Growth Plate Issues: What to look for and how to make the pain go away?

Growth plate injuries account for 15% of all skeletal injuries in children and occur twice as often in boys. Besides the occasional bump or bruise, children should not complain of regular pain. If your child comes to you concerned with new aches and pains; take a moment to run through a checklist that might help our healthcare professionals help you even better.

• Does your child complain of pain in their knees or feet?
• Has your child increased the amount of physical activities that they are involved in at school or with after school sports?
• Do you notice a bump under your child’s knee or back of their heel?
• Is your child involved in sports that are more high impact ie: running, gymnastics, dance, or football?

If your child answers yes to any of these questions, our professionals can help you understand more about common growth plate injuries and how physical therapy can help after an injury occurs.
Children are susceptible to injuries that adults aren’t because their growth plates are still open. Boys are more susceptible to these injuries because their growth plates close on average 2-3 years after that of a girl. If an injury to the growth plate is not addressed early, then more severe damage to the bone itself can occur. Along with general categorized fractures at the growth plate; kids are also at higher risk for avulsion fractures at the level of the hip, knee, and ankle. Because children are not skeletally mature, their ligaments are stronger than their bones. A general sprain of a ligament in an adult can actually lead to a fracture in a child. This is the most commonly seen in soccer players and dancers. Each bone has its own growth plate, but the bones in our lower extremities that are most involved include the femur, tibia, and calcaneus. The two most common lower extremity growth plate injuries are associated with the knees and the feet. Listed below are these 2 types of injuries and associated paths for healing in order to get your child back pain-free participating in the activity they love.

1. Runner’s/Jumper’s knee

Medical Diagnosis: Osgood-Schlatter(OS) and Sinding-Larsen Johannsen(SLJ)

Common Sports: Running, Gymnastics, Basketball, Football

Problem: Injury at the junction of the femur, tibia, and patella. This can be caused by direct trauma to the patella and tibia, or as a repetitive knee flexion injury.

Signs/Symptoms: Pain, swelling, and/or bony deformity at tibial tubercle that is associated with running, squatting, jumping activities. Same reproducible pain in (SLJ) except that point of discomfort is right at the base of the kneecap rather than on the lower extremity bone.

Prevention: Relative rest is key. Decreasing sporting activities that increase pain for an appropriate length of time. Regular stretching of the quadriceps and hamstring muscles are very important. Education on proper jumping, landing, and squatting form can reduce the risk for recurrence. Ice at the point of pain assists in reducing sharp pain complaints.

2. Heel Pain

Medical Diagnosis: Sever’s Disease

Common Sports: Dance, Gymnastics, and Running

Problem: Repetitive landing or impact on the heel bone.

Signs/Symptoms: Pain, swelling, and/or bony deformity at the back of the heel. Pain with contact of heel in the ground not only with sporting activities, but with basic walking and standing. Squeezing of the heel will illicit pain.

Prevention: Relative rest remains key here. Stretching of the gastrocnemius and soleus, which form the Achilles is necessary. General strengthening of the core and hip muscles to reduce pressure being placed on the heel. Gel cups inserted in the shoes and frequent icing will also assist in pain management. Good shoe wear can also assist in reducing frequent of recurrence.

Both of these problems are treatable. Appropriate diagnosis by our local pediatric orthopedic physician’s will get your children on the right track for pain relief. Our clinics offer pediatric PTs who are happy to help give you and your child the tools to get them right back into their activities with a greater knowledge of avoiding this injury in the future.

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