Common Growth Related Injuries by Aaron McDermott MISCP
During late childhood and adolescent years there are several physical changes that occur in the
body. Growth spurts can change our skeletal shape quite quickly and with that comes increased risk
of certain injuries.
As our bones grow, they can outpace the rate of lengthening and growth of the
associated soft tissues like muscles, tendons, nerves, and blood vessels. These soft tissues are then
relatively short compared to the bone and so are placed under increased tension and stress. This can
lead to injury. These injuries generally occur in active children and teenagers who play/do sports
involving a large amount to jumping, running, sprinting, pivoting, and kicking/throwing.
Sudden fluctuations to the volume (hours/week) of activity being done can also cause the onset of pain.
There are 3 main categories of growth-related injuries however sudden growth can be a contributing factor in more injuries.
- Traction Apophysitis injuries
As our bones grow rapidly the new bone can often be a little softer initially. Apophysitis’ generally occur where the tendons of large muscle groups attach to the new bone. An irritation of the bone/ tendon attachment (enthesis) occurs causing pain during the activity and often afterwards.
Common Apophysitis’ include:
- Osgood – Schlatter Disease – pain to the front of the knee and shin.
- Sinding Larsen Johansson syndrome – pain to the bottom of the knee cap.
- Severs Disease – Pain to the back and bottom of the heel.
- Pelvic Apophysitis – there are several sites of apophysitis around the hip including
the attachments of large muscle groups such as quadriceps, groin, and hamstrings.
- Bone stress injuries
As mentioned above the new bone being laid down is quite soft during and after a growth spurt. This leaves it susceptible to injury. There is a continuum of bone stress injuries, and the severity largely depends on the time frame which the bone is exposed to increased levels of mechanical stress.
The continuum is as follows: Normal bone to stress response to stress reaction to the ultimate progression of a stress fracture.
Common bone stress injuries include:
- Pars interarticularis fractures – pain most commonly in the low back and posterior pelvis.
- Navicular fractures – pain on the inner side of the foot near the arch
- Metatarsal fractures – pain located in the forefoot.
- Other less common sites such as tibia (front/ inside of shin) and femur (pain at the top of the thigh/hip)
- Nerve / Muscle injuries
Normally nerves are not stretched tight within our limbs, they have some room to slide up and down within their protective sheaths as we move. The sudden increase in limb and trunk length places our nerves under increased tension and this can contribute to pain and muscle strains. Our nervous system can also struggle to co-ordinate our changing bodies, and this can also contribute to injury.
Being assessed by a physiotherapist or physician is the first step in treating growth related injuries. From there you will be advised on the best treatment approach to ensure as little time is lost from your sport or activity.
Treatments often include a strengthening & co-ordination training program to help protect and support the injured area. Stretching programs assist in stretching the associated taught muscle groups. Soft tissue treatments like dry needling, massage or self-release are used to reduce tension. Understanding the nature of the injury and deciding the appropriate training volume for it is hugely important, your physio will talk the patient, parent, and coaches through this.