Latest information on COVID-19

Minimize risk of kids' overuse sports injuries

James Gamble, MD, PhD

James Gamble, MD, PhD, an orthopaedic surgeon at Packard Children's, is seeing more overuse injuries in children.

Exercise and sports participation can be a double-edged sword for children who are at risk of suffering from overuse injuries. 

"We want children involved in physical activity, especially since we have an obesity crisis. Yet you can have too much of a good thing," said James Gamble, MD, PhD, an orthopaedic surgeon at Lucile Packard Children's Hospital.

Children who participate in extensive sports activities can experience a breakdown in their bones, ligaments and tendons, resulting in injuries. Youngsters may be more prone to these injuries now, as they spend more time at sports during these long summer days. Gamble offers some tips on how to minimize injury risk:

Take a few days off every week

To help avoid overuse injuries such as stress fractures, Gamble highlights the importance of maintaining proper volume and intensity. "If kids are involved in an activity that stresses their bones, ligaments and tendons every day, their body doesn't have time to heal," he said. "I recommend sports participation no more than five days a week, with two days off to rest."

Warm up to minimize injury

'"You can't just go out and start running or playing soccer," said Gamble. "There needs to be a very aggressive warm-up period when children regain their flexibility. There's also the need for proper stretching and using the proper equipment, even in practices."

Gamble emphasizes hamstring flexibility, especially during pre-season conditioning. "Hamstring strains are one of the most common conditions we see," he noted. "Strengthening and toning abdominal and gluteal muscles is highly important, as these muscles protect the back."

Injuries among boys and girls

"The ratio is changing," said Gamble. "I'm definitely seeing more girls, especially for sports injuries like anterior cruciate ligament (ACL) tears, which are now three times more common in girls than boys. It's an absolute epidemic." Girls are at a greater risk for ACL tears even in non-contact sports, he added.

Stanford Medicine integrates research, medical education and health care at its three institutions - Stanford School of Medicine, Stanford Health Care, and Stanford Children's Health. For more information, please visit the Office of Communications website at

2022 ISSUE 1

Understanding the world within us

COVID-19 Updates

Stanford Medicine is closely monitoring the outbreak of novel coronavirus (COVID-19). A dedicated page provides the latest information and developments related to the pandemic.