Running injuries in children and adolescents

July 1, 2008

With any outdoor physical activity comes the risk of injury. This article provides an overview of running injuries specific to the pediatric population, such as strains and fractures, as well as prevention methods.

Making the case for running

Running is increasing in popularity. In 2005, more people participated in consistent running programs and road races than previous years.1 Among 5K races, those under 20 comprised 17.6% of all runners. For 10K races, this group made up 7.3%.1 In addition, there are numerous youth races available throughout the US. In 2005, the Austin Kids 800M Marathon had 20,000 finishers.1 These are running-specific statistics, and do not take into account a larger number of children and adolescents participating in organized sports in which running is an integral part of training.

Assessing a running-based injury

It is estimated that over 25% of runners will experience injuries that require medical attention during their careers.5 The majority of these injuries will stem from overuse, and will not be the result of an acute injury. A 15-year longitudinal study of high school cross-country runners reported higher rates of injury among adolescent cross-country girls than other "high-risk" sports including football, wrestling, and gymnastics.3 The vast majority of these injuries involved the lower extremities.

To begin your assessment of these injuries, a thorough history should be performed. This should include questions about onset, location, severity, in addition to running-specific questions including weekly mileage, rate of increase in mileage, terrain, training techniques (eg, sprints, hill repeats, stadium stairs, etc.), and shoe type and condition. It is helpful if the runner brings his or her shoes to the office visit, so wear patterns can be assessed.

The physical exam should focus on the area of injury, as well as the joint above and below the level of complaint. It is also helpful to examine the uninjured contralateral extremity. General assessments of range of motion, gait, leg length, and foot architecture are part of any comprehensive evaluation.

Strains

Muscle strains are common injuries in runners, and are more common in older adolescents.3 When assessing these injuries, there are some things to consider that are unique to children. As children grow, bones lengthen before tendons and ligaments. These musculoskeletal imbalances cause decreased flexibility, and may predispose pediatric runners to injury.

Other risk factors for muscle strain are increased participation in hill climbing, poor technique, and sudden acceleration/deceleration maneuvers like hurdles. Hamstring strains are common in runners and can occur at the origin, mid-substance, or insertion of these muscles. Typically, distal injuries are slower to heal than proximal ones. Other common sites of muscle strain in the lower extremities are in the quadriceps, specifically the rectus femoris and the medial head of the gastrocnemius at the musculotendinous junction.