Sports Medicine

Our Specialties

High School Sports Injuries

Adolescent Athletes

Teenage athletes are injured at approximately the same rate as professional athletes, but because they are often still growing, it is extremely important seek proper treatment immediately. A child's bones grow at a different rate of speed from that of muscles and tendons. This uneven growth pattern makes younger athletes more susceptible to muscle and tendon injuries, and growth plate fractures. Improperly cared for, a high school sports injury can cause problems that require surgery as an adult and may lead to arthritis later in life. To ensure the best possible recovery, it is imperative that coaches, parents, and young athletes themselves, all follow safe guidelines for participation, treatment, and returning to the game after an injury.

Acute and Overuse Injuries

Injuries among young athletes fall into two basic categories: acute and overuse. Both types include injuries to the soft tissues (muscles and ligaments) and bones.

  • Acute injuries—These are caused by a sudden trauma, such as collisions with obstacles on the field or between players. Common acute injuries among young athletes include contusions (bruises), sprains (partial or complete ligament tears), strains (partial or complete tear of a muscle or tendon), and fractures. A twisting force to the lower leg or foot is a common cause of ankle fractures and ligament injuries (sprains).
  • Overuse injuries—Gradually occurring over time, these injuries are a result of an activity repeated so frequently that the body does not have enough time to heal before the activity is repeated again. Muscles, ligaments, tendons, bones, and growth plates can be affected. Common examples of overuse sports injuries include: elbow injuries in overhand pitchers; shoulder injuries in swimmers; and wrist Wrist, Distal Radius Fracture Wrist, Scaphoid Fracture and elbow injuries in gymnasts and cheerleaders.

Stress fractures are also common overuse injures. When an athletic activity is too great, breakdown of older bone occurs rapidly. But because the young athlete's body cannot produce new bone to replace it quickly enough, the bone is weakened and stress fractures can occur, often in the shinbone and bones of the feet.

Catastrophic Sports Injuries

Catastrophic injuries have been reported in a wide range of sports, including ice hockey, wrestling, football, swimming, soccer, pole vaulting, cheerleading, and gymnastics. Many sports, especially contact sports, have inherent dangers that put young athletes at special risk for severe injuries. While rigorous training and proper safety equipment may help, children are still at risk for severe injuries to the head and neck, with damage to the brain or spinal cord.

It is extremely important for coaches, parents and young athletes to be aware of the guidelines and regulations developed for each sport to prevent head and neck injury, and to ensure that they are followed closely.


Concussions are mild traumatic brain injuries caused by a blow to the head or body that result in the brain moving rapidly back and forth inside the skull. Although certain sports—such as football, ice hockey and soccer—have higher incidences of concussion, they can occur during any sport or recreational activity.

In 2010, the American Academy of Pediatrics recommended that young athletes with concussions be evaluated and cleared by a doctor before returning to sports. The American Academy of Neurology issued a similar statement, stressing that doctors who clear athletes for return to sports should be trained in managing and assessing sports concussions.

Dr. Stewart has worked closely with PCPs (primary care providers), ER (emergency room) doctors, and ATCs (athletic trainers, certified) to help develop return-to-play protocols for athletes following concussions.

Growth Plate Injuries

A child's long bones do not grow from the center outward. Instead, growth occurs in the growth plates—areas of developing cartilage near the ends of long bones. The growth plates are the last portion of bone to harden (ossify) into solid bone, and this only occurs when a child is fully grown. This makes a child's bones more vulnerable to growth plates fractures. The growth plates regulate growth and help determine the length and shape of adult bone, so injuries in this area can result in disturbances to bone growth and bone deformity. Growth plate injuries occur most often during football, basketball, or other contact sports, and in high-impact sports such as gymnastics.

Prompt Medical Attention

A high school athlete who develops a symptom that persists or affects athletic performance should be examined by a doctor. Untreated injuries, whether acute or due to overuse, can lead to permanent damage or disability. Of course, some young athletes may downplay symptoms to continue playing. Pain with activity or at night, changes in form or technique, and decreased interest in practice are common signs of injury. Coaches and parents must be able to recognize these and other symptoms and act appropriately, even when young athletes try to minimize their importance.

Doctor Examination

During examination of the injury, the doctor will look for points of tenderness and check range of motion, as well as discuss symptoms, how the injury occurred, and the athlete's medical history. Imaging tests, such as X-rays, or other tests, may be needed to further evaluate the bones and soft tissues.


Depending on the nature and severity of the injury, treatment may include a combination of physical therapy, strengthening exercises and bracing. Surgery may be required for more serious injuries.

Return to Play

A young athlete's injury must be completely healed before returning to sports activity. After a joint problem, that means no pain or swelling, a full range of motion, and normal strength.

In the case of concussion, the player must have no symptoms during exercise or at rest, and should be cleared by the appropriate medical provider before returning to sports.

Although stories in the media about professional athletes playing while injured may create a different impression, especially in the eyes of young athletes, it is extremely important for coaches, parents, and athletes to all understand that, depending on the type and severity of the injury and the treatment required, the young athlete may not be able to return to the game at the same level of play, no matter how much effort is put into injury rehabilitation.


Many high school sports injuries can be prevented through proper conditioning, sport-specific training and appropriate equipment and gear. Understanding and following the rules of the game and displaying good sportsmanship also help make the sport safer.

Young athletes who are out of shape at the beginning of the season should gradually increase activity levels and slowly build to a higher level of fitness. When athletes suddenly increase the intensity, duration or frequency of activity, injuries may occur.

Athletes who play on more than one team are at higher risk for overuse injuries, so limit the number of teams your child plays on during a season. It is also important that young athletes do not play one sport year-round. Making sure your child takes regular breaks and plays other sports is essential to preventing injuries.

Young baseball pitchers are at high risk for developing overuse injuries to the shoulder and elbow. For this reason, age-based guidelines have been developed for the number of pitches and types of pitches that should be thrown.

VIDEO: Throwing Injuries with Kirk Cousins & Dr. Bruce Stewart, Holland Hospital Sports Medicine

VIDEO:Knee Injuries with Kirk Cousins & Dr. Bruce Stewart, Holland Hospital Sports Medicine

VIDEO:Dr. Bruce Stewart Knee Injuries in Athletes, Holland Hospital Physician Lecture Series, May 2015

VIDEO: Ankle Injuries with Kirk Cousins & Dr. Bruce Stewart, Holland Hospital Sports Medicine