by loading.
Diagnosis: By a Doctor.
Treatment: Protection (unloading) and rest. Possible alternative training in agreement with a doctor and / or physiotherapist.
Inflammation of the hip joint
Inflammation of the hip joint occurs often as an acute condition in children between 2 and 12 years old. This is the most common cause of hip pain (groin) in children under 10 and is more common in boys.
Symptoms: Pain in the groin and possibly the front of the thigh.
Diagnosis: By a Doctor.
Treatment: This condition usually heals itself and is benign, but it should be examined by a doctor.
Hamstring strain (muscle pull in the back of the thigh) is a relatively common overload injury in athletics. It often occurs suddenly when an athlete sprints or jumps. Hamstring strains are not as common among young athletes.
Symptoms: Sudden stabbing pain in the back of the thigh. Can appear very dramatic.
Diagnosis: Predominantly via clinical examination (i.e. by physiotherapist or Doctor, without scans).
Treatment: It is important to employ rapid, acute care according to PRICE (see Acute Care section)! Followed by rehabilitation by a physiotherapist (the L-protocol). With effective rehabilitation, the prognosis is good and an athlete is usually back in athletics training after seven to nine weeks.
The Lengthening protocol (L-protocol)
This is a video with Carl Askling’s research-based rehabilitation program (in Swedish) for hamstring injuries, the so-called L-protocol. Research has shown that eccentric lengthening exercises are effective in rehabilitating acute hamstring injuries in sprinters, jumpers and elite football players. The program applies to both injuries of sprint and stretch type. In the event of an acute injury, it is important to have the injury thoroughly examined by a knowledgeable person before starting rehab.
The L-protocol should always be performed painlessly and can normally be started 3-5 days after the injury.
- The Extender: twice every day, 3 set x 12 reps
- The Diver: every other day, 3 set x 6 reps
- The Glider: every 3rd day, 3 set x 4 reps
- 00.10 1. The Extender
- 01.08 Three common errors
- 02.39 2. The Diver
- 03.33 Two common errors
- 04.32 3. The Glider
- 05.13 Two common errors
Carl Askling is a certified physiotherapist, PhD. Carl works clinically in Stockholm with rehabilitation of hamstring injuries. In his research, he is affiliated with the School of Gymnastics and Sports (GIH), Stockholm.
Is relatively common in young, growing athletes. It develops near the growth plate, as a result of intensive athletics. Osgood-Schlatter’s is a loosening of the tendon attachment and it is often possible to see a displacement of the tendon insertion (see picture). This usually occurs around the ages of 9 to 15, and is more common in boys, probably as they start puberty later, at an age when they begin training more intensively in sport.
Symptom: Distinctive soreness around the insertion of the patella (knee cap) tendon to the tibia (lower leg bone).
Diagnosis: Predominantly via clinical examination of a Doctor/Physiotherapist. If doubt remains an x-ray can be taken.
NOTE! These issues are related to the growing process! It is important that training is varied and adjusted!
Treatment: Avoid sporting activities that aggravate the pain. Perform alternative exercise, preferably in response the level of pain aggravation (you can use a pain scale). Unloading, protection or taping (see instruction video). The young athlete can continue to train but adaptation is important. Review the exercise plan for the coming week (current period), adjust the load on knees (jumps etc.). Refer to a physiotherapist. This condition is self-healing in most cases.
Instructional video for knee taping.(in Swedish)
This condition resembles jumper’s knee (see below) and occurs in growing children and young people. In the growing athlete, the pain develops around the lower tip of the knee cap, and develops as a result of recurrent overloading.
Symptom: Distinctive soreness over the lower tip of the kneecap. Swelling. Stiffness. Limping.
Diagnosis: Via clinical examination by a Doctor and an x-ray.
Treatment: Symptomatic, avoid sporting activities that aggravate the pain. The young athlete can continue to train but adaptation is important. Review the exercise plan for the coming week (current period), adjust the load on the knees (jumps etc.). Early activation of the thigh muscle, see “jumper’s knee” below. This condition is self-healing in most cases and disappears when an individual is fully grown.
Jumper’s knee- Patella Tendinopathy
An overload injury in the tendon caused by intense sports. The symptoms usually develop gradually. Jumper’s knee is unusual in growing children but it can still occur (see also Osgood-Schlatter’s which is a more common cause of knee pain). Jumper’s knee is more common among boys / young men who jump frequently, this is probably as they start puberty later (compared to girls), at an age when they begin training more intensively in sport.
Symptoms: Pain around the lower tip of the knee cap (in the tendon itself). Swelling over the same area.
Diagnosis: Predominantly via clinical examination of a Doctor.
Treatment: Adaptation of loading (initial unloading). Rehabilitation with a physiotherapist. The first phase of rehabilitation is isometric (static) exercises for the anterior (front) thigh muscles (quadriceps), to achieve pain relief. Contract the muscle for about 45 sec x 5 with 2 minutes rest in between. Taping or possibly a knee support. If symptoms do not correspond to those listed above, a Doctor should be consulted.
Osteochondritis Dissecans (OCD)-Fragmentation of bone / joint cartilage.
This is a bone and cartilage fragmentation in the knee joint that usually affects young people between the ages of 12 and 16, and is more common in boys. A crack occurs in the bone and cartilage and, in the event of fragmentation, a free body (small piece of bone/cartilage) can form in the knee joint. Usually, however, the crack heals and no fragmentation occurs. This problem is caused by small recurring traumas or overloading.
Symptoms: Pain during rest and after physical activity. Locking in the knee.
Diagnosis: By a Doctor.
Treatment: Most often self-healing, in rare cases surgery is required. Refer to a physiotherapist.
Chondromalacia Patellae/Anterior knee pain
Is an umbrella term for knee pain that occurs diffusely around the anterior (front) part of the knee joint/cap. This is more common in young girls.
Symptoms: Ache/Soreness associated to loading. Often aggravated by stairs and sitting on the heels. Usually no joint swelling.
Treatment: Avoid aggravating activity. Vary training. Strength training. Physiotherapy if required. The prognosis is good.
Acute trauma to knee joints with joint swelling
A Doctor should always be contacted to determine if an x-ray examination is required. Treatment then follows any findings.
Young athletes who experience persistent pain in their knee or hip, i.e. pain that lasts for more than two weeks and does not improve with rest, should always be examined by a Doctor. As a pain in the thigh and knee may originate from the hip joint.
Medial tibial stress syndrome (MTSS)- Shin splints.
Is common in young athletes. The cause is often overloading and this usually occurs when changing surfaces or training type, for example when you start training indoors in the autumn or start training with more hopping.
This can be prevented by ensuring a more gradual transition between types of training sessions and environments, for example, by delaying the use of spikes. Try to review the balance between exercise load and recovery and check you have well-fitting shoes.
Symptoms: Tenderness/soreness along the inner edge of the tibia (shin bone). Some swelling can occur over the same area. The symptoms are often exacerbated by continued loading.
Diagnosis: Predominantly via clinical examination.
Treatment: Stop training following the onset of symptoms, and exercise in ways other than running and hopping. Rest followed by guided exercise. Physiotherapy as necessary. The return to athletics should be gradual, for example, by starting with warm-up jogging and coordination intervals and delaying the reintroduction of jumping. Should symptoms persist other treatment may be required. Seek medical attention if the symptoms do not resolve after 4 to 6 weeks, or if the pain is very localised, i.e. the size of a one-pound coin.
Haglunds heel-calcaneal apophysitis (also called Sever’s disease)
Affects active, growing people between the ages of 8 and 15 years old and can, occasionally, occur in both heels at the same time. It is caused by intensive sports participation and is commonly seen in sports which require high amounts of loading of the feet and ankles, such as jumping, hopping etc.
NOTE! These problems are related to the growth plates and are not overloaded tendons!
Symptoms: Pain is located on the heel bone (inside or outside), around the Achilles tendon attachment on the back of the heel. This area is often swollen and sore.
Treatment: Prompt unloading and inserts under the heel are recommended, for example using gel cushions or heel cups (see picture). During rehabilitation, it is important to remember that the pain comes from an overloaded (i.e. compressed) growth plate. This means that young people with growth plate problems should not perform similar rehabilitation programs to adult athletes that have tendon problems! It is possible to rest and unload until the pain is gone. You can continue with varied exercise and activities that do not load the feet and heels. A young athlete can continue to train but adaptation is important, review the plan for the coming week, and adjust the amount of loading on the feet/heels (jumps etc.). The prognosis here is always positive. The discomfort usually disappears when the individual is fully grown, but it can take up to six months, or a year, before the problem has fully healed. In case of long-term problems, medical advice is recommended.
Instructional video for taping of the heel. (in Swedish)
Twisting an ankle, i.e. turning the foot inwards, is, unfortunately, common in sports. Most commonly this leads to injury of the ligaments on the outside of the ankle and bleeding occurs if a ligament is ruptured.
Symptoms: Acute/sudden onset. The athlete twists the ankle, with the foot turning inwards and often under the body.
Diagnosis: Predominantly via clinical examination. If an athlete cannot weight-bear on the foot after 4 to 7 days then a Doctor should be consulted for further investigation.
Treatment: It is important to take action quickly, via acute care with PRICE/POLICE! Rehabilitation with a physiotherapist. The prognosis is good. In the case of less severe ankle sprains, balance training can start early (i.e. after 2-3 days), this can begin first on the floor, on a soft surface. During the first weeks after an ankle sprain, the injury is vulnerable and there is an increased risk of exacerbation (by twisting the ankle again). As such it is important to continue balance exercises for 4-8 weeks after the injury, preferably supplemented with ankle strengthening exercises.
Back problems in children under 10 to 12 years old are very rare. Back pain is much more common when children reach puberty and go through periods of rapid growth. Young athletes around 16-19 years of age, who also train at the elite level, more often suffer back pain compared to young athletes of a similar age who exercise at a lower level.
Symptoms: Pain in the lower back (lumbar spine) associated with loading.
Diagnosis: Predominantly via clinical examination. In many cases, the back pain of these elite athletes has a so-called structural explanation that cannot be detected with regular clinical examination, therefore, supplementary investigation, for example, with an MRI scan may be needed.
NOTE! Back problems around these ages (16-19) are often related to the final stages of growth!
Treatment: Stop training following the onset of symptoms, and exercise in ways other than running and hopping. Rest followed by guided exercise. Referral to a physiotherapist. Return to athletics should be gradual. You can also read the sections on Exercise and Puberty, and Growth.
In the case of persistent complaints, it should be noted that there are causes of back pain in children that require consultation with a Doctor, to seek a diagnosis and prompt treatment (e.g. stress reactions / fractures, tumors, herniated discs, spondylitis, congenital kyphosis, etc.).
Read more research about back pain; Back problems common to elite athletes.
Frequently asked questions:
What are the most common symptoms of an overload injury?
An overload injury usually builds up gradually, for example, by beginning with a feeling/awareness in the foot or lower leg that something doesn’t feel quite right. Often this feeling/awareness is fairly well-localised to an area or point.
When can an athlete return to competing after an injury?
In order to reduce the risk of reoccurrence of injury (or a new injury), an athlete should have been able to exercise normally for two weeks prior to any competition.
Written by: Lena Haggren Råsberg and Jenny Jacobsson
Instructional video: Tommy Eriksson
References and tips for further reading:
Askling CM, Tengvar M, Thorstensson A. Acute hamstring injuries in Swedish elite football: a prospective randomised controlled clinical trial comparing two rehabilitation protocols. Br J Sports Med. 2013;47(15):953-959. doi:10.1136/bjsports-2013-092165
Askling CM, Tengvar M, Tarassova O, Thorstensson A. Acute hamstring injuries in Swedish elite sprinters and jumpers: a prospective randomised controlled clinical trial comparing two rehabilitation protocols. Br J Sports Med. 2014;48(7):532-539. doi:10.1136/bjsports-2013-093214
Brukner P. Brukner & Khan’s Clinical Sports Medicine: Injuries, Vol 1, 5ed, McGraw- Hill Australia. 2017.
Danielsson och Willners Barnortopedi. Studentlitteratur. 2006.
Peterson L, Renström P. Sports Injuries. 4ed. Taylor and Francis. 2016.
Sundell CG. Low back pain in adolescent athletes. Umeå University medical dissertations, 2019.
Thomeé R, Swärd L, Karlsson J. Nya Motions- och idrottsskador och deras rehabilitering. SISU Idrottsböcker. 2011.
Sports Medicine Physician, pediatric orthopedics, chief physician Astrid Lindgren’s Hospital, Stockholm. Head physician Swedish Athletics.