"Growing Pains”: Understanding and Treating Apophysitis in Adolescents

Apophysitis in children, also known as growth plate inflammation or traction apophysitis. It is a condition characterized by pain and inflammation at the site where a muscle or tendon attaches to a growth plate in a child's bone. It commonly occurs in physically active children and adolescents during periods of rapid growth. The growth plates are areas of developing cartilage tissue that are present at the ends of long bones, and they are responsible for bone growth and development. This tissue is very responsive to pressure and movements. However, it is also easily irritated and less resistant to injury/pain by repetitive incorrect or overloading forces. 

Apophysitis most commonly affects the lower extremities, particularly the feet, knees, heels, and hips. Some of the specific types of apophysitis seen in children include:

1. Osgood-Schlatter disease: This condition involves inflammation and pain at the patellar tendon insertion on the tibial tuberosity, which is the bony prominence below the knee.

2. Sever's disease: Also known as calcaneal apophysitis, it causes pain and inflammation at the growth plate in the heel bone (calcaneus).

3. Sinding-Larsen-Johansson syndrome: This condition involves inflammation and pain at the inferior pole of the patella (kneecap) where the patellar tendon attaches.

The exact cause of apophysitis is not fully understood, but it is believed to occur due to repetitive stress or tension on the growth plates during physical activities. Factors such as rapid growth, weak muscles or tendons, poor biomechanics, and overuse can contribute to the development of apophysitis.

The primary symptom of apophysitis is localized pain, which tends to worsen with physical activity and improve with rest. Other symptoms may include swelling, tenderness, and difficulty with activities that involve the affected area. 

Treatment

Treatment for apophysitis focuses on managing symptoms and promoting healing. The following measures are commonly recommended:

1. Reducing or modifying activities that worsen the pain can help alleviate symptoms and prevent further irritation.

2. Ice therapy: Applying ice packs to the affected area for 15-20 minutes several times a day can help reduce pain and inflammation.

3. Specific movement patterns and exercises: Specific strengthening exercises f throughout the lower limb can reduce sheering or excessive forces that are known to irritate the growth tissue in the apophyseal attachment (secondary growth plate). These exercises can help relieve tension and improve strength & flexibility. Exercises should be performed under the guidance of a physiotherapist. Stretching the area only has not been shown to help this condition. Although the muscles in rapidly growing children and adolescents are often tight, this is normally more associated with poor movement patterns and weakness, rather than tightness of the muscles. It is essential that a thorough strength and biomechanical assessment is undertaken in clinic to address and look to remedy any issues which can increase the strain on the growing body. 

5. Orthotics: In some cases, shoe inserts or orthotic devices may be recommended to provide additional support and alleviate stress on the affected area.

It's important to note that apophyseal injuries are often disregarded in children and adolescent, as it is a growth-related condition that does show improvements following closure of growth plates and completion of growth. However, it is important to question what is the child or adolescent missing out on in this period? Are they enjoying their sports or are they in pain? Are they moving freely and as efficiently as they can? Therefore, what is the influence on this individual in the short-term, and long-term. 

Consult an experienced physiotherapist who works with children and adolescents for an accurate diagnosis and appropriate management of apophysitis in children. They can provide tailored advice based on the specific condition and individual circumstances. 

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