Dr. Sean T. Lordan

1. Watch for the classic signs and symptoms of a growth plate injury

Besides trauma, many growth plate injuries can be caused due to overuse in a young athlete who has experienced a recent growth spurt (or not). Any sport requiring repetitive training like dance, gymnastics, track and field or football will increase a child’s likelihood of a growth plate injury.

As a parent, it is important to be on the lookout to prevent a growth plate injury from progressing from an inflamed joint to the point of a fracture. Luckily there are several observable signs you can watch for, and report to your child’s Pediatrician. 

First, check for changes in your child’s gait or posture that are outside of the norm. The first question I ask most parents of children with suspected growth plate injuries is, “has your son or daughter had a significant growth spurt in the past year?” The growth spurt combined with the observational tips I divulge next will help clue you in to a potential more serious injury. Look to see if your child is slouching more, or if they are walking with a slight limp. Are they walking on their toes or taking a shorter stride length than normal? If they play sports, do they accelerate as quickly as they once did? Do they have pain in a specific area (can point to it) of their body after activity? 

In the worst cases your child may not be able to bear weight through a particular body part, or even move their affected limb.

The first step as a parent is to ask your child where it hurts. If they point to a bony prominence, and it is tender to the touch, they may have an inflamed growth plate. These are all clues that may indicate joint Apophysitis, the fancy term for a “growth plate injury.” 

Mention this to your child’s Doctor when you go to see them. All too often parents downplay their Children’s pain or symptoms! Doctors will confirm with X-Rays, MRI, CT or Bone Scans at the hospital, and they will refer to PT for conservative treatment if caught early enough.

2. Do this to treat joint ppophysitis at home

The benefits of massage and light stretching in the early phases of rehab can’t be understated when it comes to joint Apophysitis. Apophysitis by definition is an inflammation of the apophysis of the joint. The first stage of rehab should focus on combining medical management (medication and creams to control inflammation) and gentle exercises to limit the inflammation at the joint. Exercises and stretches will differ depending on which bony prominence is affected. 

In general, it is safe to say that if you can gently massage the muscles around the affected joint (as an adjunct to professional care) this should be helpful and may shorten the course of care. Pain at the joint happens due to a traction force of the muscle “pulling away” from the bone causing an excess of stress at the growth plate. The initial plan of rehab care should be to gently relieve that pulling effect, and massage does a great job at that.

3. What’re The Most Common Sites of Joint Apophysitis? 

The most common sites of traction apophysitis from growing pains are:

Sever’s Disease (at the achilles)

Osgood Slaughters (at the knee / tibial tubercle)

Sinding-Larsen–Johansson Syndrome (at the kneecap)

AIIS / ASIS (at the hips)

Sacral ALA (In the low back/ sacrum area)

Iselin disease (base of the 5th toe)

These are all conditions treated successfully by Physical Therapy.

4. What NOT to do for joint apophysitis

My advice for those diagnosed with joint Apophysitis is contradictory to the “classic medical approach,” of “rest and stretch.” I tell my pediatric patients at their Initial Exam with me not to do any “conventional stretching” around the site of pain for at least two weeks. I define conventional stretching as, “pull and hold with this strap for 60 seconds.” 

The reason for avoiding static and dynamic stretching early is multifactorial. First off, most stretches are taught completely wrong (or are delivered verbally on worksheet of stick figures) and don’t accomplish their original intention of creating muscle length to a specific tissue. 

Considering a child with joint Apophysitis is experiencing inflammation due to too much force pulling at the joint- why are we mimicking those same exact forces with stretches?It is ok to eventually reincorporate those forces, but only when the growth plate is slightly healed are ready for them again.

We need let the body get out of the acute stage of healing. I recommend two weeks of no stretching. Instead of stretching I encourage moist heat, NSAID’s, ultrasound, massage, Graston Technique and dry needling as options to improve muscle length to the mid belly portion of the muscles involved. After two weeks when the inflammation at the epiphysis has calmed, I work in limited range dynamic stretching and then finally pain-free static stretching when the tissues can accommodate it.

5. How physical therapy will help

As I mentioned above PTs are in a unique position to help children and adolescents with repetitive overuse (and traumatic) growth plate injuries. We use state of the art research and technology to reduce trauma on joints and to provide a pleasurable experience in order to work through growing pains. Usually we have some fun while we are at it! If you are still unsure of whether or not PT can help, please feel free to reach out anytime and I would be happy to guide you to the right medical professional. I can be reached at [email protected]

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Dr. Sean T. Lordan is the owner of Concierge PT in Sutton. He is a husband, father and resides in Grafton with his family.