Children’s sport is a great way to build fitness, social wellbeing and encourage the continuing habit of exercise for your children. In a world that is becoming more and more sedentary it is great to see communities that value children’s sports and activity. But what do you do when your little athlete suddenly has a growth spurt or starts showing signs of injury?
Unfortunately, one thing that is becoming more common in children’s sport are overuse injuries. Overuse injuries are caused by repetitive stress to a tissue over a period of time without sufficient recovery time between repetitions. This could be running and rapid direction changes on a soccer field, or throwing a cricket ball over and over. It is believed that overuse injuries in children have become more common recently due to early specialization in one sport. For example, a child that plays soccer 5 times a week is much more likely to suffer from an overuse injury than a child who also trains 5 times a week but in different sports and activities (for example 2 days of soccer, one day of swimming, one day of cycling and one day of surfing). Having a range of activities instead of a single specialization allows much more recovery time for the body between each session of a particular sport.
Are overuse injuries different in children than in adults?
A matured skeletal frame is very different from a growing one. One major difference in children is that their skeleton has more cartilage, and growth plates. Growth plates are the portions at the end of long bones where growth is actually occurring, and this area of bone is softer than the mature skeleton. It should be noted that when a child grows, it starts with the skeleton, and then the muscles, tendons and ligaments follow. This can cause a period of tightness of the soft tissue. The growth plate of the bone is actually weaker than the soft tissues that attach to the bone (i.e. the tendons and ligaments). So while overuse injuries in an adult tend to be in the soft tissues, in children they tend to be in the bones where the tendons attach.
Children are especially vulnerable to this during a growth spurt, when the tight soft tissues are pulling on the bones. This is why you should never assume growing pains are nothing to worry about in an active child. This could be the time to take some precautionary steps to avoid injury.
A very quick anatomy lesson
In the picture below is an X-ray of a child’s knee (left) and an adults knee (right). What appears to be empty space between the thigh and leg on the left is actually the portion of bone that is still cartilage in the child. As you can see there is also a line of no bone just above and below the joint surface. This is the growth plate (called the epiphyseal plate in the image). The area of bone closest to the joint is called the epiphysis, and on the other side of the growth plate is the metaphysis. As you can see in the adult knee, the epiphysis and metaphysis are fused, and most of the cartilage has become bone.
Are overuse injuries worse for children than adults?
Usually kids heal quickly from pain and injury, but if the injury gets to an advanced stage it can be serious. This can be avoided as long as signs of injury or pain are not ignored, and addressed quickly and properly. The growth plate is vulnerable, and when a tendon starts pulling on the epiphysis of a growing bone, it could cause it to slip on the remaining bone, or be pulled away from the bone. This is not easily reversible and can in many cases lead to skeletal deformity as the bones mature. Stunted growth may also occur as a result of severe growth plate injury. This will in turn may change the mechanisms of multiple joints and muscles in the body, potentially leading to higher risk of injury later in life.
What should parents look out for?
As you watch your child play, it can be helpful to keep an eye on how they’re moving. If their running or kicking has changed, or if your child complains of pain, that can be the first sign something is not functioning correctly. A child who loves their sport might not complain of the activity being painful, so it is important to ask if you’re not sure.
Monitor your child’s growth, and identify growth spurts early on. They can still play, but be aware that they are more susceptible to injury at this time, and it is not a good time to increase exercise frequency or intensity. Should there be any sign of injury, cut down on exercise frequency and intensity until the growth spurt is over. Other than getting taller, growth spurts can be identified by increased hunger, clumsiness, needing more sleep, and gaining weight. Growth spurts occur in all children and teenagers, but are especially common in the early stages of puberty.
Be especially aware of clumsiness as a sign of a growth spurt. Your child’s coordination and skill in their sport might decline during a growth spurt, but this is absolutely not the time to increase intensity or frequency of exercise to “fix” this. As the body grows, the child has to get used to the changing shape and higher center of gravity in their own time, and excessive training can set them up for growth plate injuries. Encourage them to continue playing (unless there is sign of injury) and explain to them that their coordination will come back, as decline of skill on top of a changing body can be a blow to a child’s confidence.
You should also be aware that growing legs might not grow at the same speed, meaning that for a while your child could be walking around on uneven leg length. This can affect their hip and pelvic joints, and shift the center of gravity, which in turn can change the mechanics of the whole body. So if they are walking unusually but not complaining of pain, you should have this investigated and monitored. Our practitioners at Spinal Symmetry can examine leg length discrepancies, and prescribe dynamic therapy where necessary to stimulate the nervous system to grow symmetrically. To avoid jarring of the hips and back pain, cutting down on exercise frequency and intensity can be wise at this time.
Some common growth plate disorders and their presentations
Osgood Schlatter’s disease is a growth plate injury of the tibial tubercle, the bony bump at the lower front knee under the kneecap, usually caused by excessive running and/or jumping. A child will complain of pain a couple of centimetres below the kneecap during activity if they are suffering from this.
Sinding-Larsen-Johansson disease is a growth plate injury of the knee cap, usually caused by excessive running and/or jumping. A child will complain of pain in the lower half of the kneecap during activity if they are suffering from this.
Sever’s disease is a growth plate injury of the heel bone, usually caused by excessive running and/or jumping. A child will complain of heel pain during activity if they are suffering from this.
Slipped upper femoral epiphysis (SUFE) is a growth plate injury of the ball of the hip, where the ball slips away from the neck of the femur and can separate completely. The cause of this one is unknown, but is thought to be related to growth spurts and overweight. It will present with pain in the hip while weight bearing, and usually a funny walk or limp. Hip pain with a limp in a child for over 3 days should be considered serious, and immediate investigation is advised. Surgery is required to correct a SUFE.
Throwing injuries of the elbow
There are multiple growth plates in the elbow, and injuries of these are associated with throwing sports such as cricket or baseball. The most common of these injuries is little leaguer’s elbow, which presents with pain on the inside of the elbow following repetitive throwing. It has a similar presentation to golfer’s elbow in adults. Osteochondritis dissecans is a condition that is common in the elbow but can occur in any joint. This is happens due to repetitive throwing motion of the young elbow, where pieces of cartilage can break loose and float inside the joint. This will usually present with painful locking and clunking of the joint.
What should I do when an injury occurs?
Firstly – it’s best NOT to just tell them to walk it off. Secondly – don’t panic. Kids tend to heal quickly and bounce back pretty well after an injury. The main focus when an injury occurs, is to avoid worsening. The child should not return to activity until that activity is pain free, and it is important that the child understands that this is important in the long term.
Make sure you have your child examined by a health practitioner. During a growth spurt, there is a chance that one leg is growing faster than the other, causing a leg length difference. As you may be aware of, Spinal Symmetry practitioners work with leg length differences and we can determine whether a child has a structural leg length difference or a functional one. A functional leg length difference can usually be corrected on the spot and maintained by Dynamic Therapy, whereas a structural leg length difference needs monitoring, treatment and time for the shorter leg to catch up (it usually does, in which case we continue to work on any functional issues that may occur). When working with a structural leg length difference during a growth spurt, we want to enhance the neurological stimulus to the shorter leg, in order to encourage growth.
What measures should we take to prevent injuries in kids?
An important point to note is that it can be harmful to view a young child as a professional athlete. It is still great to encourage them if they show amazing natural talent in a sport, but keeping in mind that the growing body and immature skeleton is ever-changing. This makes children more vulnerable to injury, and bone deformity and stunted growth if injury is ignored. Skill and interest can change over time, and while it is important to encourage exercise and fitness, we also need to listen to any concerns raised by a child, coach, or health practitioner, and allow time to let the body get through a growth spurt or to let an injury heal, without putting more pressure on a child mentally or physically during these phases. Remember that a variety of different activities is safer than early specialisation in one sport. It is also wise to allow time off from a frequently played sport off-season.
By keeping an eye on how the child is feeling and moving, you will find that they usually bounce back quite quickly from injury, as long as it is handled appropriately early on. Monitoring their growth, listening to any issues raised, and making sure their injuries are addressed by treatment as needed (including dynamic therapy if required) will ensure that your child will be able to happily continue playing their chosen activities.