The type of injuries we see in our young athletes strongly correlates with age and development. Today’s blog will focus on the three types of injuries we see most often in the young athlete and how we differentiate what may be going on.
Tendon injuries. Bone injuries. Growth Plate Injuries.
We can gather a few hints as to what may be going on by the nature of the pain. This is why a thorough history taking is key. We need to listen to the patients as their Physical Therapists.
Bone pain can be local or diffuse, doesn’t warm up, progressively worsens, hurts with weight bearing. Tendon pain is local to the tendon, may warm up with activity, can be variable in nature, and aggravated by contraction or stretching. Growth plate pain is local to the tendon attachment (growth plate zones), may warm up, and is aggravated by increased training volume and/or intensities.
Bone stress injuries (BSIs) are common during large hormonal changes while tendon issues commonly arise during high stress training times. During the growing years when growth plates are open, they remain a vulnerable area for injury. This tends to be later for male athletes. For both males and females, growth plates tend to close about 2 years after puberty. Curious about your growth plate status? X-rays can confirm how close they are to being closed.
Let’s talk anatomy.
The long bones of the body, including the femur, tibia, fibula, metatarsals (in the legs), and humerus, radius, and ulna (in the upper body), can be divided into three main components:
- Diaphysis – The long shaft in the middle of the bone.
- Epiphysis – The rounded ends of the bone.
- Apophysis – The small growth plate where the diaphysis and epiphysis meet.
Bone growth occurs at the epiphysis where bone cells multiply pushing bone tissue wider and longer, which eventually fuses in the teenage years. During the developmental years, the apophysis—also known as the growth plate—is particularly susceptible to injury, particularly in pre-teen and teenage athletes.
Apophyses, or growth plates, are 2-5 times weaker than surrounding tissues, making them highly susceptible to injury during childhood and adolescence. Growth plates are the weak link.
Apophysitis refers to the inflammation of an apophysis, occurring either from an acute event or chronic overload, presenting as either inflammation or a traction injury (avulsion fracture) on imaging.
Apophysitis occurs at various sites where tendons attach to growing bones, particularly in locations of high stress. Some of the most common conditions based on location are:
- The front of the pelvis – inflammation where the strong and tight hip flexors attach at the front of the pelvis
- Osgood-Schlatter Disease: inflammation of the tibial tuberosity where the quads attach below the kneecap on the lower leg
- Sever’s Disease: inflammation of the calcaneal growth plate – bottom of the heel
- Sindling-Larsen-Johansson Syndrome: Inflammation at the inferior pole of the patella (kneecap)
- Little League Elbow: inflammation at the medial (inside) elbow
- Iselin’s Disease: inflammation at the base of the fifth metatarsal (little toe on the outside of the foot
- Iliac Crest Apophysitis: inflammation along the iliac crest
Apophysitis vs Bone Stress Injury
While apophyseal injuries are common in younger athletes, it’s important to distinguish them from bone stress injuries (BSIs) and muscle strains, which typically affect older athletes.
Understanding a patient’s symptom location is critical.
BSIs can occur in any bone of the body, but typically present in the lower leg, long bones of the feet, femur in a few different locations, and tailbone, all slightly different locations than previously listed for apophysitis injuries.
In an upcoming blog, we will discuss the differences in how we treat each of these injuries.
*Credit to Nathan Carlson, PT for some of the content of this blog.
