Growth Plates
When bones grow, they grow from soft areas of bone and cartilage called “growth plates” which are located on the ends of bones. Given that these areas of bone are less dense, they are particularly prone to injury during childhood. As children mature and begin to reach their maximum height, these growth-plates eventually solidify and become regular strong bone.
Growth plate injuries can range from mild to severe depending on the cause and extent of the injury. The most common form of growth-plate injury is a “traction” injury which occurs when a ligament or tendon pulls on the soft growth-plate, causing the growth plate to become inflamed and tender. These traction injuries are often the result of a lot of repetitive activity, such as a running, jumping, walking, or sport. They can also be more common in children who are currently experiencing a growth spurt.
There are several common locations for these growth-plate injuries:
- The back of the heel near the achilles tendon (Sever’s disease)
- The front of the knee, just below or on the kneecap (Osgood Schlatter’s or Sinding-Larsson-Johansson Sydrome)
- The fronts of the hip bones
- The bony part of the buttock
Signs and Symptoms
Fortunately, most cases are mild whereby pain may only occur with sport and be localised to the affected area of bone. If left untreated however, the child may develop a painful limp that worsens after sport or may feel too sore to continue playing. In extreme cases they may also have parts of the growth-plate separate from the underlying bone, potentially affecting the ability for the bone to grow.
Growth-plate traction injuries are common in children and adolescents who:
- Play a lot of sport, particularly those that involve running and jumping
- Are taller or currently going through a large growth spurt
- Have had a history of previous growth-related pains or injuries
Treatment for Growth-Plate injuries
The best way to manage these traction growth plate injuries is to:
- Get plenty of rest from sports or activities that cause pain.
- Apply ice to the sore area after sport for 20 minutes.
- Ensure footwear is supportive and appropriate for the given sport.
If pain persists, these injuries can often be treated by your physiotherapist with a personalised rehabilitation program, soft-tissue release, advice around managing symptoms, and by making a plan to reduce the load through the growth-plate. Depending on the growth plate that is injured, the use of a foot orthotic, brace or heel lift may also be recommended by your physiotherapist as these can significantly improve growth plate pain when properly prescribed.
Should you have any questions about the content within this blog please send us an email at blackburn@backinmotion.com.au or if you feel that the above points are relevant to you, you can book in a Free Initial Assessment at Back In Motion Blackburn 9878 1919 or book online at https://www.backinmotion.com.au/blackburn/make-a-booking.
References:
Cassas, K., & Cassettari-Wayhs, A. (2006). Childhood and Adolescent Sports-Related Overuse Injuries. American Family Physician, 73(6): 1014-1022.
Dogan, M. S., Doganay, S., Koc, G., Gorkem, S. B., Ciraci, S., & Coskun, A. (2015). Calcaneal Apophysitis (Sever’s Disease): MRI Findings. Journal of Nepal Paediatric Society, 35(2): 172-174.
James, A. M., Williams, C. M., Luscombe, M., Hunter, R., & Haines, T. P. (2015). Factors associated with pain severity in children with calcaneal apophysitis (Sever disease). The Journal of Pediatrics, 167(2): 455-459
James, A. M., Williams, C. M., & Haines, T. P. (2013). Effectiveness of interventions in reducing pain and maintaining physical activity in children and adolescents with calcaneal apophysitis (Sever’s disease): a systematic review. Journal of Foot and Ankle Research, 6(16)
McCrea, J. D. (1985). Paediatric Orthopaedics of the lower extremity. Mount Kisco, NY: Futura.
Perhamre, S., Lazowska, D., Papageorgiou, S., Lundin, F., Klassbo, M., & Norlin, R. (2013). Sever’s injury: A clinical diagnosis. Journal of the American Podiatric Medical Association, 103(5): 361-368.