Article Written by Brigit Lim, MPT
The start of fall usually signals the start of scholastic sports, ramping up to a more competitive level for those involved in advanced leagues, or perhaps the start back to recreational sports after a summer off. Wherever the student athlete is in their sports journey, the goal for parents and coaches is to make sure they stay injury-free. What may not be well known is that the most common age for young athletes to suffer an injury (whether it be repetitive or traumatic) is between the ages of 10 and 14 years, which coincides with the pubertal growth spurt. For girls, the average age is 11 but can range from 9 to 14 years, and earlier for African American girls than Caucasian girls. During this time, girls are more susceptible to sprains (ligament injuries) and trunk injuries. The average age of puberty for boys is around 13 years, but it can range from 10 to 14 years. During this time frame, boys are more likely to have strains (tendon/muscle injuries) and fractures. The onset of puberty has been linked to timing from parents’ history, obesity, ethnicity, socioeconomic status, nutrition and stress12.
While skeletal maturity allows for more height and strength, often bone length grows quicker than the muscles’ ability to catch up, which leads to significant decreases in flexibility. For girls, as the pelvis widens there is increased valgus (angling inward) at the knee, which places more strain on the ACL and patella because the hip muscles have not developed the coordination to help with knee stability3. Long story short, kids may not run, jump, or throw with the same biomechanics as they used to, which could increase the risk of injury.
As kids are playing sports in these more vulnerable age ranges, other factors to consider are: What is the level of competition? How competent is the player in said sport? And how much is too much? Every research article leans into tailoring a preventative program that is individualized to the athlete, especially if they are in higher levels of play. The reality is many young athletes are balancing school, other extracurricular activities, and possibly social challenges common in these age groups, so trying to master an individualized plan may seem a bit overwhelming to the player and parent. This article is meant to gently summarize what the research is saying, but as always, there is more gray than pure black and white.
Movement Changes During Growth Spurts
Every article agrees that as a child goes through puberty, their movements may become more uncoordinated and need more refinement; back to basic training movements may be necessary for higher-level athletes to evaluate where breakdown may occur. How long this phase might last is purely individualized. The reason an athlete can become more awkward during a growth spurt is that the bones elongate faster than the muscles can adapt to support them. With the lack of muscular strength/control, there can become an over-reliance on ligaments/tendons to stabilize the joint at end range or with sudden starts/stops, thus heightening the risk of sprains/strains. The recommendations in the articles were to review the foundations of the sport at the start of the season, or as competitive play increases, and see how a child performs to determine whether or not they should be moving on to more advanced movements, regardless of training age. There was also consistent evidence supporting neuromuscular training during the warm-up to help reconnect brain/muscular coordination. Of course, the type of neuromuscular exercise reviewed in articles varied, but the warm-up typically ranged from 10 to 25 minutes and consisted of a mixture of balance, plyometrics, and stretching movements needed for sport. The effectiveness of injury prevention was enhanced by cardiovascular warm-up. The compliance rate was better for older teens than younger athletes, and was dependent on level of competitiveness4. The biggest issue with the articles I reviewed is that they focused primarily on limb neuromuscular coordination and less so on how the trunk is the foundation. At our clinic, we know that to have coordinated arm or leg movements, trunk stability must come first. If the abdominals, back extensors and/or gluteals are weak, then the spine cannot provide a stable base, and if the base is clumsy, the young athlete will struggle harder to execute extremity movement.
For adolescents who have a significant growth spurt not just in their legs, but in their spine column height, they are at higher risk of ligament injuries in their lumbar spine because they now have much longer levers, with limb length placing more torque on spinal structures if trunk muscle coordination/strength is lacking. For competitive athletes trying to train at the same volume/intensity, while simultaneously going through large rapid growth periods, it is necessary for coaches and parents to watch and pay attention to nagging limps or aches, decreased form, or looking more uncoordinated in practices, as it might be the body’s way of signaling a need to assess neuromuscular control.
Flexibility Changes with Growth Spurts
As mentioned earlier, flexibility often diminishes during adolescent growth spurts, especially in the legs. Tightness in the hamstrings, quads and calves can lead to back pain, painful bony growths on the shin or heel with explosive repetitive movements, and possibly avulsion fractures if a muscle is tight enough at a growth plate during an explosive force. Some evidence shows pre-activity static stretching of 4×15-30 sec/muscle at 60-100% intensity helps with sprint-related muscle activity and helps warm-up joint range of motion, but does not prevent overuse injury with endurance-based running activities. When comparing dynamic stretching vs. static stretching for pre-activity warm-up, no significant difference existed in research reviews for one having a better outcome than another; the ideal type of stretching warm-up seemed to be more sport-specific. Also, static stretching of 60-90 sec/muscle groups specific to sport for 2-6 days/week did not necessarily improve muscle length but did decrease risk of injury because the belief is the muscle-tendon junction becomes more pliable therefore reducing the risk of injury where muscles breakdown5.
There is a lack of specific protocols for which stretch is the best for which muscle group, but realistically most kids (and adults) have poor awareness of how to stretch their hamstrings without placing tension on their backs or nerves, or how to stretch their quads without cheating using their backs or hips. While no research exists for specific stretching procedures, research does support the role of physical therapy as an effective intervention in reducing repetitive strains due to tightness – most likely because the therapist is teaching the individual how to stretch correctly for their body/sport. At our clinic, we would argue the best outcomes are due to one-on-one training over online videos or handouts, as the therapist can correct mistakes quickly and accurately.
Lastly, recent research shows myofascial manipulation (a type of soft tissue treatment) along the muscle-tendon/tendon-bone junction, along with stretching, is a good adjunct to help lubricate these stiff tissues where there is the most strain placed on them during periods of rapid growth. Physical therapists can perform this technique as well as teach athletes how to effectively do massage to specific sites that need frequent care during growth spurts.
Injury Prevention with Cross-Training
The final point of many reviews in injury prevention with sports was the push to cross-train the young athlete. One study found boys 10 to 12 years old who played multiple sports, instead of specializing early, had more physical fitness and better gross motor coordination. Because these athletes had fewer injuries, the connection was perhaps due to a development of a wider range of control of movement through space and improved proprioception in different conditions. Allowing a child to alternate between a more serious sport and recreational sports allowed for physical activity while reducing the risk of overuse injuries, whereas single-sport athletes who specialized before 14 years of age were 2x more likely to have a history of multiple injuries. The concern for us as physical therapists is that since a very small percentage of athletes will achieve elite status at a collegiate or professional level, injuries sustained early on trying to reach these levels could lead to early-onset arthritis or a lifetime of nagging injuries. If the research is consistently saying young athletes are less likely to suffer repetitive overuse injuries with cross-training, we would urge parents and coaches to allow kids to play in different types of sports, at different levels of competition, without guilt.
Besides physical benefits of cross-training, the psychological benefits allow athletes to make friends in different social circles and to play a sport for fun versus feeling they have to be perfect for every practice and game, which can happen at more elite levels. Statistically, the burnout rate for higher-level competitive athletes is greater between middle school and high school; factors at play could be if the student athlete feels they cannot be perfect in school and sport, then they may drop sport to decrease the mental/emotional stress felt trying to balance everything.
Our goal at the clinic is to help student athletes, their parents, and coaches achieve the best performance possible – but in a timeline that is appropriate to that player’s coordination and development. Education for all is a huge part of injury prevention, as is having realistic goals in the healing timeline after an injury. As physical therapists, we have the knowledge of how the body heals with different injuries, of the changes the body makes during growth periods, and how to guide training for bones and muscles so that the athlete can adapt during these phases. We would like to see every youth athlete become an adult athlete, competitive or recreational, who knows how to take care of their body for the long term and becomes an expert on injury prevention.
- Guest Editorial Sports Health Vol 15 2023 ↩︎
- Silva et al. Sports Injury patterns in children and adolescents according to their sports participation level, age and maturation BMC Sports Science, Medicine and Rehabilitation 2022 ↩︎
- Johnson et al. “My Kid Is Going Through a Growth Spurt-What Should I Do?” Taking an Interdisciplinary Approach to Athletic Development During the Adolescent Growth Spurt Strength and Conditioning Journal 2025 ↩︎
- Ding et al. Effectiveness of Warm-Up Intervention Programs to Prevent Sports Injuries among Children and Adolescents: A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health. 2022 ↩︎
- Behn et al. Effects of Stretching on Injury Risk Reduction and Balance Journal of Clinical Exercise Physiology 2021 ↩︎
