By Peter H. Edwards, Jr., M.D.

Sports activity in athletes of any age can lead to repetitive stress-type injuries often called overuse conditions. Young athletes are at even greater risk due to growth centers in the bone and their inherent weakness and from muscular imbalances that often develop with growth. Overuse conditions develop when micro-injuries occurring during play accumulate because athletes haven’t rested enough between activities. Three common overuse injuries are: Sever’s disease (calcaneal apophysitis); Osgood-Schlatter’s disease and shin splints.

Sever’s disease is an overuse condition of the heel’s (calcaneus) growth center. It occurs among children ages 8 to 12. Indoor soccer on a hard field is particularly stressful to this area of the foot. Soccer players complain of pain at the back of the heel, made worse with activity. As the condition worsens, even regular walking can be painful. Treatment involves rest, ice, wearing heel cups, stretching and time. All young athletes “outgrow” this condition, given time. Athletes should see a physician if pain continues after two to three weeks despite rest and icing treatment.

Osgood-Schlatter’s disease is a common cause of pain in front of the knee among children ages 10 to 14. The growth center at the top of the leg (tibia) becomes inflamed due to the repetitive pull of the tendon inserting there. Pain feels worse after activity and is relieved by rest and ice. As the condition worsens, pain is more persistent. Players may experience swelling and warmth at the front of the knee. Treatment with rest, ice, inflammation medicine and limiting knee bending usually improves the condition. Occasionally, straight leg casting or bracing is required. However, this condition is self-limiting, and all young athletes will “outgrow” this condition. Athletes should see a physician if pain continues after two to four weeks despite rest and icing treatment.

Shin splints are an inflammatory overuse condition in the leg, just above the ankle on the inside. Shin splints do not occur at the center of the leg or above. Pain in that area is most likely a stress fracture or other condition. Athletes with shin splints are usually 12 years old or above and most often have completed or nearly completed growth. Pain worsens after activity and is relieved with rest. Often, athletes complain of soreness at the beginning of play that improves until the activity is almost over, when it worsens again. Treatment is rest, ice and control of foot pronation, if it is excessive. Athletes should see a physician if symptoms continue after two to four weeks to be sure a stress fracture hasn’t developed.

Clearly, overuse conditions of the leg are common among young soccer players. However, conditions can be treated with rest and ice. The best prevention is a varied training program allowing adequate recovery time for young athletes’ growing bones and tissues. If recognized early and treated quickly, soccer players can reduce their time out from the action.