These days it isn’t uncommon for kids to have sporting commitments on most days of the week. This is obviously great for physical, mental and social development, however with increased training demands comes the possibility of overuse injuries. This is especially common coming off a prolonged reduction in training load over the holiday break, and can present in the form of Achilles, knee, hip and/or groin pain.

Apophysitis is one of the most common forms of overuse injury, unique to adolescent athletes who have yet to reach full skeletal maturity. The apophysis is a form of growth plate that acts as an attachment for the muscle-tendon unit. In developing athletes this becomes the point of biomechanical weakness and is therefore susceptible to repetitive stress-related injury. Apophysitis refers to irritation, inflammation, and microtrauma of this site as a result of repetitive stress.

There are numerous contributing factors to the development of Apophysitis. Firstly, with significant growth during puberty, bone growth exceeds that of surrounding soft-tissue. This places more tension at the attachment site as muscles become relatively tighter & flexibility is reduced. Biomechanical factors both local or remote to the area of pain can also be responsible for exacerbating forces through the apophysis. This ranges from flat feet or lack of control at the hip to incorrect technique or running mechanics.

The three most common sites and their timeframe are:

– The heel (Calcaneal apophysis) > Sever’s Disease (M & F = 8-12 yrs)

– Below the kneecap (Tibial tuberosity) > Osgood Schlatter’s Disease (F = 8-13yrs, M = 12-15yrs)

– The groin (Pubic symphysis) > Osteitis Pubis (M & F = 15yrs +)

Fortunately in most cases symptoms will resolve once full bone maturity is reached without any significant long-term effects. However, in serious cases where extreme tensile forces are placed through the muscles, an avulsion fracture can occur at the apophysis, leading to immediate disability. Therefore it is beneficial to respond promptly if a young athlete continues to complain of pain at these sites to ensure they avoid further injury.

These conditions can be quite limiting, however with the help of Physiotherapy treatment that includes soft tissue release, strengthening programs, biomechanical & training-load advice, many young athletes will be able to continue to pursue their sporting passion.

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