Preventing sport injuries in children

Why do you think sports injuries are increasing in children?

A key issue is the shift from children playing a range of sports to focussing on single sports at increasingly younger ages. Children are now taking part in organised sports from as early as four years old, focusing on one sport rather than developing diverse movement patterns through varied activities. This early specialisation, combined with the pressure to excel and a lack of proper rest, leads to repetitive stress on developing musculoskeletal systems that aren't designed to handle such demands.

What common injuries are you seeing?

Sports injuries in young people fall into two categories: traumatic injuries (sprains, fractures) and overuse injuries. The types of injury we see vary with age and sport. 

Younger children are smaller so traumatic injuries tend to be lower energy, but there are specific injuries you should look out for. Injuries to the growth plate (where long bones grow) can be easily missed as they may appear as mild sprains, but they can have long-term consequences if not properly managed. The growing skeleton can remodel very well over time, but not all injuries are forgiving in this way, so it is important to get a proper assessment.

Single sport specialisation also leads to overuse injuries being more common. These injuries are often seen in developing joints such as the knee or elbow, with repetitive strain injuring the bone and cartilage in the joint. This can result in stress fractures, which can settle with rest, but may need medical attention to minimise long-term problems. Stress fractures are sometimes seen in the spine and hip of young dancers and gymnasts, while young runners and footballers might see these in their legs. Throwing or racquet sports can also cause stress fractures in elbows.

As children get older, overuse injuries tend to shift to involve the junction between their more powerful muscles and their still immature bones. Apophysitis (inflammation of the junction between muscle/tendon and bone) often affects the knee in young people doing jumping sports like netball, basketball and volleyball. With explosive activities like sprinting and jumping, these areas of relative weakness can result in tendon ruptures. Shoulder injuries are increasingly common in overhead sports like tennis and swimming, while hip and groin injuries are more frequent in sports requiring repetitive kicking movements.

ACL (anterior cruciate ligament – an important knee ligament) tears in teenage athletes are also increasingly common due to more intense participation in twisting and turning sports like football, netball and basketball. Female athletes are more likely to sustain ACL injuries due to a combination of factors, including hormones and anatomy. Treating these injuries is complex in a growing skeleton, but is very important for the long-term health of the knee joint. 

What's particularly troubling is we're seeing injuries in younger age groups that were previously predominantly seen in more mature athletes. Stress fractures and tendonitis in 10 - 12-year-olds were virtually unheard of a few decades ago but are now regularly encountered.

What warning signs should parents watch for?

Parents should keep an eye out for both obvious and subtle indicators that their child may have a sports injury. Children often minimise or hide their pain, particularly when they fear being removed from their sport or disappointing coaches and parents.

Persistent pain that doesn't resolve with rest should never be ignored. If a child complains of pain during or after activity that lasts more than a few days, or is experiencing any pain that affects their daily activities, I’d advise seeking medical attention. Pain at night in older children and adolescents is a particular worry. Young children may often experience night time ‘growing pains’, but this is less common in older children so should be assessed. 

Changes in performance can also be early indicators of developing problems. If a previously enthusiastic child suddenly becomes reluctant to participate in a sport, shows decreased performance or appears to be favouring one side, they may be compensating for pain or injury.

Physical signs include visible swelling or bruising, but also more subtle changes like altered movement patterns, reduced range of motion or muscle weakness. Parents should trust their instincts – if something seems different about their child's movement or behaviour around sports, it's worth investigating.

How can parents help prevent these injuries?

Parents should encourage children to participate in multiple sports and activities throughout the year. This approach helps develop diverse movement patterns, prevent repetitive stress and reduce the risk of overuse injuries. I strongly advise against single-sport specialisation before age 14-16, and at any age, ensuring rest periods between training is essential. Children should have at least one full day off per week from organised sports and should take extended breaks from their primary sport over the year.

Avoiding sudden increases in training load is also key to injury prevention. Training loads should be increased gradually, following the 10% rule, where weekly training volume increases by no more than 10%, as sudden spikes in activity intensity or duration significantly increase injury risk.

Nutrition, hydration and adequate sleep form the foundation of injury prevention. Growing athletes have higher energy needs than adults, so ensuring proper nutrition is critical to support normal growth alongside adapting to training demands. Sleep is a highly undervalued component of injury prevention. When sleeping, the body repairs and rebuilds muscle tissue – yet many young athletes are getting less than the recommended 8 hours of sleep, often due to early morning training or late evening practices, as well as academic pressures and increased screen time.

And most importantly, the focus of sports should be enjoyment, not performance. Parents should strive to create an environment where children feel comfortable reporting pain without fear of disappointing adults or losing playing time. The goal should be raising healthy, active young adults who maintain a positive relationship with physical activity throughout their lives for both their physical and mental health, rather than pushing children to the point of injury at the expense of their long-term wellbeing. 

Find out more about paediatric orthopaedics at The Portland Hospital.