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  • Writer's picture Dane Monaghan - Physio

Bone Stress Series: Part 1 - Growth Injuries

Intro slide - bone stress

Bone Growth-Related Injuries

Growth spurts can cause a range of physical changes during the adolescent years. This can predispose children and teenagers to growth-related injuries or pain. Growth is going to happen, it is understanding and managing the risks of growth-related injuries that we will discuss today. 

Most growth-related injuries occur in children and teens with more active lifestyles. These injuries tend to be overuse or overload-related meaning they are completing activities that are quite repetitive such as jumping, landing, and running. 

This places ongoing stresses on muscle tendons and their attachment to the bone. As children develop during a growth spurt, bones can lengthen faster than the surrounding muscles, ligaments, and tendons leading to a higher rate of strains and sprains. 

Our children’s bones break down and remodel during a growth spurt to help elicit growth. Injuries occur when this process cannot deal with the external stressors and the growth already occurring. This can leave bones weaker and therefore more prone to injuries as serious as fractures. 

Knowing how to reduce the risk of developing these conditions and how to treat them if they arise allows us to keep your children continuing to play their favorite hobbies and sports. 

Next, we will discuss the most common growth-related injuries 

Osgood Schlatter Disease

Presentation Pain at the front of the knee, below the kneecap (Shown in photo) Who it affects and how? 

  • Usually occurs in adolescent growth spurts between ages 10 to 15 years for males and 8 to 13 years for females (11.4% in males, 8.3% in females) 

  • Common in males and athletes who participate in sports that involve running and jumping.

  • Symptoms can present on both sides in 20% to 30% of patients

(Indiran & Jagannathan, 2018) 

Osgood Schlatter

Sinding-Larsen-Johansson Syndrome Presentation

Pain at the front of the knee at the bottom part of the knee cap (Shown in photo) Who it affects and how? 

Patients are typically young active boys aged 10 to 13 years. Symptoms are usually;

  • Worse with exercise, stair climbing, squatting, kneeling, jumping, and running

  • May report that they limp after exercise

  • Can be unilateral or bilateral

  • Is relieved by rest

Sinding Larsen Johannson

Sever’s Disease 

Presentation Pain in the heel, where the Achilles inserts into (Shown in photo) Who it affects and how? Can range between the ages of 8-14 years old (Males 2-3 x more likely) Symptoms

  • Pain is usually absent when the child gets up in the morning

  • Increased pain with weight bearing, running or jumping

  • Symptoms can present on both sides in 60% of patients

  • May have limitations in ankle range of motion 

Sever's disease

How Physio can assist Growth-related injuries

1. Load Management + Exercise prescription

With the mechanism of this injury being one of overuse or overloading a particular structure, managing loads becomes an essential part of rehab for growth-related injuries. Understanding differing loads from a variety of sports and activities helps assist this process Exercise prescription can also assist in prevention or managing growth-related injuries. Having a base level of strength training can help this process while balancing the loads from other bone-loading activities

2. Symptom Management

As stated above, bones can lengthen faster than the surrounding muscles, ligaments, and tendons leading to a higher rate of strains and sprains. Muscles, particularly, get tight in those suffering from a growth-related injury. Soft tissue massage, trigger pointing, and other manual therapy techniques can be beneficial in relieving associated tension from these particular injuries.

3. Taping / Offloading affected structures Taping and other techniques can assist in offloading affected structures of growth injuries.

Knee taping for example can help support the joint during loading.

Physio helping growth injuries


Growth-related injuries in adolescents can be ignored or mistaken for 'growing pains'

If these symptoms sound familiar then please get an assessment from Nicole or Dane at High Line Active Physiotherapy and get you or a loved one managed appropriately

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