Your child comes home from practice limping. Their heel hurts, or their knee aches just below the kneecap. They can still run, but it’s getting worse. You’re not sure whether they should push through it or stop altogether.
We see this a lot. The good news is that these problems have a name and a clear explanation, and surgery is rarely needed (Achar and Yamanaka, 2019). They’re growth plate injuries, and while they can be sore and frustrating, they’re very manageable.
What is a growth plate injury?
Children’s bones grow from softer areas of cartilage called growth plates. Some of these sit exactly where a tendon attaches to the bone, and they’re weaker than the tissue around them. When a muscle and its tendon tug on one of these spots over and over, before the bone has fully hardened, the growth plate gets irritated. The medical name is apophysitis (Achar and Yamanaka, 2019).
These are mostly overuse injuries in children who are growing and have tight muscles (Achar and Yamanaka, 2019). They tend to show up during growth spurts. A 2024 review in the British Journal of Sports Medicine found that growth-related injuries peaked during the teenage growth spurt, and that faster growth of the legs was linked with more injuries (Parry et al., 2024).
Sever’s disease (heel pain)
Sever’s disease is the most common cause of heel pain in children (Hernandez-Lucas et al., 2024), and it’s often linked to sports like soccer and basketball. The Achilles tendon and the thick band under the foot (the plantar fascia) both attach to the growth plate at the back of the heel bone. Running, jumping and landing keep pulling on that spot and irritate the young bone.
A 2023 review by Nieto-Gil and colleagues found that tight calves, which limit how far the foot bends up towards the shin, were the factor most often studied. High pressure under the foot and the way the foot sits came next. Body weight, age and playing sport were also among the factors linked with it. The children in the studies were about 11 years old on average.
What you can do at home
- Cut back the load. Your child doesn’t need to stop everything. Relative rest, which means cutting back the amount or intensity of the activity that brings on the pain, is part of standard treatment (Achar and Yamanaka, 2019). If they play three sports, consider focusing on one during a flare-up.
- Stretch the calves. Tight calves are the factor most often linked with Sever’s (Nieto-Gil et al., 2023), and stretching is part of standard treatment (Achar and Yamanaka, 2019). Try gentle, held calf stretches a few times a day, once with the knee straight and once with it bent.
- Heel raises or cups. Taking some strain off the tendon is part of treatment (Achar and Yamanaka, 2019), and a review of trials found that non-surgical options such as insoles and shoe inserts helped ease Sever’s symptoms (Hernandez-Lucas et al., 2024). A simple gel heel cup in school and sports shoes is an easy place to start.
- Ice after activity. Icing after activity is part of standard treatment (Achar and Yamanaka, 2019). If the heel is sore after sport, a short session of ice wrapped in a cloth can help settle it.
Osgood-Schlatter disease (knee pain)
Osgood-Schlatter disease is the most common growth plate problem of the legs in children who play sport (Corbi et al., 2022). It affects the bony bump just below the knee, where the kneecap tendon attaches. The big thigh muscle (the quadriceps) pulls on this growth plate through that tendon with every jump, sprint, squat and landing.
Up to 10% of teenagers are affected (Neuhaus et al., 2021). It usually appears around the teenage growth spurt and in sports with lots of explosive movement (Corbi et al., 2022). A review by Lucenti and colleagues (2022) found the main factors studied were to do with the muscles, mainly tightness in one of the thigh muscles (the rectus femoris), along with repeated loading from sport.
Your child will usually have a tender, sometimes swollen bump below the kneecap that hurts during and after activity. It may be sore on the stairs, when kneeling or with any explosive movement.
What you can do at home
- Stretch the front and back of the thighs. Tight thigh muscles are one of the main factors (Lucenti et al., 2022), and stretching appears to help with Osgood-Schlatter (Neuhaus et al., 2021). Try a standing or side-lying thigh stretch a few times a day, plus gentle hamstring stretches.
- Strengthen around the knee. Once the worst of the pain settles, we often add gentle strengthening of the thighs and buttocks, such as wall sits, mini squats and glute bridges.
- Manage activity, don’t stop it completely. As with Sever’s, relative rest is the standard advice (Achar and Yamanaka, 2019). The goal is to find a level of activity that doesn’t make the pain much worse.
- Ice after activity. As with Sever’s, icing after activity is part of standard care (Achar and Yamanaka, 2019).
Sinding-Larsen-Johansson syndrome
This is the lesser-known cousin of Osgood-Schlatter. The same kneecap tendon is involved, but the trouble is at its top end, where it attaches to the bottom of the kneecap. The cause is the same: the thigh muscle pulling over and over on a growth plate that is still developing.
The pain sits at the bottom of the kneecap rather than below it (Achar and Yamanaka, 2019). It’s managed the same way as Osgood-Schlatter, with stretching, sensible activity levels and strengthening that builds gradually.
Other growth plate injuries to know about
Growth plate injuries can happen wherever a strong muscle attaches to growing bone. They’re more common in the legs, including several spots around the hip, and they can also affect the elbow (Achar and Yamanaka, 2019). A few worth knowing about:
- Hip bone and sit bone. Pain along the top of the hip bone, or at the sit bone where the hamstrings attach. These hip injuries tend to appear later in the teenage years than heel and knee problems (Parry et al., 2024).
- Elbow pain from throwing. Repeated throwing and racket sports can irritate the growth plate on the inner elbow, so young cricketers and tennis players are at risk. Keeping an eye on how much they throw and hit matters.
Why growth spurts matter
Growth-related injuries peak during the teenage growth spurt, and faster growth of the legs is linked with more of them (Parry et al., 2024). So a child who has played sport happily for years can start getting heel or knee pain during a growth spurt, even if their training hasn’t changed much. Parry and colleagues (2024) describe these injuries following the order in which teenagers grow: feet and ankles first, then knees and hips. That’s why Sever’s disease often appears first, followed by knee problems like Osgood-Schlatter.
How we treat growth plate injuries
Non-surgical care is the standard approach for these conditions, and a review of trials found it an effective option for easing Sever’s symptoms (Hernandez-Lucas et al., 2024). For Osgood-Schlatter, treatment is also mainly non-surgical (Neuhaus et al., 2021). Here’s what our care usually involves.
Soft tissue work. We work on the muscles and tendons that attach to the sore growth plate. For Sever’s, that means the calf and the sole of the foot. For Osgood-Schlatter and Sinding-Larsen-Johansson, we focus on the thigh muscles and the tissues around them.
Joint mobilisation. Limited bending of the ankle is one of the factors most often linked with Sever’s (Nieto-Gil et al., 2023), so we check the ankle and gently mobilise it where it’s stiff. We check the hips too.
Strengthening. Once the worst of the pain settles, we add targeted strengthening for the muscles around the sore area.
Getting the activity balance right. We help you and your child find the right balance between staying active and giving the growth plate time to recover. That might mean less training, a change in the type of activity or rest days planned around matches.
Growth plate injuries are a common part of growing up in sport. They don’t mean your child is broken or has to stop playing.
One important exception: if your child suddenly can’t put weight on the leg after a particular incident, that’s different from the slow build-up of a typical growth plate injury. Have it checked promptly. A sudden, strong muscle contraction while the growth plates are still open can pull a small piece of bone away, known as an avulsion fracture (Eberbach et al., 2017).
If your child has heel pain, knee pain or any ongoing ache that is holding back their sport, we can help. You can read more on our growth plate injuries page. A proper assessment shows exactly what is going on and gives you a clear plan.
Get in touch or book an appointment.
Frequently Asked Questions
Should my child stop sport if they have Sever's or Osgood-Schlatter?
Usually not completely. Standard advice is relative rest (Achar and Yamanaka, 2019). Cut back the amount or intensity of the activity that brings on the pain, and look for a level that doesn't make it much worse.
Why does my child's heel hurt after running or soccer?
Heel pain during sport in children is most often Sever's disease. The Achilles tendon and the thick band under the foot pull on the growth plate at the back of the heel. A 2023 review found tight calves were the factor most often studied, followed by high pressure under the foot and the way the foot sits (Nieto-Gil et al., 2023).
Why do growth spurts cause knee and heel pain?
Growth-related injuries peak during the teenage growth spurt, and faster growth of the legs is linked with more of them. A 2024 review describes these injuries following the order adolescents grow in, from the feet and ankles to the knees and then the hips (Parry et al., 2024). That is why Sever's disease often appears before knee conditions like Osgood-Schlatter.
When should I get my child's growth plate pain checked urgently?
If your child suddenly can't put weight on the leg after a particular incident, have it checked promptly. That's different from the slow build-up of a typical growth plate injury. A sudden, strong muscle contraction can pull a small piece of bone away at the growth plate, known as an avulsion fracture (Eberbach et al., 2017).
References
- Achar S, Yamanaka J. Apophysitis and osteochondrosis: common causes of pain in growing bones. American Family Physician. 2019;99(10):610-618.
- Parry GN, et al. Associations between growth, maturation and injury in youth athletes engaged in elite pathways: a scoping review. British Journal of Sports Medicine. 2024;58(17):1001-1010.
- Nieto-Gil P, et al. Risk factors and associated factors for calcaneal apophysitis (Sever’s disease): a systematic review. BMJ Open. 2023;13(6):e064903.
- Lucenti L, et al. The etiology and risk factors of Osgood-Schlatter disease: a systematic review. Children (Basel). 2022;9(6):826.
- Corbi F, et al. Osgood-Schlatter disease: appearance, diagnosis and treatment: a narrative review. Healthcare (Basel). 2022;10(6):1011.
- Neuhaus C, Appenzeller-Herzog C, Faude O. A systematic review on conservative treatment options for Osgood-Schlatter disease. Physical Therapy in Sport. 2021;49:178-187.
- Hernandez-Lucas P, et al. Conservative treatment of Sever’s disease: a systematic review. Journal of Clinical Medicine. 2024;13(5):1391.
- Eberbach H, Hohloch L, Feucht MJ, et al. Operative versus conservative treatment of apophyseal avulsion fractures of the pelvis in the adolescents: a systematical review with meta-analysis of clinical outcome and return to sports. BMC Musculoskeletal Disorders. 2017;18(1):162.