It starts with a slight limp after a Saturday game or a child mentioning their heel “feels tight” on the way home from practice. For many parents, the first instinct is to hope it’s just growing pains. But as youth sports move toward year-round schedules and high-intensity travel leagues, those small aches are increasingly turning into significant injuries.
We are seeing a shift in pediatric health care: Conditions once reserved for professional athletes — like stress fractures, chronic tendonitis, and ACL tears — are now appearing in elementary and middle school clinics. Because a child’s body is still developing, these injuries aren’t just “mini” versions of adult problems. They require a specialized approach to support growth and long-term development.
To help parents better understand what to watch for, we spoke with Dr. Matthew Propst, a pediatric sports medicine specialist at UTMB Health. Drawing on both his clinical expertise and his experience as a parent, Dr. Propst offers guidance on recognizing early warning signs and helping young athletes stay healthy, resilient, and active in sports.
Children’s bodies aren’t “mini adult” bodies
One of the biggest misconceptions in youth sports is that children respond to physical stress the same way adults do. According to Dr. Propst, the fundamental difference lies in the developing skeleton.
“The most important thing to remember is that children have growth plates — areas of developing cartilage near the ends of their bones,” Dr. Propst explained. “These are the weakest links in a young athlete’s musculoskeletal system. In an adult, a hard fall might result in a ligament sprain, but in a child, that same force can cause a fracture at the growth plate.”
Because these plates are responsible for future bone growth, injuries here require a specialized eye. What presents as a simple rolled ankle or sore heel might be an irritation of the growth plate that needs a specific recovery plan to ensure the bone continues to develop correctly.
Common injuries: Sudden vs. slow
Sports injuries generally fall into two categories: acute (sudden) and overuse (slow building).
Acute injuries: Sprains, strains, and tears
These happen in an instant, with a collision on the field or a bad landing. While kids are resilient, serious injuries like anterior cruciate ligament (ACL) tears do occur. Dr. Propst noted that while ACL tears are less common in very young children, they increase as kids enter their teens. “If there is a sudden pop, immediate swelling, or the knee feels unstable, that’s a signal for an evaluation,” he said.
Overuse injuries: The “syndromes”
Overuse injuries happen over time due to repetitive stress. Dr. Propst explained that these conditions are essentially irritations of the growth plate or the surrounding tendons:
Sever’s disease: heel pain that’s common in soccer and basketball players. If your kid limps on the field but seems fine by dinner, it’s often growth plate irritation in the heel.
Osgood-Schlatter disease: characterized by a painful bump just below the kneecap. It is a leading cause of knee pain in running and jumping sports.
Little League elbow and shoulder: repetitive stress caused by overthrowing. Unlike leg issues, arm issues usually require a complete break from throwing to prevent long-term growth interference.
Risk factors: The rise of year-round play
A major factor in the increase in these injuries is the trend toward early sport specialization and year-round play. While professional athletes have a clear off-season, many youth travel teams are in a state of constant competition.
“The pros only do the World Series once a year,” Dr. Propst pointed out. “But we see kids playing fall ball, a school team, a club team, and a summer travel league. They basically have a ‘World Series’ every four months.”
Without a true off-season, specific muscle groups and joints never get a chance to recover. Other risk factors include:
Poor conditioning: Jumping into a high-intensity season without a baseline of fitness.
Improper equipment: Worn-out cleats or ill-fitting protective gear can compromise safety.
Inadequate warm-ups: Muscles and tendons need dynamic stretching and light movement before the whistle blows to avoid strains.
The “silent” concern: Concussions
While we often focus on limbs, head safety is paramount. Concussions can occur in any sport, not just contact ones. Dr. Propst advises parents to watch for “quiet” symptoms: “It isn't always a loss of consciousness. Look for confusion, nausea, sensitivity to light, or a child who just seems ‘off’ or unusually irritable after a game.” Any suspected head injury requires an immediate move to the sidelines and a medical evaluation.
Navigating the pressure to perform
One of the hardest parts of being a sports parent is knowing when to push and when to pull back. Many kids feel immense pressure to play through pain to avoid letting down their team or coaches.
“It’s often hard to tease out what is new vs. what is a lingering issue when a child has been playing through discomfort,” says Dr. Propst. “A medical evaluation provides the objective playbook a family needs. It shifts the conversation from ‘toughing it out’ to following a clinical plan that keeps the child safe while they stay active.”
By providing specific guidance, such as school notes that allow for “participation as tolerated,” a specialist can help bridge the gap between complete rest and full-speed play.
The parent’s playbook for prevention
Helping your child stay healthy doesn’t require expensive trainers. Dr. Propst suggested these simple, actionable habits:
The 10 percent rule: Never increase training volume or intensity by more than 10 percent per week. This prevents the spike in activity that leads to stress fractures.
Cross-training: If your child won’t take a season off, switch sports. Moving from soccer to swimming or baseball involves different muscle groups, allowing the overworked ones to rest.
Fuel and hydration: Proper nutrition is essential for repairing the micro-stress that occurs during play. A fatigued body is a body prone to injury.
Consistency in recovery: The goal of any recovery plan is to build a foundation of strength that protects the joints. “The real progress happens between appointments,” Dr. Propst explained. “It’s about making those prescribed stretches and exercises a part of the daily routine, rather than just something done at the clinic.”
Your pre-Game safety checklist
Before the whistle blows, ensure your athlete is set up for success:
Check the gear: Do the cleats still fit? Is the helmet cracked? Proper protective gear is the first line of defense.
Hydrate early: Don’t wait until the game starts. Hydration begins the day before a big event.
Dynamic warm-ups: Encourage active stretching (like leg swings or lunges) rather than just sitting and reaching for toes.
Listen to the body: If a child is favoring a side or limping, take it seriously. Early rest is better than a season-ending injury.
When is it time to see a doctor?
Schedule an evaluation with a UTMB Health sports doctor if you notice:
Pain that causes a child to limp or change their technique
Pain that keeps them up at night
Sudden injury with significant swelling or instability
Persistent pain that lasts more than a few days
Any suspected concussion symptoms (headache, nausea, confusion)
Why specialized pediatric care matters
Children aren’t just small adults. Their injuries require pediatric expertise. At UTMB Health, the pediatric sports medicine team understands the nuances of the growing skeleton. From managing a complex fracture to helping a teen recover from a concussion, the goal is to protect the child’s long-term growth and get them back to the game they love.
“Kids are resilient,” Dr. Propst said. “When we give them the right tools and the right amount of rest, they bounce back incredibly well.”
Find a UTMB Health pediatric sports expert near you.