Risks of and Techniques to Avoid Growth Plate Injuries in Young Athletes

Monday February 9, 2015

Do you have an aspiring young gymnast, soccer player, dancer, or baseball player who spends all their waking hours supporting that passion?  When you see a clinic that will help develop your child in that sport, do you jump on it to help them be at their best (as well as stay up with the incredible competition of youth sports)? This is common and understandable.  However, this article will explain the importance of more general sports conditioning, stretching, and stabilization programs to help avoid the potential of career ending growth plate injuries in athletes particularly in the 10 – 14 year old age range.

What are growth plates?

Growth plates are regions of developing cartilage in children’s bones that act as centers of the rapid cell production that result in increased bone length and proper bone formation. As children enter adulthood, their growth plates are gradually replaced by solid bone and sealed.

How can growth plates be injured?

Growth plates are susceptible to injury because of their relative weakness compared with the surrounding stable bone, ligaments and tendons. As a result, when children fall and place great pressure on their bone, the growth plate will sustain injury more commonly than the relatively stronger supporting structures.

In addition, growth plate injuries can occur because of overuse. Growth plate fractures make up 15 to 30 percent of childhood fractures. Common growth plate injury is reported in the wrists of young gymnasts, the ankles of young runners and in the shoulders of children participating in throwing sports, such as baseball.

What can parents do to recognize a growth plate injury?

Parents should always be attentive to the physical condition of child and adolescent athletes. A growth plate injury can be recognized by persistent pain and one point of tenderness in any of the areas near growth plates. If a child reports a sudden fall or accident during play and complains of persistent pain, the injury should be brought to a physician’s attention.

If ability to participate in athletics is hindered by any discomfort in motion, it is possible that overuse has resulted in a growth plate injury. Any deformities observed in growth plate regions should also be reported to a physician. Because of the possible long-term effects of growth plate injuries on growth, medical attention should not be postponed if there is any suspicion of injury.

What are some types of Growth Plate Injuries?

1.       Sever’s Disease

Sever’s disease is an acute injury to the growth plate at the back of the heel,  common in young athletes. It is most common between the ages of 10-12 years. Pain is experienced though the back of the heel where the Achilles tendon inserts into the heel bone. In children, there is a growth plate located at this site. During periods of rapid growth the calf muscle and Achilles tendon become tighter, causing excessive forces through the growth plate. Forcible and repeated contraction of the calf can injure the growth plate causing pain.

Causes: Excessive tightness through the calf complex, weakness through the calf complex, poor foot mechanics (excessive pronation), playing sport on hard surface or in cleats and excessive running and jumping.

2.       Osteochondritis dissecans

Repetitive throwing causes compressive forces on the lateral (outside) aspect of the elbow, which, over time, may compromise the blood supply to the articular cartilage and underlying bone. Known as osteochondritis dissecans, this condition is usually seen in 10- to 14-year-old patients. The patient typically complains of pain on the outside of the elbow. Loss of motion, particularly when the elbow is being extended, is also common. Swelling and locking of the joint may also occur. X-rays will usually show the area in question and can assist in the diagnosis.

3.       Osgood-Schlatters

The main cause of Osgood-Schlatter lesions is too much tension in the patellar tendon. The tension can come from overuse from sports activity and from growth spurts. Usually both happen together. Both put extra stress on the tibial tuberosity.

During growth spurts, the tendon may not be able to keep up with the growth of the leg bones. The tendon becomes too short and constantly pulls at the tibial tuberosity. Tension from sports activity comes from overuse. When the quadriceps muscle, on the front of the thigh, works, it pulls on the patellar tendon. The tendon in turn pulls on the tibial tuberosity. If the tension is too great and occurs too often while the bone is developing, it can pull the growth area of the tibial tuberosity away from the growth area of the shinbone.

The bump forms because the separated growth plates keep growing and expanding. The area between the bone fragments fills in with new tissue, either cartilage or bone. The new tissue causes the tibial tuberosity to become enlarged and painful.

Another possible cause of Osgood-Schlatter lesions is abnormal alignment in the legs. Kids who are knock-kneed or flat-footed seem to be most prone to the condition. These postures put a sharper angle between the quadriceps muscle and the patellar tendon. This angle is called the Q-angle. A large Q-angle puts more tension on the growth plate of the tibia, increasing the chances for an Osgood-Schlatter lesion to develop. A high-riding patella, called patella alta, is also thought to contribute to development of Osgood-Schlatter lesions.

How does a doctor treat a growth plate injury?

A doctor will treat a growth plate differently depending on the degree of injury suffered. Minor injuries may simply require a period of rest to allow the damaged region of the bone to reform without added stress to inhibit the process. A more serious injury may require immobilization and possibly surgery to restore the integrity of the growth plate and ensure the proper maturation of the bone. In addition, strengthening and range-of-motion exercise may follow treatment to restore normal mobility. If left untreated, growth plate injuries can potentially cause disability to young athletes. Medical attention should be sought immediately if the symptoms described earlier are observed.

How can growth plate injuries be prevented?

Growth plate injuries can be prevented in young athletes by improving their skeletal condition and ensuring that their bones are strong enough to withstand the pressures placed on their bodies during rigorous activity. This can be accomplished by:

  • Including calcium in their diet. The increased consumption of milk and other dairy products will favor production and increase bone density. This will strengthen the bones and enable them to withstand the forces exerted upon them during play. If children refuse to eat foods high in calcium or are lactose intolerant, consult a physician about alternative diet plans or calcium supplements.
  • Wearing precautionary protective gear. Required and recommended protective apparatus should be worn by children during participation in athletics. Such gear as shin guards, helmets and appropriate padding should be worn during all forms of competition to provide protection from injury.
  • Beginning strength training in young athletes. Children should be in appropriate condition to participate in their sport. The increased fitness of children’s muscles will provide support for their more fragile skeleton and will decrease the risk of fracture. In addition, strength training increases bone mineral density, which will increase bone strength. Growth plate injuries can be prevented in young athletes by improving their skeletal condition and ensuring that their bones are strong enough to withstand the pressures placed on their bodies during rigorous activity.
  • Flexibility programs.  It’s a careful balance where one must avoid excessive stretching so as the joint has stability, but have enough flexibility so the muscles don’t pull on the growth plate.
  • Activity Modification, Padding, and Soft tissue Treatment (Massage)

These measures will reduce the risk of growth plate injury in young athletes, but children are still more susceptible to injury from play than adults and should be carefully monitored in their activity. By recognizing growth plate injuries in young athletes, parents can ensure a safer sports environment for their children.  UNC Wellness Center Personal Trainers can provide specific flexibility and strength training programs to help provide stability and mobility to your young athlete.

By Susan Kroll, MS, PT, CSCI