Overuse Syndromes

By Edward S. Pratt, M.D., M.B.A.

Overuse syndromes tend to affect kids when they are rapidly growing. As kids grow, their muscles can occasionally mature more quickly than their bones, becoming stronger than the bones they are mounted upon. The resulting over pull and irritation at the point of muscular attachment leads to pain with activities, sports, carrying heavy book bags and so forth. These “enthesopathies” are usually self-limiting, respond to activity modification and mild over-the-counter medications such as ibuprofen. Back pain associated with overuse, many times is related to high intensity sport in a skeletally immature athlete, or recurrent heavy lifting. The classic example is that of the sixth grade girl with the 60 pound book bag. Awareness is half the battle. Getting extra copies of books to leave in class or at home and providing extra time to change out books at a locker can go a long way in limiting the stress. I have also seen children that are pushed by their parents and themselves to achieve great feats in competitive sports. Many sports such as swimming and gymnastics require kids to dedicate themselves to superhuman workout schedules in order to succeed. Extreme physical and emotional duress can develop under these conditions, in a child ill equipped to recognize or deal with it. Occasionally the only way a child has of pleading for help is to develop an injury or painful condition.  Occasionally, the workup will reveal a painful benign tumor (osteoid osteoma), stress fracture, or other even more serious problem that would have gone undiagnosed had an investigation not been performed. It is important to remember however, that just because the physical workup is negative does not mean there is no problem. It is important to remember that most kids will not continually complain unless there is something wrong. Recurrent complaints of pain should be evaluated by a physician.