Is your child complaining of pain below the knee or in the heel during or after they are physically active? Have you put it down to just growing pains?
Adolescent apophysitis is a common orthopedic condition that affects the growth plates of children and teenagers. It is characterised by pain and inflammation in the bones and tendons that attach to the growth plates, which are the areas of bone that are still growing and developing. This area is more vulnerable to injury as kids go through their rapid growth spurts. This condition can cause significant pain and discomfort and can prevent kids from playing the sport that they love.
The reason an apophysis is prone to injury in children and adolescents is because it is a weaker cartilaginous attachment between 2 parts of the bone compared to the strong attachment of the tendon to the bone.
There are 2 main types of injuries that can occur at the apophysis.
The less common one is an acute event called an avulsion injury where a sudden traction force is applied to the apophysis, which causes it to pull apart.
The other more common type is a slowly building injury commonly termed traction apophysitis caused by traction forces applied by the muscle-tendon unit to the apophysis over time that eventually leads to change at the apophysis, causing it to widen. This traction is sometimes felt as pain to the young athlete but not always. Sometimes an acute avulsion injury can occur after a period of traction apophysitis.
Traction apophysitis is a common presentation in young athletes as a result of increased traction of the muscle-tendon unit on the apophysis. This is thought to be due to a combination of excessive loading and growth of the bones, possibly leading to less flexibility of the tissues during the growth period.
Traction apophysitis usually occurs in children between the ages of 9 and 14, with boys 3-4 times more likely to have the problem. It tends to occur in girls at an earlier age than it does boys as they tend to have their growth spurt earlier.
There are several different types of adolescent apophysitis, each of which affects a different area of the body. The most common types include:
Osgood-Schlatter disease: This condition affects the growth plate in the knee, and is characterized by pain and swelling at the top of the shinbone (tibia). It is most commonly seen in active adolescents who play sports that involve running, jumping, and repetitive knee movements. 20% of active adolescents experience this condition.
Sinding-Larsen-Johansson disease: This condition affects the growth plate in the knee, and is characterized by pain and swelling at the lower pole of the patella (knee cap). It is most commonly seen in active adolescents who play sports that involve running, jumping, and repetitive knee movements.
Sever's disease: This condition affects the growth plate in the heel, and is characterized by pain and swelling in the heel and ankle. It is most commonly seen in active adolescents who play sports that involve running, jumping, and repetitive ankle movements.
Iselin's disease: This condition affects the growth plate of the 5th metatarsal (long bone on the outside of the foot). It is commonly seen in soccer players, basketball players and those sports that involve running and jumping with lateral movement.
All these conditions are benign and self limiting. They will usually go away when the growth plate fuses completely.
Complete cessation of activity is not recommended and most adolescents are able to continue some type of activity and tolerate some pain during play provided it goes away completely within 24 hours and they don’t need anti-inflammatories or analgesia to enable them to stay active. An individualised rehabilitation program can help limit the pain and reduce secondary complications as well as addressing any predisposing factors.
Treatment usually involves some manual therapy to help reduce tension in tight muscles, gentle stretches and strengthening of the muscles around the affected area. Taping, ice and heat may be effective in helping reduce pain. Orthotic therapy can be useful if foot mechanics are contributing to the problem.
If your child has joint pain that is limiting their activity, a consultation with the physio at Winston Hills Physiotherapy Centre can be beneficial to get an accurate diagnosis, set up a rehabilitation program, help guide management of playing and training and to ensure the prevention of further complications.