Growth Plate Injuries
By Alana Mayes – Senior Paediatric Physiotherapist & Musculoskeletal Team Leader of Ocean Kids Health.
Having treated growth plate injuries for many years, I have seen how helpful early intervention and education can be in preventing them from impacting children’s ability to be as physically active as they want to be. Growth plate overuse injuries can be managed quickly and relatively easily if identified and managed early, so knowing the signs is key!
Growth plate overload injuries commonly occur in children aged over 7 years. Most growth plate overuse injuries settle with time and do not cause any long-term issues; however, they can impact sports participation at a time when it is very important for long-term health to maintain a physically active lifestyle. Early management of growth plate injuries assists children to maintain their activity levels, reduce pain and identify and treat the modifiable risk factors to prevent growth plate overuse injuries in the future.
So, what is a growth plate?
- They are growth centers at the ends of long bones (and some short bones ie. Vertebrae in the spine, toes and fingers) where new bone is laid down, lengthening and widening the bone
- They are made of cartilage when they are open
- Growth plates become gradually calcified (turned to bone) when closure occurs – most during puberty though some starting as young as 7 and as old as 21.
Risk factors for growth plate injury:
- Growth plate is vulnerable during large growth spurts
- Skeletal maturity (your skeleton doesn’t necessarily mature at the same rate as you age)
- Nutrition – energy in vs. energy out AND nutritional quality/variety
- Load – Amount, type, frequency, duration
- Hormone production
- Menses-late onset or irregular periods
Overload injuries occur during the time that the growth plates are in the process of closing- that is-when the open cartilaginous growth plate is slowly being turned to bone. Traction, compressive and shearing forces applied to the growth plate during activities can cause inflammation and irritation of the growth plate. Growth plate overload injuries are most commonly triggered by a sudden increase in activity or change in the type of activity the child is doing. For example, if they return to footy after having several months off where they rested, then in order to get their fitness up, suddenly begin doing long training sessions of running. Other key triggers include a sudden growth spurt or a change in nutrition, stress or sleep which impacts children’s ability to recover from activity.
Most common growth plate injury sites include:
- Sever’s disease (heel pain)
- Osgood Schlatter disease (knee pain)
- Sinding-Larsen-Johansson syndrome (knee pain)
- Gymnasts’ wrist (wrist pain)
- Thrower’s elbow (elbow pain)
- As well as several sites around the pelvis and foot
Osgood Schlatter Disease:
Children most commonly have a gradual onset of initially “niggly” pain at the site of the growth plate. It is usually very specific where they feel the pain and becomes increasingly painful and eventually restrictive over time. As the overload injury continues, they may experience:
- Loss of flexibility
- Loss of strength
- Loss of power
- Tenderness to touch over the growth plate
- Swelling over the growth plate
- Improvement with short period of rest (especially in the early stages)
- Walk with a limp
Early management of growth plate overload injuries is key and usually involves a short period of activity modification while the underlying factors are addressed. Your physiotherapist will assess for these and will provide treatments to reduce pain and restore flexibility, strength, power, neuromuscular control and provide education around managing loading and recovery, as well as return to sport. Massage, taping and footwear prescription can be very helpful in reducing symptoms. In my experience, I have found it is vital to understand WHY the growth plate injury has occurred. Addressing the underlying causes (of which there can be multiple!) speeds recovery and also prevents flare ups or future growth plate overload injuries.
We love supporting kids to live active and healthy lifestyles! If you have any questions about growth plate injuries, please do not hesitate to get in contact with our wonderful team.
Senior Paediatric Physiotherapist
Musculoskeletal Team Leader of Ocean Kids Health.