Back to School, Back to Sports: What East York Parents Should Know About Kids' Sports Injuries.

Every year the same thing happens. Kids finish summer, most of it spent sleeping in and doing not much. Then the first week of September hits. Tryouts start, soccer picks back up, hockey pre-season begins, cross-country meets get scheduled, and by the end of the month my schedule at PRT East York fills up with parents asking why their otherwise healthy kid is suddenly limping.

It isn't random. It's a load pattern, and most of it is preventable if you know what to watch for. This is what I actually see walk through the door at 1400 O'Connor Drive between late August and November, what to worry about, what to shrug off, and how to ramp a kid back into sport without ending their season in week two.

Why the fall spike happens

Kids are not miniature adults. Their bones grow before their muscles and tendons catch up, so any period where load drops off (like a summer of pool days and popsicles) followed by a sudden return to full-intensity play is a recipe for overuse injury.

Three things stack up in early September:

• The deload was too long. Two months of low activity de-conditions tendons and bone in ways that don't just bounce back in one practice.
• Volume goes from zero to sixty. Most kids' fall sport doesn't ease in. Week one is often three practices plus a scrimmage. That's a bigger jump than most adult training plans would tolerate.
• New sport, new demands. A kid who spent summer swimming and biking is now cutting, sprinting, and landing on hard surfaces again. The tissues that get loaded most in soccer or hockey haven't been touched since June.

Layer on a growth spurt (which for a lot of kids lines up neatly with back-to-school) and you have the exact conditions where growth-plate injuries and overuse tendon problems show up.

The injuries I see most in East York kids

Here's what actually walks into the clinic through September and October. I'm keeping it to the ones that show up week after week, not the one-off broken collarbone from a bad tackle. Those need urgent care, not a chiropractor.

1. Sever's disease (heel pain)

The number-one call I get in September. A kid, usually 8 to 14, starts complaining about heel pain after soccer practice. Hurts to run. Sometimes limps for the first few steps in the morning. Often bilateral.

Sever's isn't a disease. It's an irritation of the growth plate at the back of the heel where the Achilles tendon attaches. When a kid is growing quickly, that growth plate is a soft spot, and the tight calf pulls on it every time they push off. Cleats make it worse. Hard fields make it worse. So does going from zero running to five sessions a week.

It's not dangerous, but it will keep coming back if all you do is rest. What actually works is calf and Achilles loading, better footwear during flare-ups (a heel lift or cushioned shoe outside cleats helps a lot), and pacing the return so the growth plate isn't getting hammered before it's ready.

2. Osgood-Schlatter (bump below the knee)

Same story, different growth plate. This one's on the front of the shin, just below the kneecap, where the patellar tendon attaches. Kids will feel a tender bump that hurts with jumping, squatting, or running. Common in basketball, soccer, and any sport with a lot of cutting.

Again, it isn't structural damage. It's a growth-plate reaction to load, and it responds to smart load management plus quad and glute strength work. Kids often outgrow it once the growth plate closes, but if they keep pushing through it hard, they can end up with a residual bump and pain into adulthood. Not worth it.

3. Ankle sprains

The most common acute injury in youth sport, by a wide margin. A kid rolls their ankle in a soccer game or coming down from a rebound and it swells up. The panic move is to strap it up and rest it for two weeks.

The much better move is a proper assessment early. Not all sprains are the same. Some need imaging (especially in kids, because that same growth-plate physiology means a "sprain" is sometimes actually a small avulsion fracture). And the ankles that get rehabbed properly rarely re-sprain. The ankles that get iced, taped, and returned to play get sprained again within a season about half the time.

4. Little League elbow and thrower's shoulder

Baseball is winding down as school starts, but the volleyball and quarterback kids are ramping up. Any repetitive overhead sport creates predictable shoulder and elbow patterns in young athletes. Pain on the inside of the elbow after throwing, or a shoulder that aches deep for an hour after practice, deserves attention. In growing kids, throwing volume is one of the strongest predictors of long-term injury. If a coach is having them throw hundreds of reps a week, the parent needs to be the one who pumps the brakes.

5. Shin splints and stress reactions in young runners

Cross-country is a beautiful sport and it wrecks kids who ramp up too fast. Same rules as adults: don't add more than about 10% mileage per week, and treat shin pain that persists past a warm-up as a real signal, not something to run through. A stress reaction in a growing tibia can become a stress fracture in the same week if the load doesn't change. I've written about the progressive fix for shin splints for adults, and most of it applies here too, with lower intensities.

6. Concussion

Any head impact where a kid is confused, dizzy, nauseous, has a headache, or just feels "off", treat as a suspected concussion. Pull them off the field and don't let them return the same day, full stop. Ontario has a return-to-play protocol, and it exists for a reason.

We treat concussions at PRT. Once a kid is medically cleared to start rehab, we work through the graded return-to-learn and return-to-sport stages with them: vestibular and oculomotor work, sub-symptom threshold exercise, cervical spine treatment for the neck component that almost always comes along with the impact, and coordination with school and coaches so nobody rushes the timeline. Kids who get structured rehab recover faster and with fewer lingering symptoms than kids who just sit in a dark room waiting to feel better. Peyton wrote the full parent's guide on this: concussion rehab for kids, what parents should know. If your kid takes a hit and something feels off, book them in.

Normal soreness vs. actually a problem

Not every ache after a hard practice needs an appointment. Here's how I sort it out for parents in the clinic.

Probably fine:

• Muscle soreness that shows up 24 to 48 hours after a new activity and eases with movement.
• Stiffness that goes away after warming up in the next practice.
• General fatigue after a big volume week.

Worth an assessment:

• Pain that gets worse across a session instead of easing up as they warm up.
• A limp that lasts more than a day or two.
• Pain that wakes them up at night or is there before they even move in the morning.
• Swelling, especially around a joint.
• Any point-specific pain over bone (not soft tissue) in a growing kid.
• Recurring pain in the same spot across weeks, even if it's "mild."

Get them to urgent care, not the clinic:

• Obvious deformity or a joint that won't move.
• Loss of function (can't put weight on it at all, can't grip, can't lift the arm).
• Any head injury with symptoms.
• Numbness or tingling that doesn't resolve within a few minutes of the injury.

How to ramp them back in without blowing it

If your kid is starting a new season this month, this is roughly the plan I'd give them. Not fancy. Not sport-specific. Just enough to keep them off my table.

The two weeks before tryouts

Get some load in. Doesn't need to be structured. A few short runs, some hill sprints, a couple of soccer touches in the park, kicking a ball around at Stan Wadlow or Taylor Creek. The point is to remind the tendons and bones that they exist before someone whistles a scrimmage.

Week one of the season

Cut intensity in half where you can. If practice is 90 minutes, don't tack on a hard bike ride after. Sleep is the recovery variable that matters most for teenagers, and school just started, so it's already compressed. Protect it.

Weeks two to four

Watch for the classic patterns. Heel pain in the mornings, a bump below the knee, an ankle that gets tweaked and shrugged off. Address them early. A twenty-minute conversation and some loading homework at week two costs nothing. Six weeks of hobbling through a season costs the season.

Simple prevention that actually works

• Calf raises, daily. Two sets of ten to fifteen. Prevents most of the Sever's cases I see.
• Wall-sit or Spanish squat, three times a week. Loads the patellar tendon in a controlled way. Prevents most of the Osgood-Schlatter cases.
• Ankle balance work. Two minutes on one leg while brushing teeth. Not a joke. It's the highest-value ankle-sprain prevention in the literature.
• Sleep. Nine hours for kids under 13, eight to ten for teenagers. Non-negotiable during a load ramp.

When to book an assessment

If any of the "worth an assessment" symptoms above have been going on for more than a week, book. Kids heal fast, but they also break down fast, and the difference between a minor pattern caught early and a season-ending stress fracture is often two weeks.

At PRT East York we assess every athlete like an athlete, including the ten-year-olds. Every appointment is 1-on-1 with a chiropractor or physiotherapist. We tell you what it is, what to do about it, and what to watch for. Sometimes the answer is "back off for a week and do these three exercises." Sometimes it's "go see your family doctor and get an X-ray." Either way, you leave knowing.

If you're closer to Scarborough, our other location on Ellesmere Road treats kids the same way. Same practitioners, same approach.

Dr. Daniel Silva, DC

Chiropractor · Co-Founder, PRT

Dan is a chiropractor and co-founder of Performance Recovery Therapy at 1400 O'Connor Drive in East York. He treats runners, lifters, HYROX athletes, and a lot of local kids trying to get through a full season without ending up in his office.

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