Apophysitis
Overuse irritation of a growth plate in a child's developing bone
Quick Facts
- Type: Childhood overuse injury
- Common sites: Knee (Osgood-Schlatter), heel (Sever)
- Cause: Repeated tendon pull on a growth plate
- Outlook: Resolves with rest as bones mature
Overview
Apophysitis is a common, painful overuse condition in growing children and adolescents. An apophysis is a growth plate where a tendon attaches to bone. While a child is still growing, these areas are softer than the surrounding bone, so repeated pulling from a tendon during running and jumping can irritate and inflame them.
Different forms are named for their location. Osgood-Schlatter disease affects the bony bump just below the knee, Sever disease affects the back of the heel, and other forms occur at the hip, elbow, and shoulder. Apophysitis is not a serious or lasting injury; it typically settles as a child finishes growing and the growth plates close, although it can limit sport in the meantime.
Symptoms
Symptoms center on the growth plate involved and are linked to activity:
- Pain and tenderness over a specific bony point, such as below the knee or the back of the heel
- Pain that worsens with running, jumping, or sport and eases with rest
- Swelling or a bony bump at the affected area, especially at the knee
- Stiffness or a limp after activity
- Tenderness when the area is pressed
The pain is usually on one or both sides depending on activity and is most noticeable during and after exercise.
Causes
Apophysitis is caused by repeated traction (pulling) on a growth plate from an attached tendon during a period of rapid growth.
- Overuse: Frequent running, jumping, or sports load the growth plate repeatedly.
- Growth spurts: During fast growth, bones lengthen before muscles and tendons fully adapt, increasing tension on the apophysis.
- Tight muscles: Tightness in muscles such as the thigh or calf adds pull on the growth plate.
It tends to flare during seasons of intense training, especially in children who play one sport year-round.
Risk Factors
- Active, sporty children and adolescents in their growth years
- Rapid growth spurts
- High-impact sports involving running and jumping
- Year-round training in a single sport without rest periods
- Tight or weak surrounding muscles
Diagnosis
Apophysitis is usually diagnosed from the history and a physical examination, without the need for extensive testing.
- Examination: The clinician finds tenderness directly over the growth plate and pain reproduced by activity or by stretching the attached muscle.
- X-rays: Not always needed, but may be used to confirm the growth plate is involved and to rule out a fracture or other problem.
- Further imaging: Rarely required, and reserved for atypical or persistent cases.
Treatment
Treatment focuses on reducing pain and load while the growth plate settles. The condition is self-limiting and resolves as the child matures.
- Relative rest: Cutting back on the activities that cause pain, rather than stopping all movement, lets the area calm down.
- Ice: Applying ice after activity helps with pain and swelling.
- Stretching and strengthening: A physical therapy program improves flexibility and strength in the surrounding muscles to reduce pull on the growth plate.
- Pain relief: Age-appropriate acetaminophen or ibuprofen can be used for troublesome pain.
- Support: Heel cups, supportive footwear, or a strap below the knee may help in specific forms.
Most children can stay active within comfortable limits and return fully to sport as symptoms improve.
Prevention
- Warm up and stretch the thigh and calf muscles before sport
- Build up training intensity gradually rather than suddenly
- Take rest days and avoid year-round single-sport overload
- Wear supportive, well-fitting footwear
- Respond early to activity-related pain by easing off before it worsens
When to See a Doctor
See a healthcare provider if a child has persistent activity-related bone pain, a limp, or pain that does not improve with rest. Prompt evaluation is also wise if there is significant swelling, the child cannot bear weight, pain follows a specific injury or fall, or there is fever, since these may indicate a fracture, infection, or another condition rather than simple apophysitis.
Frequently Asked Questions
What is apophysitis in simple terms?
Apophysitis is irritation of a growth plate where a tendon attaches to bone in a growing child. Repeated pulling during running and jumping inflames the area, causing pain at spots such as below the knee or at the back of the heel.
Does my child need to stop sports completely?
Usually not. Most children do better with relative rest, meaning they ease off painful activities rather than stopping everything. Working within comfortable limits, stretching, and gradually returning to full sport as pain improves is the typical approach.
Will apophysitis cause permanent damage?
Apophysitis is generally not harmful in the long term and resolves as the growth plates mature and close, usually by the late teens. A residual bony bump can remain in some knee cases but is harmless.
How long does apophysitis last?
Symptoms can come and go over months, often flaring during active seasons and growth spurts. With load management and stretching, individual flares usually settle within a few weeks, and the condition resolves as the child finishes growing.
References
- American Academy of Orthopaedic Surgeons (AAOS). Osgood-Schlatter Disease and Sever's Disease.
- American Academy of Pediatrics (AAP). Overuse Injuries in Young Athletes.
- MedlinePlus, U.S. National Library of Medicine. Osgood-Schlatter disease.