Why Young Athletes Are Not Small Adults
Children and adolescents get hurt differently than adults, because their skeletons are still growing. Near the ends of each long bone sits a growth plate (physis) — a zone of cartilage where new bone forms. Growth plates are often the weakest link in a growing athlete’s musculoskeletal system: the same twisting force that sprains an adult’s ligament can fracture a child’s growth plate instead, and the same repetitive throwing load that irritates an adult’s tendon can stress a child’s growth plate.
This guide from Dr. Michael Hendel, MD, PhD — an orthopedic sports medicine surgeon in Bethlehem who serves as a team physician for PIAA District XI football and the PIAA state wrestling tournament, and covers professional athletes for the Reading Royals (ECHL) and Lehigh Valley IronPigs (Triple-A) — walks parents through the most common youth sports injuries, when to seek care the same day, and how to reduce overuse risk.
Common Youth & Adolescent Sports Injuries
Growth-Plate Injuries
Growth-plate fractures can occur at the wrist, ankle, knee, elbow, and shoulder. Two points matter most for parents. First, a growth-plate injury may not show on the initial X-ray, because the plate itself is cartilage; tenderness directly over a growth plate is often treated as a fracture until proven otherwise. Second, most growth-plate fractures heal well with appropriate treatment, but a minority can disturb growth — which is why they deserve orthopedic follow-up rather than a wait-and-see approach.
ACL Tears in Young Athletes
ACL tears, once considered an adult injury, are now well recognized in adolescent athletes — particularly in cutting and pivoting sports like soccer, basketball, football, and lacrosse. A pop at the time of a twisting injury, rapid swelling within hours, and a feeling of the knee giving way are the classic signs. In skeletally immature athletes, surgical techniques exist that respect or avoid the growth plates, and current practice generally favors timely treatment of unstable knees, because repeated giving-way episodes can damage the meniscus and cartilage. You can read more on the ACL reconstruction page and the ACL surgery recovery timeline.
Shoulder & Elbow Overuse in Throwers
Young pitchers and throwers are prone to overuse injuries of the shoulder’s growth plate (often called “Little League shoulder”) and of the inner elbow (“Little League elbow”), where repetitive throwing stresses the growth plate on the inside of the elbow. The warning signs are pain during or after throwing, loss of velocity or control, and pain that returns each time the athlete resumes throwing. These are not injuries to play through — continued throwing can convert an irritation into a stress fracture of the growth plate, and the treatment is rest measured in weeks to months, followed by a structured return-to-throwing program.
Osgood-Schlatter Disease
Osgood-Schlatter is pain and a tender bump just below the kneecap, where the patellar tendon attaches to the growth center of the shin bone. It appears during growth spurts, especially in jumping and running sports. It is usually self-limited — symptoms settle as the skeleton matures — and treatment centers on activity modification guided by pain, quadriceps and hamstring flexibility work, and ice, rather than complete rest. An evaluation is still worthwhile to confirm the diagnosis and exclude less common causes of knee pain in a growing athlete.
Ankle Sprains vs. Fracture Red Flags
Ankle sprains are among the most common youth sports injuries, and most heal well with a short period of protection followed by balance and strengthening exercises. The catch in children: the growth plate of the fibula sits exactly where sprains hurt, and a twisting injury that would be a sprain in an adult can be a growth-plate fracture in a child. Seek same-day evaluation and X-rays if your child:
- Cannot bear weight for more than a few steps immediately after the injury or later that day
- Has tenderness directly over the bone or growth plate rather than the soft tissue below and in front of the ankle bone
- Develops rapid, marked swelling or bruising
- Has any visible deformity, or numbness and tingling in the foot
More on evaluation and treatment of ankle injuries is on the ankle fracture care page.
Same-Day Evaluation vs. Watchful Waiting
Seek care the same day (office, urgent care, or emergency department depending on severity) when any of the following is present:
- Obvious deformity, or a bone that looks or feels out of place
- Inability to bear weight or use the injured limb
- A pop followed by rapid joint swelling — a sign of significant internal injury such as an ACL tear or fracture
- A joint that locks, will not straighten, or gives way
- Numbness, tingling, coldness, or color change beyond the injury
- Tenderness directly over a bone or growth plate
- Any suspected head or neck injury — these take priority over everything on this list
Observation at home for 24–48 hours is often reasonable when the child can bear weight comfortably, swelling is mild, tenderness is in the soft tissues rather than over bone, and pain improves with rest, ice, compression, and elevation. If pain or swelling is not clearly improving within a few days — or the child is limping, favoring the limb, or avoiding play — schedule an evaluation. Persistent symptoms after a “minor” injury are the most common way growth-plate injuries and stress injuries get missed.
Preventing Overuse Injuries
Most overuse injuries in young athletes are predictable and preventable. Principles supported by major sports medicine organizations include:
- Follow pitch counts and rest requirements. Youth baseball pitch-count limits and mandatory rest days exist because throwing volume is the strongest modifiable risk factor for arm injury. Counts should include all games, all teams, and showcases — and young pitchers should avoid pitching year-round or pitching for multiple teams in the same season, and should take an extended break from overhead throwing each year.
- Favor sport sampling over early specialization. Playing multiple sports through early adolescence develops broader athletic skills and is associated with lower overuse injury risk than specializing in a single sport at a young age. For most athletes, specialization — if it happens at all — can wait until the high school years.
- Build in rest. Common-sense guidance includes at least one to two rest days per week, a scheduled off-season from each sport, and keeping weekly organized training hours roughly in line with the child’s age in years.
- Respect growth spurts. Injury risk rises during periods of rapid growth, when bones lengthen faster than muscles and tendons adapt. Flexibility work and temporarily moderated training loads help during these windows.
- Take pain seriously. Pain that alters mechanics, persists after activity, or returns with each session is a signal to reduce load and get evaluated — not a toughness test.
What a Team-Physician Evaluation Involves
Whether at the field or in the office, a sports medicine evaluation of a young athlete follows the same structure Dr. Hendel uses covering high school, collegiate-level, and professional athletes:
- History: the mechanism of injury, whether there was a pop or immediate swelling, prior injuries, training volume, and the athlete’s sport and position — which shape both diagnosis and return-to-play planning
- Focused examination: inspection, palpation of bony landmarks and growth plates, range of motion, strength, and ligament-specific stability tests, compared side to side against the uninjured limb
- Imaging when indicated: X-rays for suspected fracture or growth-plate injury, and MRI when ligament, meniscus, or cartilage injury is suspected
- A plan in plain language: the diagnosis, treatment options (most youth injuries are treated without surgery), and specific criteria for returning to practice and competition — based on restored strength, motion, and sport-specific function, not just the calendar
Dr. Hendel sees young athletes at his office at St. Luke's Orthopedic Care, 153 Brodhead Road (Rear Entrance), Bethlehem. When surgery is needed, it is performed at St. Luke's Orthopedic Hospital — West End Campus in Allentown. His experience spans the full spectrum of team coverage — PIAA District XI football and PIAA state wrestling, the Reading Royals (ECHL) and Lehigh Valley IronPigs (Triple-A), and formerly as an assistant team physician for the New York Giants (NFL). Learn more about his practice on the sports medicine page and knee surgery page, or read about Dr. Hendel.