Youth Injuries: Youth Sport Has Never Been More Competitive and Young Athletes Aren’t Just Small Adults
If you’ve ever heard someone say, “It’s probably just a strain,” when a young athlete complains of pain, it’s worth thinking twice.
One of the biggest misconceptions in sports medicine is that children and teenagers can be assessed and treated in the same way as adults. They can’t. Children are not miniature adults—and neither are their injuries.
Youth sport has also never been more competitive or more demanding. Many young athletes today are training across multiple teams, multiple sports and development programs, often all at once.
At SportsFit Physio and Health, a large proportion of our caseload is made up of adolescent athletes, from footballers and netballers to gymnasts, runners, basketballers and soccer players, and we’re seeing a growing number of them presenting with overuse injuries, particularly during adolescence. The developing athlete is biologically very different to the mature athlete, and understanding those differences is critical for making the correct diagnosis and getting young athletes safely back to sport.
In many cases, the diagnosis that is most likely in a 15-year-old is completely different to the diagnosis that would be most likely in a 30-year-old presenting with exactly the same symptoms and, importantly, the way we treat these injuries differs immensely too.
The good news? Many of these injuries are preventable with better load management and when they do occur, understanding what’s actually happening in a growing body makes all the difference to recovery.
Growing Bones Change Everything
During adolescence, bones are growing rapidly. This means that young athletes have several structures that simply don’t exist in adults, including:
- Growth plates (physes)
- Apophyses (sites where tendons attach to growing bone)
- Synchondroses (cartilaginous joints that later fuse)
These structures are made of cartilage rather than mature bone, making them the weakest link in the musculoskeletal system during growth.
In adults, excessive force usually injures the muscle, tendon or ligament. In adolescents, the exact same force is often transmitted to the growing bone instead.
Adolescence is one of the most complex stages of physical development. During this time:
- Bones are still growing
- Growth plates have not fully closed
- Muscles often become tight during growth spurts
- Strength and coordination are still developing
- Energy demands are extremely high
When you combine these biological changes with high sporting loads, the risk of injury increases. In fact, research suggests that 40–50% of youth sports injuries are overuse injuries.
Adult Injury vs Adolescent Injury
Imagine two athletes present with the exact same complaint: “I felt a sharp pain while sprinting.”
One athlete is 34 years old. The other is 14. Despite describing the same symptoms, the list of possible diagnoses is very different.
Adult athlete
In an adult, sudden pain while sprinting immediately raises suspicion for injuries such as:
- Hamstring strain
- Calf muscle tear
- Quadriceps strain
- Adductor strain
- Tendon injury (depending on location)
- Less commonly, a ligament injury if associated with a change of direction
Adolescent athlete
In a growing athlete, our thought process changes considerably. While muscle injury is certainly possible — particularly in older adolescents — it is often lower on our list of likely diagnoses, especially before skeletal maturity.
Instead, we may be considering:
- Growth plate (physeal) injury
- Apophyseal irritation (traction apophysitis)
- Acute apophyseal avulsion injury
- Osteochondral injury
- Bone stress injury
- Joint pathology
- Less commonly, a true muscle strain
The exact diagnosis depends on the athlete’s age, where they are in their growth spurt, the location of pain, and the mechanism of injury.
This is why experienced clinicians don’t simply diagnose “a pulled muscle” based on the history alone. In adolescent athletes, understanding what is still growing is often just as important as understanding what hurts.
Growth Plates: The Weak Link
Growth plates (physes) are responsible for longitudinal bone growth. Until they close in late adolescence, they are significantly weaker than the surrounding ligaments and tendons.
This means injuries that might produce a ligament sprain in an adult can instead produce:
- Growth plate (physeal) injuries
- Salter-Harris fractures
- Growth disturbances (if missed)
Missing these injuries can have significant long-term consequences, including angular deformity or limb length discrepancy in severe cases. Fortunately, most heal extremely well when recognised and managed early.
Apophyses and the Truth About “Growing Pains”
Many tendons in adolescents don’t attach directly into mature bone. Instead, they attach into secondary growth centres called apophyses. These areas are particularly vulnerable during periods of rapid growth because:
- Bones lengthen rapidly
- Muscles temporarily become relatively tight
- Tensile forces increase dramatically across the tendon attachment
Common examples include Sinding Larsen Johansson syndrome, pelvic apophysitis and pelvic avulsion fractures. The two we see most often in young athletes are Osgood-Schlatter disease and Sever’s disease.
Osgood-Schlatter Disease
Pain at the front of the knee where the patellar tendon attaches to the shinbone. This occurs when repetitive running and jumping irritate the growth plate. We see many of these youth overuse injuries in young footballers, basketballers and netballers.
Sever’s Disease
Heel pain caused by irritation of the growth plate where the Achilles tendon attaches. This
To many parents these are labelled as “just growing pains.” In reality, they are true overload injuries that require careful load modification, progressive rehabilitation and management of training loads — not simply rest until the pain disappears.
Left unaddressed, pain from these conditions can:
- Persist for months or even years
- Continue even after growth plates close
- Lead to chronic tendon irritation
- Increase the risk of future knee or heel pain
They are best thought of as load-related injuries in growing athletes, not just harmless aches.
Avulsion Injuries: When the Tendon Pulls Off the Bone
One injury that is almost unique to adolescent athletes is an avulsion injury.
In adults, when a muscle contracts forcefully (such as during sprinting, kicking or jumping), the muscle or tendon is usually the structure that fails. In adolescents, however, the tendon is often stronger than the growing bone it attaches to.
Instead of the tendon tearing, it can pull off a small fragment of bone from the apophysis. This is known as an avulsion fracture.
These injuries commonly occur around the pelvis, including the:
- Anterior superior iliac spine (ASIS)
- Anterior inferior iliac spine (AIIS)
- Ischial tuberosity (“sit bone”)
- Iliac crest
They often present as a sudden, sharp pain during explosive movements such as sprinting, kicking or jumping, and many young athletes describe hearing or feeling a “pop.”
Because they can initially feel like a muscle strain, avulsion injuries are sometimes missed or misdiagnosed. Fortunately, the vast majority heal very well with appropriate diagnosis, load management and rehabilitation, although larger or significantly displaced fractures occasionally require orthopaedic review.
Understanding the difference between a muscle strain and an avulsion injury is another example of why assessing adolescent athletes requires a different diagnostic approach than assessing adults.
Stress Fractures Are Becoming Increasingly Common
One of the biggest changes we’ve seen in youth sport over the past decade is the increasing number of bone stress injuries.
Young athletes today often:
- Play year-round
- Represent multiple teams
- Complete additional strength and conditioning
- Attend representative programs
- Participate in specialist coaching
- Rarely experience a true off-season
Their bones simply don’t always have enough time to adapt. Stress injuries caused by repetitive loading exceeding the bone’s ability to recover and occur in many locations including:
- Tibia
- Fibula
- Femur
- Pelvis
- Lumbar spine (pars)
- Navicular
- Metatarsals
Certain stress fractures are considered high risk because they have higher chances of progressing to complete fracture, delayed healing or even surgery. Early diagnosis in these injuries is absolutely critical.
Muscle Injuries Are Surprisingly Rare
Many parents assume their child has “pulled a muscle.”
Interestingly, true muscle strains are actually relatively uncommon in younger adolescents, particularly before or during peak growth. Instead, pain around muscles is often referred from:
- Bone
- Growth plates
- Apophyses
- Joint structures
This is why we are often cautious about diagnosing hamstring or quadriceps strains in younger teenagers without first ruling out more important causes. As skeletal maturity increases, muscle injuries gradually become more common and begin to resemble adult injury patterns.
Ligament Sprains and Tendinopathies Are Less Common Than You Might Think
Adults commonly present with:
- Achilles tendinopathy
- Patellar tendinopathy
- Gluteal tendinopathy
- Lateral ankle ligament sprains
In adolescents, these diagnoses are certainly possible, particularly in older teenagers, but they are generally less common than in adults. Instead, similar pain may actually represent:
- Apophysitis
- Growth plate irritation
- Avulsion fractures
- Bone stress injury
- Osteochondral injury
- Physeal fracture
Treating a young athlete as though they simply have “tendon pain” or “a sprain” can delay the correct diagnosis and prolong recovery.
When Training Volume Becomes Too Much
One of the biggest predictors of injury in youth athletes is training load.
Research shows that athletes who train more hours per week than their age (for example a 13-year-old training more than 13 hours per week) have almost double the risk of serious overuse injury.
Another key risk factor is rapid increases in training load. Sudden spikes in sport participation — particularly increases greater than 15–20% week to week — significantly increase injury risk.
The Problem with Early Sport Specialisation
Many young athletes today specialise in a single sport from an early age.
While this might seem like the pathway to elite performance, research actually shows the opposite.
Early sport specialisation is associated with:
- Higher injury rates
- Increased burnout
- Reduced enjoyment of sport
- Increased psychological pressure
Research suggests these athletes are 2–2.5 times more likely to suffer serious youth overuse injuries, up to 50% of young athletes in intensive programs experience burnout, and around 70% of children stop organised sport by age 13.
Interestingly, many elite athletes actually played multiple sports as children and specialised later in adolescence.
Diversification early, specialisation later appears to be the healthier pathway.
Pain During Sport Is Never “Normal”
This is perhaps the single most important message for parents and young athletes: pain during sport is always a red flag.
Children are remarkably resilient. Unlike many adults, they generally don’t develop persistent aches simply because they’re getting older. If a young athlete experiences pain while running, sprinting, jumping, kicking, throwing or changing direction, their body is telling us something.
Even more concerning is pain that:
- Makes them limp
- Causes them to stop participating
- Changes the way they move
- Prevents them finishing training or competition
- Prevents sleep or wakes them in the night
If pain stops an adolescent from playing their sport, it should never be dismissed as “normal” or something they should simply push through. It doesn’t necessarily mean there is a serious injury, but it absolutely warrants assessment.
Addressing pain early usually means:
- Faster diagnosis
- Shorter recovery
- Less time away from sport
- Reduced risk of developing a more significant injury
If your child is experiencing ongoing pain during or after sport, it’s worth having it assessed.
We Also Ask Different Questions
Assessing an adolescent athlete isn’t just about where it hurts. As physiotherapists, our first question isn’t simply “Where does it hurt?” It’s also: “How old is this athlete, and where are they in their growth and development?”
We also want to understand:
- Are they currently going through a growth spurt?
- How many sports are they playing?
- Has their training load recently changed?
- How much are they sleeping?
- Are they eating enough to support growth?
- Have they had previous stress injuries?
- Are they showing signs of fatigue or burnout?
Often, these answers explain why an injury has occurred — and help us prevent it from happening again.
Imaging Decisions Are Different Too
Adults with similar symptoms often don’t require imaging. In adolescents, however, we generally have a lower threshold for imaging when we suspect:
- Growth plate injury
- Bone stress injury
- Osteochondral injury
- Avulsion fracture
- Persistent night pain
- Pain that prevents sporting participation
The aim isn’t to scan everyone. The goal is simply to avoid missing diagnoses that can become much more significant if an athlete continues training.
Practical Load Management Tips for Parents
The goal of youth sport isn’t less sport. The goal is better managed sport.
Here are some practical guidelines:
1. Follow the “Hours = Age” rule
A good rule of thumb is that weekly organised sport hours should not exceed the athlete’s age.
For example:
- 10-year-old → up to 10 hours per week
- 13-year-old → up to 13 hours per week
This includes training and games across all sports combined.
2. Avoid sudden spikes in training
Training loads should increase gradually, ideally no more than 10–15% per week.
3. Schedule rest days
Young athletes should have 1–2 days per week completely off sport. Rest is when the body adapts and recovers.
4. Avoid year-round sport
Ideally athletes should take 2–3 months off per year from any single sport. This doesn’t mean no activity — just playing different sports or activities.
5. Prioritise sleep and nutrition
Adolescent athletes should aim for
- 8–10 hours of sleep per night
- Adequate nutrition to support both growth and sport
Growing athletes often require much more food than parents expect.
6. Encourage multi-sport participation
Playing multiple sports can:
- Reduce overuse injuries
- Improve athletic development
- Maintain enjoyment of sport
Overall this will also keep youth athletes playing sports or staying active for longer.
When Should Parents Seek Assessment?
One of the most common questions we hear is: “Should we just give it a week and see how it goes?”
Sometimes that’s reasonable, but there are several situations where we’d recommend having a young athlete assessed sooner rather than later.
Arrange an assessment if your child:
- Has pain during sport rather than just soreness afterwards
- Stops playing because of pain
- Begins limping or changes the way they run
- Has pain that is progressively worsening over days or weeks
- Has pain that returns every training session or game
- Has swelling, significant bruising or an obvious deformity
- Has pain directly over a bone rather than within a muscle
- Has night pain or pain at rest
- Cannot comfortably hop on the affected leg
- Has pain that persists for more than 7–10 days despite reducing activity
Pro-tip: Don’t ignore pain that “warms up”
Many significant adolescent injuries, including bone stress injuries and growth-related overload conditions, can initially feel better once the athlete has warmed up. This doesn’t necessarily mean the injury has resolved.
In fact, pain that predictably returns every training session or game is often a sign that the underlying tissue is not coping with the current training load.
Early assessment frequently means:
- A quicker diagnosis
- Less time away from sport
- A lower chance of developing a more serious injury
- Greater confidence for both athletes and parents
Our goal isn’t to stop children playing sport. Our goal is to identify why they’re experiencing pain, modify training appropriately where needed, and help them return safely while continuing to enjoy the sports they love.
The Bottom Line
Young athletes are not simply miniature adults. Their growing skeleton changes:
- The injuries they sustain
- How those injuries present
- Which structures are most vulnerable
- How we investigate them
- How we treat them
- How quickly we expect them to return to sport
Understanding these differences allows us to make more accurate diagnoses, prescribe age-appropriate rehabilitation and help young athletes stay healthy throughout the years that matter most for both sporting development and lifelong physical activity.
If your child is experiencing pain during training or competition, particularly if it causes them to limp, change the way they move, or stop participating, it is worth having them assessed early.
When it comes to adolescent athletes, early diagnosis is one of the most powerful tools we have. The right diagnosis at the right time often means a faster recovery, fewer weeks on the sidelines, and a safer return to the sport they love.
The Big Picture
Young athletes aren’t just managing sport. They’re also managing:
- Growing bones and muscles
- Developing coordination and strength
- School and life stress
- Sleep and recovery needs
- Huge energy demands for growth
All at the same time. The goal of youth sport isn’t early success. It’s long-term health, enjoyment and staying in sport for life.
Concerned about your child’s sports load or ongoing pain? At SportsFit Physio and Health, we work closely with young athletes across multiple sports to manage training loads, treat injuries early and keep them doing what they love.
Todd Grbac
Physiotherapist
References
Caine D, DiFiori JP, Maffulli N. Physeal Injuries in Children’s and Youth Sports: Reasons for Concern? British Journal of Sports Medicine. 2006.
DiFiori JP, Benjamin HJ, Brenner JS, et al. Overuse Injuries and Burnout in Youth Sports: A Position Statement from the American Medical Society for Sports Medicine. British Journal of Sports Medicine. 2014.
International Olympic Committee. IOC Consensus Statement on Youth Athletic Development. British Journal of Sports Medicine. 2015.
Loud, K. Adolescent Bone Health. JAMA Pediatrics. 2006.
Maffulli N, Longo UG, Spiezia F, Denaro V. Sports Injuries in Young Athletes: Long Bone Stress Injuries. Sports Medicine. 2010.
Patel DS, Roth M, Kapil N. Stress Fractures: Diagnosis, Treatment and Prevention. American Family Physician. 2011.
Sharadze, D., Abramov, A., Konovalov, O., Fomina, A., Generalova, Y., Kakabadze, E., Bokova, E., Eliseeva, T., Kostinskaya, M., Smirnov, D., & Urazgulov, A. (2023). The Incidence of Sports Injuries Among School-Aged Children and Adolescents. Georgian Medical News, (343), 193–198.
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