Diagnosis & Treatments

Diagnosing overuse injuries

At Boston Children’s Hospital, we know that the first step to treating your child is forming an accurate, timely diagnosis.

To diagnose an overuse injury, your child’s orthopedic specialist will take a medical history and perform a physical exam on your child. During the exam, the doctor will move the joint around to pinpoint the area of discomfort.

The doctor will also get x-rays to make sure there isn’t a true fracture. But x-rays can be deceiving, because children can have stress fractures and damage to their growth plates that can’t be seen on x-rays. So occasionally, clinicians will use MRI (magnetic resonance imaging) to get detailed images of the injury and verify that there is — or isn’t — a certain condition.

Treating overuse injuries

Boston Children's Hospital's Orthopedic Center provides patients with comprehensive care — including evaluation, diagnosis, consultation, non-surgical therapies, surgery, and follow-up care.

Initial treatment to stabilize an overuse injury usually includes “R.I.C.E.” (rest, ice, compression, and elevation), as well as medications to help control pain and swelling.

But the most important therapy for the injury is simply to rest it — restricting all activities that involve using the injured muscle, tendon, ligament, or bone — for a period of weeks or months as determined by your child's Sports Medicine specialist. The doctor may also recommend a splint, cast, or boot to protect the injured area from further damage.

For an unusually severe overuse injury, treatment options may include:

  • temporary crutches or a wheelchair
  • physical therapy to stretch and strengthen the injured muscles, ligaments, and tendons
  • surgery if the injury is recurring, if there's persistent pain, or if a muscle, tendon or ligament is badly torn

Caring for your child as he heals

Your child's doctor will give you guidance about how long your child's overuse injury should be rested in order for it to heal. Most overuse injury patients are able to return to sports and regular activities after several weeks or months of rest and healing time.

During the healing period, it's important for everybody in the family to support the young athlete's resolve to rest the healing area, since he may feel disappointed and even a bit depressed at not being able to play his sport.

Coping and support

At Boston Children's Hospital, we understand that a hospital visit can be difficult, and sometimes overwhelming. So, we offer many amenities to make your child's — and your own — hospital experience as pleasant as possible. Our Hale Family Center for Families staff will give you all the information you need regarding:

  • getting to Children's
  • accommodations
  • navigating the hospital experience
  • resources that are available for your family

In particular, we understand that you may have a lot of questions when your child is diagnosed with an overuse injury. Will this affect my child long term? When can he return to his sports and activities? Children's can connect you with extensive resources to help you and your family through this stressful time, including:

  • patient education: From the first doctor's appointment to treatment and recovery, our staff will be on hand to walk you through your child's treatment and help answer questions you may have — How long will his recovery take? Will he need home exercises and physical therapy? We'll help you coordinate and continue the care and support your child received while at Children's.
  • parent-to-parent: Want to talk with someone whose child has been treated for an overuse injury? We can often put you in touch with other families who've been through the same process that you and your child are facing, and who will share with you their experience at Children's.
  • faith-based support: If you're in need of spiritual support, we'll connect you with the Children's chaplaincy. Our program includes nearly a dozen clergy — representing Protestant, Jewish, Muslim, Roman Catholic, and other faith traditions — who will listen to you, pray with you, and help you observe your own faith practices during your Children's experience.
  • social work: Our clinical social workers have helped many families in your situation. Your Children's social worker can offer counseling and assistance with issues such as coping with your child's diagnosis, stresses relating to dealing with a child's injury, changing family dynamics, and financial issues.

If you live far from Boston, we can help

As an international pediatric orthopedics center, Children’s treats young patients from all over the world. Global Services assists families residing outside the United States: We facilitate the medical review of patient records; coordinate appointment scheduling; and help families with customs and immigration, transportation, hotel, and housing accommodations.

Overuse injuries glossary

  • brace: a custom-made protection worn around an area while it heals
  • cartilage: a smooth, rubbery tissue that cushions the bones at the joint, and allows the joint to move easily without pain
  • diagnosis, diagnostics: identifying disease or injury through examination, testing and observation
  • extension and flexion: the acts of straightening (extending) and bending (flexing) a knee, elbow or other joint
  • growth plate (physis): cartilage at either end of a bone from which growth occurs
  • ligament: elastic band of tissue connecting bone to bone
  • microtrauma: a small injury to the body, such as microtears to muscle fibers, stress to the tendon, bruising of the bone; can occur to bone, muscle, tendon or ligament. If not allowed rest in order to heal, accumulated microtraumas can lead to overuse injuries.
  • MRI (magnetic resonance imaging): produces detailed images of organs and structures within the body; shows the amount of damage from an overuse injury
  • non-surgical (non-operative) treatments: alternatives to surgery; most treatments for overuse injury are non-surgical
  • orthopedics: the medical specialty concerned with diagnosing, treating, rehabilitating and preventing disorders and injuries to the spine, skeletal system and associated muscles, joints and ligaments
  • orthopedist/orthopedic surgeon: a physician concerned with diagnosing, treating, rehabilitating and preventing disorders and injuries to the spine, skeletal system and associated muscles, joints and ligaments
  • osteopenia: less bone mineral density than normal, a precursor to osteoporosis
  • osteoporosis: loss of bone density
  • overuse injuries: sports-related microtraumas that result from repetitively using the same parts of the body, usually by overtraining; can occur to muscle, tendon, ligament or bone
  • physis, physes: medical name for the growth plate(s) at both ends of a bone that is not yet skeletally mature; the source of bone growth
  • physical therapy: a rehabilitative health specialty that uses therapeutic exercises and equipment to help patients improve or regain muscle strength, mobility and other physical capabilities
  • skeletally immature: the bones of the skeleton have not yet fully grown, as with pre-pubescent or early-adolescent children
  • tendon: a band of tough, inelastic fibrous tissue that connects a muscle with its bony attachment
  • tibia: shin bone

See our complete glossary of orthopedic terms.