'Underuse' amid Covid-19 is a real problem

The global Covid-19 pandemic seems to have put a halt to the overuse injuries in adolescent and high school athletes that used to be so prevalent. Fewer overuse injuries is a good thing. The problem is that the pendulum of activity has gone the other way, toward far less activity than in the pre-Covid days.

It’s still too early to have definitive data, but limited survey based data from parents report that kids were less physically active during April and May compared to February. Also importantly, older kids tended to be affected by the Covid-19 restrictions more than the younger kids, with steep declines in physical activity.

Exercising Less And Sitting More

A recently published study from authors at the USC School of Medicine examined physical behavior patterns in 211 children between the ages of 5 and 13, from 35 U.S. states.

This study was based on surveys of parents, so it likely has some recall bias involved, but nevertheless shows some troubling trends.

54% of parents of 5- to 8 year-olds reported their kids were substantially less active, and 64% of parents of older kids reported their kids were seated much more and active much less compared to pre-Covid recollections.

Low Income Households Are At Higher Risk

These surveys are not definitive but do suggest that children who are raised in low income households may be at particular risk for exercising less and sitting more. Most physical activity during the Covid pandemic takes place in the immediate home neighborhood, so kids who live in more densely packed areas with higher traffic volume and safety issues are particularly affected.

The survey findings in the kids seem to follow the same pattern seen in adult surveys, where socially and economically disadvantaged groups are disproportionately impacted by Covid-19 restrictions.

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For guidelines and best practices for WHEN AND IF your local authorities have deemed it safe to return to the play, check out U.S. Soccer's PLAY ON home page HERE.

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Any Movement Is Better Than No Movement

Prior to the Covid-19 restrictions, we would hear about how overscheduled, overworked, and overly structured kids’ lives were. During the pandemic the survey reveals that this has changed dramatically. 90% of the parents indicated that their kids were involved in unstructured free play activity (not surprising, given that school sports, recreational clubs, and competitive clubs are mostly shut down…) and 55% of the parents said that “going for a walk” constituted most of the activity.

Perhaps there’s an opportunity for improvement in those numbers, with parents leading the way. The most basic point I’d like to make is: any physical movement is better than sitting at a desk with no movement.

If walking is the best you can do, perhaps there’s a way to turn that into a family activity to foster connection as well as safe movement?

Kids generally enjoy being around other kids and tend to move more in that setting. Are there “pods” you can create for safe activity?

If you have access to a park, perhaps the parents can rotate taking small groups of kids for unstructured play, while maintaining the recommended six feet spacing?

Our restrictions will someday end. I hope that when the situation gets back to some semblance of normal that we can look back on this experience and carry good habits forward.

Key Points:

Preliminary data regarding kids’ activity pre-Covid compared to during-Covid shows a dramatic decrease in physical activity.

Any movement is better than no movement. As difficult as it may seem, try to find opportunities to put movement and free activity into kids’ daily lives.

(Dr. Dev Mishra is in private practice at the Institute for Joint Restoration in Menlo Park, California, and Medical Director of Apeiron Life. He is the creator of the online injury management course and the Good to Go injury assessment App for coaches, managers, parents and players. Mishra writes about injury recognition and management at

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