Apophysitis is a condition characterized by inflammation where a tendon attaches to a growth plate in a bone. This condition commonly affects active children and adolescents during periods of rapid growth. It develops due to repetitive stress on these vulnerable areas, leading to localized pain and discomfort.
Understanding Apophysitis
Growth plates are areas of cartilage located near the ends of long bones in children and adolescents. These plates are responsible for the longitudinal growth of bones, producing new bone tissue as a child grows. As children mature, these growth plates gradually harden into solid bone, typically closing by late adolescence, around ages 13-15 for girls and 15-17 for boys.
Before they close, growth plates are softer and more susceptible to injury than the surrounding bone, ligaments, or tendons. Apophysitis occurs when repetitive stress or overuse, often from physical activities like running, jumping, or throwing, causes inflammation where a muscle’s tendon pulls on the growth plate. This condition is prevalent in young athletes during growth spurts because their bones, muscles, and tendons grow at different rates, leading to increased tension on these attachment points.
Where Apophysitis Occurs
Apophysitis can manifest in various locations throughout the body where tendons attach to growth plates, with specific names often given to the condition based on the affected area.
- Osgood-Schlatter disease causes pain and swelling just below the kneecap, where the patellar tendon attaches to the shinbone. It is observed in young athletes involved in sports requiring running, jumping, and kneeling.
- Sever’s disease affects the growth plate at the back of the heel where the Achilles tendon inserts. This leads to heel pain, especially during or after activities like running and jumping, and is seen in young, active children.
- Little League elbow involves pain on the inner part of the elbow. This condition impacts young athletes who engage in repetitive overhead throwing motions, such as baseball pitchers.
- Apophysitis can also affect the hip and pelvis, involving tenderness at muscle attachment points. This is common in adolescents with tight hip and thigh muscles, particularly those involved in activities like running, sprinting, or dance.
- Iselin’s disease affects the base of the fifth metatarsal bone in the foot, causing pain and swelling due to repetitive stress from the peroneus brevis tendon.
Recognizing the Signs
The symptoms of apophysitis include localized pain and tenderness directly over the affected growth plate. This pain worsens during or after physical activity and tends to improve with rest. For instance, with Osgood-Schlatter disease, pain below the kneecap can intensify with running, jumping, or climbing stairs.
Swelling or redness may be visible around the affected area. A noticeable bump can also form below the kneecap in individuals with Osgood-Schlatter disease. Children might also experience stiffness in the affected limb, such as stiffness in the feet when waking up with Sever’s disease, or difficulty fully straightening the arm with Little League elbow. Limping or walking on tiptoes can occur, particularly after activities that aggravate the condition.
Getting a Diagnosis
A healthcare professional diagnoses apophysitis through a physical examination and medical history review. The examination involves assessing the affected area for pain, tenderness, and any visible swelling or bumps. The doctor will also inquire about the patient’s activity levels, the onset and progression of symptoms, and what activities make the pain better or worse.
Imaging studies, such as X-rays, may be performed, but not to confirm apophysitis itself. Instead, X-rays are primarily used to rule out other potential causes of pain. While X-rays might show an open growth plate or some soft tissue swelling, apophysitis often does not present clearly on these images.
Managing and Recovering
Managing apophysitis involves non-surgical approaches to reduce pain and inflammation while allowing the affected growth plate to heal. The initial step involves rest and modifying activities that exacerbate the pain. This does not mean complete cessation of all activity, but rather avoiding movements that cause significant discomfort. Applying ice to the painful area regularly can help reduce swelling and pain. Over-the-counter pain relievers may also be used to manage discomfort.
Physical therapy can play a supportive role in recovery by addressing muscle imbalances, tightness, and weakness. Exercises may include stretching and strengthening the muscles that attach to or surround the affected growth plate. A gradual return to activity is important once pain has subsided, progressing from light movements to sport-specific drills, ensuring that pain does not recur. Using appropriate footwear and ensuring proper technique during sports can help reduce stress on growth plates and prevent recurrence. Apophysitis is generally a self-limiting condition, meaning it resolves as the child’s skeletal maturity is reached and the growth plates close.