Growth related injuries are a concern for the junior sporting population and those involved in their management, including coaches, parents, medical and allied health professionals. Young sports people with these growth related injuries are often seen at The Melbourne Sports Medicine Centre.
Sporting participation levels are high for juniors and their musculoskeletal systems can be stressed by the loading forces they are exposed to via either high levels of specialization (with multiple teams) or the exposure to the mixed loads from concurrently undertaking a number of different sports. Over time junior sports, in many cases, have become more serious, increasing the frequency and intensity of training and competition.
The growing bones of children and adolescents have a number of differences to the fully developed mature bone structure of adult.
Children tend to grow in “spurts”, and during rapid growth periods, bone lengthens or grows quicker than the muscles and tendons that are attached to it. This results in the muscles and tendons being permanently on stretch, placing greater tension on these tissues and the bone, and resulting in less strength and co-ordination to control the bone. This contributes to the awkwardness that is commonly seen during these rapid growth periods
Tendons attach muscle to bone. In children, the tendons attach via a section of cartilage (which is softer than the calcified attachment of adult tendon) - this is potentially vulnerable point and is subject to acute and overuse injury. There is also a vulnerable point at the junction of the growth plate and the shaft of the bone which is also subject to injury.
Serious conditions can result and a missed or delayed diagnosis can have significant consequences, particularly if it has occurred during the rapid growth period.
Common growth related conditions seen at the Melbourne Sports Medicine Centre
This is a splitting or fragmenting of a piece of cartilage and attached bone from a joint and is most common at the knee, elbow, ankle, and hip associated with pain, swelling, catching, and often “locking” of the joint.
There is nearly always associated swelling of the joint. If an early diagnosis is made and activity is restricted, conservative treatment (physiotherapy) may settle the problem. However in some cases, surgical intervention may be necessary. Surgery aims to either remove the fragment, or if possible, reattach it to the joint surface.
Osgood Schlatter’s Disease (OSD)
When the lower portion of the patella tendon pulls on its attachment to the tibia (shin bone), an inflammatory response can result. As this attachment point is also part of the growth plate it is also a vulnerable area. OSD is more common in boys and tends to occur between the ages of 10 and 16.
Symptoms include acute pain and often swelling over the upper shin. The pain is aggravated by jumping, squatting, running and especially kneeling. Early diagnosis with assessment of related biomechanical factors and an individualized management plan can help minimize the impact OSD.
Severs occurs in children generally between the ages of 10 and 12 and again is more common in boys. It is caused by the achilles tendon pulling on its attachment to the heel creating an ongoing inflammatory response. Again there are individualized interventions that can help alleviate these symptoms and minimize impact on activity levels.
Contact our reception at The Melbourne Sports Medicine Centre on 9650 9372 to determine whether an appointment with our sports doctors, physiotherapists or podiatrists are most appropriate for the initial management of the growth related injury that concerns you.
Ref: AFL Community: ‘Growth Related Injuries in Juniors’