“Active Rest” is Best for Overuse Injuries in the High School Athlete

By Harry A. Bade, III, MD, FACS

Back in the 80’s and 90’s the emphasis for high school athletes was to be well-rounded.  Many of the athletes participated in three different sports throughout the school year.  The trend has changed and many athletes now are focused on only one sport and participating in that one activity year round.  As you can imagine, from an orthopaedic-overuse- standpoint, this is not ideal.  Tissues need time to rest and repair but this doesn’t mean that the athlete needs to stop training.

Despite the increase in education regarding overuse injuries, they continue to increase in the youth athletic population.  Growth plate injuries are one type of injury that is exclusive to the pediatric population.  As we all know, the skeleton continues to mature.  For most females, the skeleton matures at an earlier age (13-15 years) compared to most males it is 15-17 years old.   Up until the time of skeletal maturity, the bones will have a cartilaginous growth plate.  This area is weaker than the bone and susceptible to micro-fractures as a result of overuse-type stresses.  Recent studies have shown that the growth plate injuries are multifactorial in nature.  Muscular imbalances after a growth spurt may predispose an adolescent athlete to an overuse injury.

For an athlete that does, in fact, have an overuse/growth plate injury, they should see an orthopeadic surgeon who will most likely prescribe rest, ice, physical therapy and mild anti-inflammatory medication.  The rehabilitation program should focus on a progressive strength training and a progressive sport specific program.  This rehab program generally will range from 4 to 6 weeks, but if symptoms persist, it could take months.

What can an athlete do to reduce their risk?  Periods of “active rest” are highly recommended, especially for throwing athletes. This does not mean to stop training.  It is quite the contrary.  Athletes can focus on flexibility, strength and cardiovascular conditioning during this time OR play other non-throwing sports that do not stress the shoulder or elbow. A general rule of thumb is: for every three months of throwing, the athlete should take at least a month off for active rest.