When Parents Should be Concerned About Persistent Joint Pain

With summer here and outdoor sports resuming, it’s not uncommon to hear, “Mom, my leg is sore,” or “Dad, my knee feels tight.” Young athletes returning to the field—especially after a year of pandemic lockdowns—may be deconditioned and prone to overuse injury.

Minor injuries from overuse or deconditioning will heal with rest. But pain that doesn’t go away after a few days of rest is called persistent joint pain and may require a doctor visit.

“Healthy young athletes shouldn’t have persistent pain after a period of rest and recovery from playing sports or strength training,” according to Charles Chan, MD, an orthopedic surgeon with Stanford Medicine Children’s Health who also sees patients in the East Bay as part of our partnership with John Muir Health.

“A child or teen who has pain should prioritize rest over training for a few days or until it subsides,” says Dr. Chan. While it’s probably OK to take a short walk during this period of time, he recommends refraining from any strenuous activity to let muscles and joints heal. This advice, he says, is for any age, even younger children playing T-ball or soccer or running on the playground. “Overuse is the gateway to injury.”

Overuse injuries are particularly concerning this year since children were less active during the pandemic and more at risk of injury. “The biggest issues I see are from overtraining or deconditioning. This occurs from a rapid ramp-up of training after a relatively long period of inactivity.”

While kids may be eager to return to sports, it’s best to start slowly and not overdo it, Dr. Chan cautions. “My advice is to let kids bounce back gradually. During the height of the pandemic, a lot of kids couldn’t train. Their muscle strength decreased and became deconditioned. When sports started again, they may have returned too quickly and hurt themselves from lack of conditioning.”

“In high school sports, for example, teams weren’t given a lot of notice that games were restarting, and so athletes had little time to prepare,” he added. Young bodies can’t always handle the physical stress and demands of the game.

When children are deconditioned or tired, their ability to recover is diminished, he adds. “A lot of sports injuries occur at the end of the game when players are fatigued, no matter the sport.”

Growing children can also experience physical stress when activity increases. Children ages 11 to 13 are most prone to growth-plate injuries, he says, including issues like Osgood-Schlatter disease, an irritation on the shinbone, and slipped capital femoral epiphysis (SCFE), on the hip.

An ounce of prevention is worth a pound of cure, and Dr. Chan urges parents to gauge their children’s well-being while playing sports. Ask them how they’re feeling, he advises. Young athletes may not complain of pain but express it through mood changes or disrupted sleep.

“We want our children to be active and at the same time safe. I recommend gradually increasing their training and activity level and insisting on rest between sessions or games. If your child expresses pain, never let them play through it. Early recognition is important, and resting until you see improvement usually works.

“My advice is to condition first. Let your child exercise to the extent that they improve strength but avoid persistent joint pain. If your child is sore, let them rest and repeat the process. If it doesn’t stop hurting, take a step back and have your child see their pediatrician, who can make a referral to a specialist, if needed.”

Dr. Chan continues, “I enjoy working with children and athletes who have a strong desire to return to their sport. Young athletes are great to work with, and our medical interventions can get them back on their field promptly.

“Sports injuries in the growing child present their own set of unique challenges, but nothing is more rewarding than seeing my patients smile when they return to sports.”

For suggestions on how to safely return your child to sports, here are some tips >