Secondary Logo

Institutional members access full text with Ovid®

A Closer Look at Overuse Injuries in the Pediatric Athlete

Stracciolini, Andrea MD*,†,‡,§; Casciano, Rebecca PhD; Friedman, Hilary Levey PhD; Meehan, William P. III MD*,†,‡,§; Micheli, Lyle J. MD*,†,‡

Clinical Journal of Sport Medicine: January 2015 - Volume 25 - Issue 1 - p 30–35
doi: 10.1097/JSM.0000000000000105
Original Research
Blog Link

Objective: To examine male-female differences in pediatric overuse sports injuries.

Study Design: Cross-sectional epidemiological study.

Setting: Tertiary level sports medicine division in a large academic pediatric medical center.

Participants: Five percent probability sample of patients 5 to 17 years seen from January 1, 2000 to December 31, 2009. About 3813 charts reviewed. Final study cohort included 1614 patients.

Intervention: Nonlinear decomposition analysis of male-female differences in overuse injuries.

Main Outcome Measures: Age, body mass index, history of previous injury, and activity type (contact/collision, team vs individual, “high overuse”).

Results: Females sustained approximately half of the total injuries. Fifty-two percent of the injuries were overuse, 61% to the lower extremity. A high proportion of tennis players, swimmers, dancers, track athletes, runners, gymnasts, and cheerleaders were seen for overuse injuries. Females sustained more overuse injuries versus males (63% and 40%, respectively). Males playing team sports have a 5.3 times higher likelihood of being seen for an overuse injury compared with males not playing team sports (P < 0.01). High-overuse sport participation increased overuse injury odds by a factor of 10 for males versus 3.6 for females (P ≤ 0.01 for males and females). Forty-six percent of the male-female difference in overuse injuries could be attributed to sport/activity characteristics—contact/collision, team, and high overuse.

Conclusions: A large proportion of the sex discrepancy in overuse injuries in this cohort was attributed to compositional differences in sports played. Future research is needed to investigate the independent effect of sex on risk for pediatric sports injuries.

Clinical Relevance: This study provides a unique analysis of male-female differences in pediatric sports injuries and is the first study to estimate the impact of the different characteristics (ie, collision, team, high overuse) of sports children play on overuse injuries sustained by young athletes. The findings will help guide future prevention efforts.

Supplemental Digital Content is Available in the Text.

*The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts;

Harvard Medical School, Boston, Massachusetts;

Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston, Massachusetts;

§Division of Emergency Medicine, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts;

Princeton University, Princeton, New Jersey; and

Harvard University, Cambridge, Massachusetts.

Corresponding Author: Andrea Stracciolini, MD, Division of Sports Medicine, Department of Orthopaedic Surgery, Division of Pediatric Emergency Medicine, Department of Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115 (

The authors acknowledge financial assistance from the Robert Wood Johnson Foundation, specifically the Health Policies Scholars Human Capital Program, granted to H. L. Friedman.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

The authors report no conflicts of interest.

Received August 07, 2013

Accepted February 10, 2014

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.