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Back To School: Childhood Injuries

  • Writer: Physical Therapy International Service
    Physical Therapy International Service
  • Sep 18
  • 5 min read

Authors: Ella Bonner and Anna Norton


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When the school year starts, it usually means sports seasons are starting, too. Tryouts, new practice schedules, and a sudden jump in training can put extra stress on young athletes. While concussions and broken bones get a lot of attention, many school-age athletes deal with overuse injuries in the elbows, knees, and heels. These are areas where growth plates are still open and vulnerable. Annual sports physicals, often required before kids can play, can be an important checkpoint. While these exams are not perfect at detecting every issue, they are valuable for catching patterns of pain, reviewing training loads, and reinforcing safe habits. 


The elbow is a complex joint made up of the humerus, ulna, and radius. On the inner side, a small growth plate called the medial epicondylar apophysis is especially vulnerable in kids who throw a lot. When the area is exposed to repeated stress, such as pitching or frequent throwing, it can become irritated or even injured. This condition is known as Little Leaguers elbow. 


Little Leaguers elbow is most common in pitchers, but it can also affect catchers and infielders who make frequent, forceful throws. Kids often complain of pain in the inner part of the elbow, and parents or coaches might notice changes in throwing accuracy or speed. Because the growth plate is weaker than the surrounding ligaments, it tends to be the first structure to show signs of stress. 


Treatment almost always begins with rest from throwing. This may last several weeks, depending on how severe the pain is. Ice and short-term use of anti-inflammatory medicine can help with early symptoms. Once pain eases, physical therapy usually focuses on improving strength and mobility in the shoulder, forearm, and core to take pressure off the elbow. When strength and flexibility return, athletes follow a gradual throwing program that starts with light catching and eventually builds up to game-level intensity. X-rays may be ordered if pain lingers to make sure there isn't a bigger problem such as an avulsion injury, where muscle can pull off portions of the attached bone. 


Prevention is just as important. Strict pitch counts and rest days, like those enforced in Little League are essential. Guidelines from Major League Baseball and USA Baseball also recommend that kids avoid pitching and catching on the same day, take regular breaks from overhead throwing during the year, and focus on proper mechanics rather than speed alone. Most importantly, young athletes should stop throwing when they feel pain or fatigue, since continuing to pitch while tired is one of the biggest risk factors for elbow injury.



Another condition that shows up in young athletes is Panner's disease. Unlike Little Leaguers elbow, which affects the inner side of the joint, Panner's disease involves the capitellum on the outer side of the elbow. It's a rare but temporary disorder where the blood supply to that area is disrupted, leading to pain and stiffness. It usually shows up in children between ages of 5 and 12 who do a lot of throwing or weight-bearing sports, like baseball and gymnastics. 


The good news is that Panner's disease almost always heals on its own with proper rest. Treatment focuses on reducing activity that causes pain, using anti-inflammatory medications as needed, and slowly restoring range of motion. In more painful cases, short-term immobilization with a sling or brace may be recommended. Once symptoms resolve, athletes can gradually return to sport. Because the condition is self-limiting, long-term outcomes are excellent and kids usually return to full activity without complications. 


Preventing Panners disease is tricky since its linked to growth and development, but the same principles apply: limit repetitive throwing, take seasonal breaks, and avoid early year-round specialization. Attention to mechanics and overall strength helps reduce unnecessary stress on the elbow. 


Sever’s disease is a disease that causes pain in the growth plate by the heel of the foot. It usually affects people going through puberty or even if someone is standing for too long. The disease happens when a sport or activity causes muscles that are tight, due to growth during puberty, to pull on the tendons leading to the growth plate becoming injured. It can be prevented by stretching before exercise, wearing good-fitting shoes, and wearing shoe inserts. 


Similar to severe’s disease, osgood schlatters disease happens to children during puberty. This is when the part of the knee below the kneecap’s tendon that attaches to the shinbone, gets irritated causing pain. It can be treated with ice, rest, stretching, or a strap over the tendon. 


Shindig Larsen Johanson's Disease is very similar to Osgood-Schlatter's in that it affects the patellar tendon. It is caused by overuse during puberty causing injury to the growth plate. If a child participates in a sport that puts a lot of pressure on the quadriceps muscle and knee such as running or kicking, this can lead to overuse. The best way it can be treated is by rest from activities, icing, pain relievers, and stretching. 


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While it is important for children to be physically active and back-to-school means new sports, it is important to prevent overuse of children’s muscles and tendons, especially when going through puberty as it can cause injury and pain in the tendons and growth plates. In most cases, while difficult for active children, rest is the best treatment!


Resources: 


Introduction: 

Bumbak, J., & Briskin, S. (2021). The preparticipation physical evaluation. American Family Physician, 103(9), 539–546. https://www.aafp.org/pubs/afp/issues/2021/0501/p539.html

Carek, P. J., Futrell, M., & Dickerson, B. (2021). Preparticipation physical evaluation. PubMed. https://pubmed.ncbi.nlm.nih.gov/33929170/

American Academy of Pediatrics. (2023). Preparticipation physical evaluation (5th ed.). American Academy of Pediatrics. https://www.aap.org/en/ppe5

Body 1: 

Stitzlein, R., & Nuelle, J. (2023). Medial epicondyle apophysitis (Little League elbow). In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK570592/

American Academy of Orthopaedic Surgeons. (n.d.). Throwing injuries in the elbow in children. OrthoInfo. https://orthoinfo.aaos.org/en/diseases--conditions/throwing-injuries-in-the-elbow-in-children

Body 2: 

Stitzlein, R., & Nuelle, J. (2023). Medial epicondyle apophysitis (Little League elbow). In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK570592/

Little League Baseball. (n.d.). Regular season pitching rules. https://www.littleleague.org/playing-rules/pitching-rules

Major League Baseball & USA Baseball. (n.d.). Pitch Smart guidelines. https://www.mlb.com/pitch-smart

Body 3: 

Andrish, J. T., & Tis, J. (2015). Panner’s disease: Literature review and treatment recommendations. Orthopedic Reviews, 7(1), 53–57. https://doi.org/10.4081/or.2015.5776

Ibrahim, M., Khlopas, A., & Surace, P. (2021). Osteochondrosis of the humeral capitellum: Diagnosis and treatment. EFORT Open Reviews, 6(10), 943–951. https://doi.org/10.1302/2058-5241.6.210042

American Academy of Orthopaedic Surgeons. (n.d.). Throwing injuries in the elbow in children. OrthoInfo. https://orthoinfo.aaos.org/en/diseases--conditions/throwing-injuries-in-the-elbow-in-children

Major League Baseball & USA Baseball. (n.d.). Pitch Smart guidelines. https://www.mlb.com/pitch-smart


 
 
 

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