Dr. Bob: My 10-year-old daughter loves her soccer. Every so often, she complains of knee pain and ankle pain. How do I know when she should rest? How do I know when to treat these aches and pains or go to the doctor? Is there such a thing as too much practice?
Answer: Your questions are very timely since the American Academy of Pediatrics just issued new guidance on their website – healthychildren.org. There are several things in this report that are pertinent to your questions.
- We encourage physical activity and want children to be engaged in activities that will carry over to adulthood. There is significant physical and mental benefit to exercise.
- It has been shown that 70% of children drop out of organized activities by age 13.
- It is estimated that 50% of sports-related injuries are related to overuse. To me, this is a startling statistic and speaks to the need to protect our children.
- Growing bones and joints are less tolerant of stress injuries compared to adults and more prone to overuse injuries.
- Overuse occurs when making the same move in repetition. The strains, sprains, pains and fatigue can occasionally lead to more serious or lingering injuries.
- The stages of overuse can progress from pain in just a specific area after a game or workout, to pain that occurs during activity but does not affect performance, to pain that precludes participation, and finally to pain that occurs when not even moving at all.
- 8 specific tips are suggested – 1) start with a sports physical before the onset of the season; 2) encourage children to vary activities; 3) know your child’s training requirements and only allow gradual increases from week to week; 4) build in breaks, daily and weekly; 5) aim for one team at a time; 6) learn from experience and avoid “playing through the pain”; 7) healthy sleep is so important; 8) set a healthy example for your child by not over-extending yourself.
Now, let me address your questions specifically.
- Her complaints of joint pain should be taken seriously. Be sure to engage in a non-judgmental conversation so you can keep open the lines of communication.
- Rest is very important to allow for the growing tissues to recover. The bones, muscles, tendons, ligaments, and other connective tissue all need time to refresh after vigorous exercise. Knowing the training schedule will be very helpful to be sure that adequate rest is built into the schedule.
- Your home remedies for pain – rest, cold packs, compression, elevation – can be helpful for acute injuries, but their continued use for chronic pain from overuse is a signal that you need to go to the doctor.
- As mentioned above, there is a “thing” as too much practice or overuse. Every child is different, and any plan of exercise and necessary rest should be individualized. (Fortunately, Little League has limited the length of some pitching outings, but I still worry that letting the child play a different position doesn’t really provide adequate rest for the pitching arm.)
One more thing – please be sure to keep open the lines of communication with your child. Encouragement is one thing, but overzealous promotion can be harmful. Check in with your child in a meaningful way on a regular basis and allow them to be honest with you. Be mindful of the stress on your child (physical and mental) as they engage in organized activities.
Dr. Saul is Professor of Pediatrics (Emeritus) at Prisma Health and his website is www.mychildrenschildren.com. Contact Dr. Bob at askdrbobsaul@gmail.com with more questions.