Apophysitis: Why Children Shouldn’t Play Through Pain

Apophysitis is an inflammation or stress injury to the areas on or around growth plates in children and adolescents. Apophysitis is usually caused by repetitive overuse activities like running, jumping, and throwing but can also occur as an acute injury with a fall or rapid, powerful movement.

What Are the Most Common Types of Apophysitis?

Apophysitis can present anywhere in the body where a muscle or tendon attaches to an area of bone where a growth plate is located. The most common types of apophysitis are:

• Sever’s Disease (back or underside of the heel)
• Osgood Schlatter’s Disease (bony area under the patella/knee cap)
• Little League Elbow (bony part of the inner part of the elbow)
• Little League Shoulder (upper part of the arm at the shoulder)
• Iliac crest apophysitis (bony part of the upper hip area near the waist)
• Sinding-Larson-Johansson syndrome (bottom part of the patella/knee cap)
• Iselin’s Disease (outside edge of the middle part of the foot)

What Are the Risk Factors?

The most common risk factors for apophysitis are periods of rapid growth where muscles and tendons can become tight and inflexible. Young athletes who play sports or perform repetitive activities such as running, jumping, or throwing and who often play through pain are also at risk.

What Are the Symptoms?

Symptoms of apophysitis can vary but there are a few key things to watch for:

• Pain that worsens during or after repetitive sports activities such as running, jumping, and throwing
• Pain, swelling, and/or tenderness to the touch overgrowth plate areas at the heel, knee, elbow, shoulder, hip, or foot

How Is It Diagnosed?

A sports medicine physician should be consulted immediately if you think your child may have apophysitis. They can perform a thorough musculoskeletal examination and may perform x-rays of the area to confirm apophysitis or rule out other injuries such as fractures.

What Are the Common Treatments for Apophysitis?

Depending on the location and severity of the injury, apophysitis can be treated in various different ways but initial treatment for the injury is always rest. Other treatments that your sports medicine physician may recommend are:

• Non-steroidal anti-inflammatory (NSAIDs), or other medications to control pain and reduce inflammation
• Ice, or Ice massage, to help control pain and alleviate inflammation of the area
• Braces or medical equipment that may help to alleviate pain and protect the area
• Rehabilitation with an athletic trainer or physical therapist that will include stretching, strengthening and treatments to reduce pain and prevent future injury
• In more severe cases, your physician may require a period of immobilization and/or non-weight bearing using a walking boot, crutches, and or cast

How to Prevent Apophysitis

Parents, coaches, and young athletes can help prevent apophysitis in young athletes by being aware of activity related pain and recognizing the symptoms of apophysitis early. If a child is having pain with an activity, they should rest until the pain has resolved before returning to those activities. It is important to maintain and improve flexibility of muscles as your child grows. Stretching and proper warmups before activities are an essential part of sport.

Avoiding sport specialization (one sport year-round) will allow your child’s body to rest from more strenuous and repetitive sport activities like throwing or jumping and will help prevent overuse injuries.

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