Growth-related injuries in adolescents are of great concern to parents of active kids and teenagers. Also known as “growing pains”, bones grow rapidly but muscles and tendons often struggle to keep up during adolescence. This imbalance can place stress on growth plates, leading to painful overuse or traction injuries in physically active youngsters.
This article discusses three common conditions every parent, coach, or young athlete should understand.
1. Osgood-Schlatter (KNEE)
2. Sever’s Disease (ANKLE)
3. ASIS Avulsion Fracture (HIP)
Osgood-Schlatter Disease (Knee Pain)
Osgood-Schlatter affects the tibial tubercle, just below the kneecap, where the quadriceps tendon inserts. It is most common in adolescents during growth spurts that are actively engaging in sport.
Symptoms
• Pain, swelling, or a hard bump below the knee
• Pain worsens with running, jumping, squatting and descending stairs.
• Tenderness and stiffness in the thigh muscles
• 20 – 30% of cases involve both knees.
• Pain usually develops over time.
Why It Happens
As the shin bone lengthens rapidly, tension develops where the tendon pulls on the growth plate of the Tibia bone. Repetitive force (e.g., from jumping or running) causes inflammation and pain.
Complications
In rare cases, excessive traction can cause an avulsion fracture, a small piece of bone is pulled away, this requires surgical intervention however this complication is rare.
Management
• Rest and ice
• Physiotherapy (stretching and strengthening)
• Patella straps for support
• Modified training and gradual return to activity is the most important management strategy.
Usually resolves once the growth plate closes (around age 13 in girls, 15 in boys). This condition may be present for between 12 and 24 months.
Sever’s Disease (Heel Pain)
Sever’s disease, or calcaneal apophysitis, causes heel pain where the Achilles tendon attaches to the heel bone. It affects children aged 8 to 15, especially those active in impact sports.
Symptoms
• Heel pain and swelling (may affect one or both sides)
• Worse after activity, better with rest
• Tenderness when squeezing the heel
• Limping or walking on tiptoes
Why It Happens
The heel bone grows faster than the muscles and tendons, leading to stress at the growth plate. Repetitive load from running and jumping leads to pain and inflammation.
Complications
Sever’s is self-limiting and does not cause long-term damage. It resolves once growth is complete.
Management
• Relative rest and load reduction
• Ice therapy
• Stretching (calves, hamstrings, plantar fascia (muscles under the foot))
• Supportive footwear, heel pads or cups
• Physiotherapy for mobility and strengthening
• Activity modification
Full recovery typically occurs within a few months, it can take up to 2 years.
ASIS Avulsion Injury (Hip Pain)
An avulsion fracture of the Anterior Superior Iliac Spine (ASIS) occurs when a powerful contraction of the sartorius or tensor fasciae latae muscles pulls a piece of bone off the front of the pelvis. This often happens in sports involving sprinting or kicking. This is the least affected area out of the three conditions discussed and is considered rare.
Symptoms
• Sudden, sharp pain at the front of the hip
• Bruising, swelling, and difficulty walking or lifting the leg
• Pain with resisted hip flexion or stretching
• There is an abrupt “crack” and pain at time of injury
Why It Happens
During adolescence, the ASIS growth plate is vulnerable. A strong contraction during explosive movement can tear the bone fragment away from the pelvis.
Complications
Surgery is only considered if the bone fragment has moved away significantly (more than 1.5cm). Delayed rehab may cause long-term groin pain or tightness.
Management
• Initial rest and use of crutches for up to two weeks or according to pain.
• Ice and anti-inflammatories
• Physiotherapy (gradual strengthening, core stability)
• Avoid early stretching of the area
• Return to sport in 12 – 16 weeks depending on severity
Prognosis is excellent with appropriate rehabilitation.
When to See a Physiotherapist
A physiotherapist can:
• Assess and diagnose these injury
• Help reduce pain and inflammation in the area involved
• Guide safe return to sport
• Provide individualised exercise and rehab plans
• Advise on footwear, strapping or orthotics
References
- Brukner, P., & Khan, K. (2017). Clinical Sports Medicine (5th ed.). McGraw-Hill Education.
- OrthoInfo by the American Academy of Orthopaedic Surgeons: www.orthoinfo.org
- SPT (2016). The Juvenile Athlete.
- Rossi, F., & Dragoni, S. (2001). Acute avulsion fractures of the pelvis in adolescent competitive athletes. Skeletal Radiology, 30(3), 127–131.
- Caine, D., Maffulli, N., & Caine, C. (2008). Epidemiology of Injury in Child and Adolescent Sports: Injury Types, Risk Factors, and Prevention. Clinics in Sports Medicine.