Growing Pains – Children and Apophysitis Injuries

Working with young athletes, I’ve seen loads of these! In one week with elite academy footballers we had three; one Osgood Schlatters, one Severs and one Sinding Larson-Johansson. All three of these injuries occur as muscle and tendon length and extensibility is unable to maintain the rapid growth of the associated bone. This increased tension, along with a high training load, increases the force exerted on the attachment of a tendon to its bony insertion. In addition, biomechanical factors such as over-pronation and knee valgus may increase the tension through a tendon by causing a stretching of the tissue due to poor position. Similarly, poor technique in landing or deceleration may have a similar result causing increased stretch and therefore tension.

The resulting increase in tension on a bone can lead to development of a traction apophysitis or cartilaginous prominence next to the growth plate of the bone. This is where the force applied to a bone causes inflammation and partial avulsion of the bone. If excessive force is continually applied (if the athlete does not reduce training load or correct biomechanical issues) it may lead to an avulsion fracture.


Usually diagnosed with the location and presentation of pain, at the insertion of a tendon to the bone. Sometimes with a bony prominence and inflammation. Rapid stages of bone growth also help to diagnose an apophysitis injury.


For all apophysitis injuries a similar protocol should be followed:

  • Reduce training load and rest from activity causing pain
  • Increase the length of muscle and tendon with stretching programmes, massage and specific soft tissue mobilisation
  • Correct biomechanical issues where possible
  • Improve strength deficits to correct technique in running, landing and decelerating and reduce biomechanical causes of increase tendon tension

For a person presenting with these issues your first step is to contact a therapist or doctor to ensure the pain isn’t anything more serious. Following correct diagnosis, begin an exercise programme including an appropriate stretching and strengthening routine to increase muscle length and reduce tension on the tendon and its insertion.

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