The impact of COVID-19 on children cannot go without mention, especially due to their physical, social and mental wellbeing having all been disrupted over the past year and a bit. As we transition back to ‘normal life’ here in the UK, with the rules continually being relaxed we have to ask the question… ‘what does this mean for children returning to sport?’ (Schmidt et al. 2020).

Physical activity can be described as ‘any bodily movement produced by skeletal muscles that results in energy expenditure’ (Schmidt et al. 2020). Research during the pandemic reported that physical activity in children declined dramatically- you may think this is obvious right? However, what might not be as clear is the internal physical effects this is having on a child’s musculoskeletal system. This is where a Sports Therapist comes in…

What we know

I can’t speak on behalf of other therapists, but I have seen a huge surge in children coming into clinic since the return to physical activity was introduced, and this is somewhat concerning.

Regular training routines for individuals have been discontinued during the turmoil of the pandemic. The unexpected breaks have damaged the quality and quantity of training and the risk of training reversibility/detraining has been higher than ever.

Detraining has many effects on our muscles and tendons, hence an increase in injuries. Some of the effects can be;

  • Reduced bone mineral density

  • Reduced oxidative enzyme activity

  • Reduced glycogen synthase activity

  • Reduced mitochondrial ATP production

  • Reduced tendon quality

Team players have struggled to create likeminded environments to train in, thus impacting them to develop their abilities using technical and tactical components, game-understanding and decision making (Peña et al. 2021). In addition, individual sports have had facilities and infrastructure closed off to them and this will have inhibited their training. What all sporting children have in common, whether they're part of a team or an individual sport, is that the exposure to forced detraining has taken its toll on their bodies. Both therapists and coaches need to consider the training history of children during lockdown as this will guide appropriate training loads going forward.

Despite ongoing advice about meeting the World Heath Organisation (WHO) recommended amount of 75 minutes of physical activity weekly or 30 minutes of daily moderate activity it isn’t always specific enough to the child. With sport in the UK being more popular than ever before the pandemic, chances are this advice is not adequate enough for those individuals, especially children who are usually exposed to 3 training sessions and a match (for example).

Some clubs and coaches, I highly suspect, offered their children home workouts/drills to complete as a substitution for training. Nonetheless, one of the main issues we faced with the pandemic was the extended measures for weeks or months with no certainty, thus, increasing inactivity time. For many sports this ended their seasons early and for others it ate into the ever so vital pre-season period (Peña et al. 2021).

With the desire to rush back to sport at the first opportunity and with restrictions easing and games/events being introduced immediately there wasn’t a lot of time for sufficient return to play protocols to be followed. As therapists, we fear this spike in load for young children can only be a concern for their physical wellbeing.

Common Overload Injuries in Children

To name just a few overuse injuries seen in children & teenagers;

  • Sever’s Disease

  • Osgood Schlatter’s Disease

  • Shin Splints

  • Jumper’s Knee

  • Little Leaguer’s Elbow

  • Stress Fracture

  • Stress Reaction to Growth Plates

  • Strains & Sprains

I believe in order to go forward and protect children from being exposed to sudden increases in load through sport, more attention should be made to return to play protocols. Within these, things like duration of the lockdown, the health status of the individual, the complexity of the sport, how much training has been completed to maintain fitness/physical readiness should all be considered when planning a return to sport (Physiopedia 2021). A return to sport criteria was created, allowing coaches/therapists to follow when children returned back to sport.

A Return to Sport Criteria

Generic return to play principles may be applied across sports to develop return to play strategies, but bear in mind that there are specific considerations needed for different sports. Therefore, coach advice and guidance would be advantageous here (Physiopedia 2021).



Schmidt, S. C, Anedda, B, Burchartz, A, Eichsteller, A, Kolb, S, Nigg, C and Woll, A. (2020), ‘Physical activity and screen time of children and adolescents before and during the COVID-10 lockdown in German: a natural experiment’, Scientific Reports, 10(1) 1-12.

Peña, J, Altarriba-Bartés, A, Vicens-Bordas, J, Gil-Puga, B, Piniés-Penadés, G, Alba-Jiménez, C and Casals, M. (2021), Sports in time of COVID-19: Impact of the lockdown on team activity. Apunts Sports Medicine, 56(209).

Physiopedia- Return to Play During a Pandemic

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