Growth plate injuries in young athletes
Overuse injuries to certain growth plates are very common in young athletes. Growth plates are the areas of bone growth present in the bones in children. Tendons attach to these growth plates at certain areas in the body. Repetitive running and jumping can cause pain and injury at certain growth plates. Two common areas are below the knee (Osgood-Schlatter disease), and at the back of the heel (Severs disease).
Osgood-Schlatter disease is one of the most common knee problems in children between ages 10 and 15 years old. It is a painful enlargement of the bump of the shin bone (tibia) just below the knee. This bump is called the tibial tuberosity. The tendon from the kneecap (patella) inserts here. The condition usually appears during a period of rapid growth.
Osgood-Schlatter disease is caused by overuse of the knee in sporting activities. Repetitive running and jumping pulls on the growth plate causing a small avulsion. It is possible tight hamstrings and quadriceps contribute to the injury. Athletes will complain of a painful bump below the kneecap, and parents may notice a bony enlargement at the top of the shin. Patients report pain that is worsened by running, jumping, and kneeling. Pain may also occur after prolonged sitting with the knees flexed.
Examination reveals a tender and enlarged tibial tubercle region, often on both sides. The remainder of the knee exam is usually normal. X-rays may show irregular boney fragments from the tibial tuberosity.
Pain control is the main focus of treatment because the condition typically resolves within 6 to 18 months. Decreasing the frequency and intensity of activity to allow healing of the tibial tubercle is the key to treating patients with severe symptoms. Ice packs to the painful area for 20 minutes after activity, as well as anti-inflammatories will help with pain and swelling. Hamstring and quadriceps stretching prior to sports will also help.
Osgood-Schlatter disease is not an absolute contraindication to sports participation, although pain can persist with activity. In patients with continuing pain it may be necessary to stop athletics for up to 2-3 months to allow the condition to heal.
Pain along the back of the heel in young athletes is a condition called Calcaneal apophysitis (Sever’s disease). The heel bone is called the calcaneus. In children, there is a growth plate (apophysis) on the back of the heel. Sever’s disease is inflammation of the calcaneal growth plate that causes pain in the heel. It is the most common cause of heel pain in young athletes.
Athletes report pain at the posterior part of the heel often in both heels. It is usually worse after running or jumping. Sports that require hard cleated shoes are especially likely to cause trouble. This condition is due to repetitive overuse and microtrauma from pulling on the growth plate at the back of the heel by the Achilles tendon.
The age of onset is usually between 9 and 14 years old. The condition resolves when the growth plate fuses usually by age 11. On exam athletes have tenderness with pressing on the back of the heel.
Treatment includes rest from the precipitating activity. Shoe modifications using a ¼ inch heel lift or arch supports may be helpful. Ice to the back of the heel and anti-inflammatories are usefull to relieve pain. Achilles tendon stretching exercises will help prevent recurrent symptoms. If pain and limp are severe a cast for 2-4 weeks may be needed.
If your young athlete experiences any symptoms of growth plate pain, they should not try to play through the pain. Rest, ice, activity restriction as above should be the initial treatment. Consult your physician for any pain that prevents your athlete from competing in their sport.
If you have any questions or ideas for future articles, please email Dr. Greg Hoffman at ghoffman@usapathway.com. For office appointments please call Dr. Hoffman at Family Medicine Associates at (817) 447-1151.