As we move through different stages of life, certain injuries can be more common at certain stages. The stage of life where we grow at the fastest rate (Peak Height Velicity –PHV) is aged 11-13 for females and 13-15 for males. During this time of rapid change in the body, we can suffer from pain related to growth.

The bones of our skeleton grow in areas called the growth plate (Epiphysis). When we are in an active growth spurt, such as during PHV, the bone at the epiphysis is undergoing rapid turnover and can be vulnerable. A natural bump of bone outside the epiphysis is called an apophysis. The area where a tendon or ligament attaches to the bone is called an enthesis. Confused? Well sometimes a large tendon or ligament can attach to the bone (enthesis) at a bump of bone (apophysis).

When we grow, the bones, especially the long bones of the lower limb, tend to grow and change before the muscles and tendons that attach to these bones get a chance to catch up. Therefore, the muscles and tendons get very tight. If these tight muscles and tendons pull too much, this can lead to pain at the tendon-bone interface (enthesitis or apophysistis).

Common areas for this to happen are just below the front of the knee (Osgood Schlatters Disease), at the bottom tip of the kneecap (Sinding-Larson-Johansson Disease), at the back of the heel (Severs Disease), at the attachment of the hamstrings to the pelvis (Ischial Tuberosity) and at the front tip of the pelvis where the sartorious (ASIS) and rectus femoris (AIIS) muscles attach.

For most people who get these injuries will have some minor pain, that often will not stop them continuing their sport or activity. Pain can be alleviated with ice, a short period of rest and maybe some stretching. The general rule of thumb we follow in these cases is that if the pain is not bad enough to make you limp, then play on. If the pain is bad enough to make you limp, then you should take a rest for a couple of weeks to allow the pain to settle. During this time, you can continue to do non-impact exercises such as cycling or swimming and you should be able to continue with our gym work.

However, for a small minority, these injuries will lead to a significant amount of time away from sport. This can happen when pain is too bad or sometimes, we get a tear at the enthesis or apophysis. These injuries represent the greatest injury burden (Time loss from training or competing) in a growing athletic population. These cases will require careful intervention.

Treatment normally consists of a relatively long period of rest (3-8 weeks) followed by a gradual strengthening, stretching and sport specific rehab programme. Return to play from injuries like this can take anywhere from 2-12 months depending on the severity of the issue.

To summarise, most of the injuries related to growth will settle quite quickly. If pain is persisting or is bad enough to make you limp, then contact us here at PMC Physiotherapy where one of our expert Chartered Physiotherapists and we will guide you back to full participation.