Macrotrauma Versus Microtrauma
in Young Athletes
Ross Hauser, M.D., Marion Hauser, M.S.,R.D.

For young athletes there are only a few mechanisms of injury: injuries that result from a single application of force (macrotrauma) and injuries that result from repetitive microtrauma to the extremity (overuse injuries). Macrotraumas are the ones that have enough force to cause a fracture of the bone. In a young athlete who undergoes a significant blow or trauma, x-ray studies to rule out a significant epiphyseal or apophyseal injury are appropriate. The young athlete who comes into the office complaining of pain due to training, with no obvious macrotrauma, is most likely suffering from an overuse injury to the ligaments and tendons. In such a case, significant apophyseal or epiphyseal injury is unlikely.

Microtraumas, or overuse injuries, resulting from repetitive athletic training are being recognized with increased frequency in young athletes. Before the advent of organized sports training and competition for children, overuse injuries were rarely seen in this age group because they rarely occur in the free-play situation. In the United States, an estimated 20 million children and adolescents between the ages of eight and 16 years are involved in organized sports, and many more participate in unorganized sports.1,2

Overuse injuries are a result of repetitive forces that exceed the ability to withstand them. Typical overuse injuries in adults involve bone (stress fractures, tendon (Achilles Tendonitis), fascia (plantar fasciitis), and ligaments (ACL sprain). In children and adolescents the areas of active growth, including the physes (growth plates), the growing articular cartilage, and the cartilage of the apophyses at the tendon-bone junctions are added to the list. But when it is all said and done, the primary sports-related injuries are still sprains and strains, even in children, adolescents, and high school athletes. The athletic trainer, team physician, parents, and of course, the young athletes need to be aware of the areas of growth. The overwhelming sports-related injuries in all of athletics, whether the athlete is old or young, are injuries to the ligaments (sprains) and muscles/tendons (strains).

In a seven year study out of Hong Kong, from the Sports Injury Clinic of the Prince of Wales Hospital, all of the patients age 16 or younger were studied. It was found that 85 percent of the sports-related injuries in the age group were non-serious.3 In regard to young adults, the data is the same. In one study from the University of Rochester, they tabulated data on 4,551 sports-related injuries in high school and collegiate athletes. The overwhelming sports-related injuries in this age group were sprains and strains around the knee and ankle. The most common sport of injury was football, with greater than 12 times the number of injuries seen in the next most common sport.4

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