Growth spurts in young athletes can lead to an increased incidence of injury. The long bones (femur, tib/fib) grow in length before the muscles elongate and develop enough strength to counteract the sudden increase in lever lengths. Imagine a young soccer/gaelic player who suddenly has a longer leg but not the muscles to generate the force required to move that heavier and now longer leg. Something will break down, usually the proximal muscles, such as the abdominals and groin.
We Chartered physios tend to work on the understanding that the bones grow about a year before the muscles develop length and strength. And this forms the basis of injuries sustained by growing young bodies. If the bones grow longer but the muscles remain the same length, then the muscle will have a relative tightness. The structure most susceptible to overload in this situation is where the muscle, via the attaching tendons, joins the bones. At these sites, we have growth plates.
The injuries we see in young athletes that are growth related and influence the growth plates are called ‘traction apophysitis’ injuries. The areas most vulnerable are the Achilles tendon insertion (Severs disease), the patella tendon on the tibia (Osgood Schlatters disease), the quads tendon into the knee cap (Sindling Larsen disease) and the attachment of the hip flexors onto the anterior pelvis.
The really interesting thing is that injuries tend to occur in predictable time sequences. They work from south to north. The Severs disease usually occurs first (in boys around 12), then Osgood Schlatters at about 14 and then the hip traction problems around 16 and 17.
The biggest causative factor in these injuries is overload of the tendon attachment due to doing too much. It is not uncommon for young athletes to train for multiple sports at the same time. Sports specialisation tends to come later in the teenage years. So it is not rare to see a 14-year-old training and competing in sports such as cross country running, basketball, soocer and different age groups in Gaelic football. They rarely get a day off during the week where they are not training.
In terms of what we do about these injuries, most of them are self-limiting. This means that they generally improve with time as the muscles catch up to the bones. If they are too sore, they back off training. When they feel good, they return to training.
However, there are some interventions that may help a young athlete nurse themselves through these injuries. Local interventions such as anti-inflammatory creams and ice tend to calm down the symptoms. Regular stretching is also needed to kick start the muscle elongation process. As a general rule strengthening exercises don’t help, as the issue is to do with flexibility and not strength. But at the end of the day, if the tendon attachment is still painful then unfortunately they need to rest, or at least modify what they are doing to incorporate rest days or training that involves no impact.