Growing Pains in Teenagers
With my experience working with young athletes at Chelsea’s Academy and England Hockey’s youth set up, I’ve developed an interest in the injuries that are unique to this age group. A quick Google search for information about “growing pains” often leads to information - including this page from the NHS - regarding this phenomenon in children under the age of 12. What about those aches and pains as teenagers go through their growth spurt?
What are some of the common growth related injuries?
Although they can occur in the upper limb, the most frequently seen conditions tend to be lower limb related.
Osgood - Schlatter’s
This is when pain is felt at the insertion of the quadriceps at the tibial tuberosity - basically the knobbly bit below the knee cap! Common in sports that involve running and/or football a lot of youngsters will experience pain in this area at some point around their growth spur.
Sever’s
This is the term given to pain at the back of the heel where the Achilles tendon connects onto the bone. As with Osgood-Schlatter’s this is common in running based sports but often starts at a younger age.
Pelvic Injuries
The two most common areas in this region to injure are the Anterior Inferior Iliac Spine (AIIS) at the front of the pelvis and the ischial tuberosity deep in the buttock. The AIIS is where the part of the quadriceps muscle - rectus femoris - originates and is susceptible to repeated and powerful kicking. The ischial tuberosity is where the hamstring originates so sprinting is the most common mechanism of injury.
Why might injuries occur?
The adolescent growth spurt is actually the second most rapid period of growth after the first two years of life. As teenagers go through this period, technically termed peak height velocity, they can grow over 10cm in a year. As well as this upward growth, they are likely to gain body mass as well lose some flexibility and co-ordination. Couple this with the other hormonal and developmental changes they are going through and it is clear to see why this can be a challenging period for many young athletes. There is some published research that suggests the risk of injury is higher during this period of change and we know there are some specific injuries that are only seen in these age groups.
It sounds obvious but one of the main reasons that adolescents have a specific injury profile is that their skeleton is still developing. Certain areas - such as the pelvis and spine - can even continue to mature into the early 20s!
Two areas in particular are at heightened risk of injury. The growth plate itself and the apophysis. This a bony tuberance where a tendon connects onto the bone. These areas are vulnerable to traction forces and are the areas affected in conditions such as Sever’s and Osgood-Schlatter’s Disease. These are the most commonly affected areas in young athletes although in sprinting and kicking based sports the attachments around the pelvis can also be vulnerable to injury.
In extreme cases can be pulled off the bone. This injury is called an avulsion fracture and whilst limiting initially it only warrants surgical intervention in extreme cases.
What can we do?
Every teenager is different but these strategies are the common ways to manage these types of injury:
Reviewing their weekly sporting schedule and ensuring they have an appropriate level of recovery time for their age group as well as variety across the week. If they are participating in one sport for more hours than their age (e.g. More than 14 hrs a week of football for a 14 year old) this might be a problem.
Carry out a thorough biomechanical assessment looking at joint range of movement, muscle flexibility, strength and co-ordination.
Use the assessment finding to put together a tailored rehabilitation program. Everyone is different so whilst some teenagers need to improve their strength, others might need to work on their flexibility or co-ordination, or both. There may well also be a role for manual therapy and/or taping depending on the presentation.
If symptoms have come on suddenly then diagnostic investigations such as an MRI, and an assessment with a sports physician might be warranted.
It is reassuring to know that most growth related issues improve relatively quickly, particularly if they are non-acute, with the right management plan.
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