Growth Plate Injuries
Reviewed by Dr Matthew Proctor
Chiropractor · AHPCSA A10954
At a glance
Growth plate injuries affect children and teenagers whose bones are still growing. Common examples include Osgood-Schlatter (knee), Sever's disease (heel) and Sinding-Larsen-Johansson (kneecap). These problems settle with time, and care focuses on adjusting how much sport your child does, hands-on treatment and targeted exercise.
Growth plate injuries are a common cause of pain in growing bones (Achar and Yamanaka, 2019). They happen where muscles and tendons attach to growing bone, and children are especially vulnerable during growth spurts, when bones lengthen faster than the muscles and tendons can keep up (Achar and Yamanaka, 2019).
The medical term is apophysitis. It means irritation at a growth plate where a tendon attaches (an apophysis), caused by the tendon pulling on it over and over. These are usually overuse injuries, not the result of a single knock or fall (Achar and Yamanaka, 2019). Common examples are Sever's disease (heel pain) and Osgood-Schlatter disease (knee pain below the kneecap). Other sites include the bottom tip of the kneecap (Sinding-Larsen-Johansson syndrome), the hip bone and the sitting bone where the hamstrings attach.
A 2024 review of elite youth athletes found that injuries generally became more common as they matured, and that faster growth in height and of the legs was linked to more injuries. Growth plate injuries tended to move up the body with age, from the heel first to the knees and then the hips, which mirrors the way children grow (Parry et al., 2024).
What makes these conditions frustrating for families is that the child often looks fine. There is no swelling, no bruising and no obvious injury. But the pain is real, and it limits what they can do. Surgery is rarely needed (Achar and Yamanaka, 2019), and the aim is to keep your child as active as comfort allows. Our parent's guide to growth plate injuries covers what you can do at home to help manage these conditions.
At our Sandton practice, we see these conditions regularly. Treatment is gentle, suited to your child's age and focused on three things. We ease the pull on the sore growth plate, get the nearby joints moving well and build the strength and flexibility your child needs to keep up with sport.
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Book OnlineCommon signs of growth plate injuries
- Heel pain during or after running, jumping or sport
- Pain below the kneecap that worsens with stairs, kneeling or squatting
- A tender, sometimes swollen bump below the knee or at the heel
- Limping during or after activity
- Pain at the bottom of the kneecap (Sinding-Larsen-Johansson)
- Hip or groin pain along the top of the pelvis in runners
- Pain at the sit bone with sprinting or kicking
- Stiffness or tightness in the calves, quads or hamstrings
- Symptoms that flare during a growth spurt
- Pain that settles with rest but returns with activity
Stretching and strengthening the muscles involved are part of the recommended care (Achar and Yamanaka, 2019). Alongside these we use soft tissue work on the tight muscles, joint mobilisation for the ankle, knee and hip and exercises that build up over time.
Our Morningside practice is convenient for families across Sandton, Bryanston, Fourways, Midrand and greater Johannesburg.
Book an appointment at our Sandton practice. We will assess your child, explain what is going on and give you a clear plan to manage it.
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Same-day appointments available at our Sandton rooms.
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Frequently Asked Questions
Growing pains are usually vague aches in both legs that come on at night and have no clear cause. Growth plate injuries (apophysitis) are different. They hurt in one definite spot, get worse with activity and are tender to touch. If your child has pain in the same place during or after sport, it is worth getting it checked.
Usually not. Recommended care is relative rest, which means cutting back on the activities that hurt rather than stopping everything, and children with Osgood-Schlatter are encouraged to keep playing sport as far as comfort allows (Achar and Yamanaka, 2019). The goal is to find a level of activity that does not make the pain much worse, so your child stays active.
It depends on the condition and the child. These problems settle with time, and they go away once the child stops growing and the growth plate fuses (Achar and Yamanaka, 2019). That happens at different ages depending on where the growth plate is. We review your child's progress at each visit.
Yes. Chiropractors are trained to assess and manage joint and muscle problems in children. Treatment is gentle, suited to your child's age and focused on taking load off the sore growth plate through soft tissue work, joint mobilisation and targeted strengthening. We also guide parents on adjusting activity and on home exercises.
Swelling and tenderness over the bony point just below the kneecap (the tibial tuberosity) is a common finding in Osgood-Schlatter, where the kneecap tendon pulls on the growth plate (Achar and Yamanaka, 2019). We can check it and explain what to expect for your child.
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.