What is Apophysitis?
 

Apophysitis is an overuse injury (repetitive running, jumping, kicking, throwing, etc.) which causes inflammation to the growth plate due to pulling of a tendon that attaches to the growth plate of the bone. It occurs almost exclusively in growing children and adolescents.

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Common Types of Apophysitis
 

Osgood-Schlatter Disease
 

Location: Front of the knee at the tibial tubercle.

The patellar tendon repeatedly pulls on the growth center at the upper tibia.

Symptoms commonly include:

• Pain just below the kneecap

• Tenderness over the tibial tubercle

• A prominent or enlarged bump below the knee

• Pain with running, jumping, squatting, or kneeling

The bump may remain prominent even after symptoms resolve and growth is complete.

Sinding-Larsen-Johansson Syndrome
 

Location: Lower portion of the kneecap

Repetitive traction from the patellar tendon irritates the developing area at the inferior pole of the patella.

Pain is typically worsened by:

• Running

• Jumping

• Squatting

• Stairs

• Sports involving repeated knee extension

Sever Disease

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Location: Heel

The Achilles tendon and other forces around the heel repeatedly stress the developing calcaneal growth plate.

Symptoms commonly include:

• Heel pain during or after activity

• Tenderness around the back or sides of the heel

• Limping

• Walking on the toes to avoid heel pain

• Pain with running or jumping

Sever disease is one of the most common causes of heel pain in active growing children.

Pelvic and Hip Apophysitis
 

Several muscles attach to apophyses around the pelvis.

Repetitive running, kicking, sprinting, or jumping can cause pain around the:

• Hip

• Groin

• Pelvis

• Upper thigh

• Buttock

These injuries are particularly common in sports involving sprinting, kicking, and rapid changes in direction
 

Little League Shoulder
 

Location: Upper growth plate of the humerus.

Repetitive throwing can stress the growth plate near the shoulder.

Symptoms may include:

• Shoulder pain while throwing

• Reduced throwing velocity

• Arm fatigue

• Tenderness around the upper arm or shoulder

Little League Elbow
 

Repetitive throwing can also place excessive stress on the developing structures around the elbow, particularly the medial epicondylar apophysis.

Symptoms may include:

• Inner elbow pain

• Tenderness

• Pain while throwing

• Reduced throwing performance

Pitch counts, adequate rest, and avoiding excessive year-round throwing are important preventive measures.

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Apophysitis vs. Tendinitis
 

Adults who repeatedly stress an area may develop tendinopathy.

Growing children may instead develop apophysitis because the developing apophysis can be more vulnerable than the tendon itself.

Therefore, pain near a tendon attachment in a child or adolescent should not automatically be assumed to be tendinitis.
 

Apophysitis vs. Avulsion Fracture

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Apophysitis usually develops gradually from repetitive stress. However, an avulsion fracture occurs when a sudden, forceful muscle contraction pulls a fragment of bone away from the attachment site.
 

An avulsion injury may cause:
 

• Sudden severe pain

• A popping sensation

• Immediate difficulty continuing activity

• Significant weakness

• Swelling or bruising

• Difficulty walking or using the affected limb

A suspected avulsion fracture should receive prompt medical evaluation and may require imaging such as an X-ray. Treatment depends heavily on which apophysis is injured and the degree of displacement.

Diagnosis
 

-Apophysitis can frequently be diagnosed from the child's history and the physical exam.

-X-rays are not always necessary.

They may be considered when:

• The diagnosis is uncertain

• Pain is severe

• There was a significant injury

• Symptoms are unusual

• Symptoms are not improving as expected

• A fracture or another bone abnormality needs to be excluded

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Treatment
 

-Most cases improve with activity modification, symptom management, rehabilitation, and gradual return to activity.
 

-Ice - may help reduce pain after activity.

-Pain Medication

-Physical therapy for persistent or recurrent symptoms
 

• Flexibility exercises

• Progressive strengthening

• Correction of muscle imbalances

• Gradual return to activity

• Sport-specific conditioning

How Long Does It Last?

Some children improve within several weeks after modifying activity, while symptoms can recur or persist for months, particularly during periods of rapid growth or continued high athletic demand. The underlying susceptibility generally resolves once the affected growth plate matures.

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When to Seek Medical Evaluation
 

A child should be evaluated when:

• Pain is persistent or worsening

• Pain causes limping

• The child cannot participate normally in activities

• There is significant swelling or bruising

• Pain occurs at rest or repeatedly wakes the child from sleep

• There was a sudden traumatic injury

• The child cannot bear weight

• There is substantial weakness or loss of function

• Symptoms do not improve with reasonable activity modification

• The diagnosis is uncertain

Fever, significant redness or warmth, severe unexplained pain, inability to bear weight, or a child who appears ill requires evaluation for causes other than routine apophysitis.

Prevention
 

• Increasing training gradually

• Following age-appropriate sports participation and throwing recommendations

• Allowing adequate rest and recovery

• Avoiding excessive repetitive training

• Maintaining appropriate strength and flexibility

• Using proper sports technique

• Avoiding sudden increases in running, throwing, kicking, or jumping

• Allowing adequate recovery between sports seasons

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                                                      References & Guidelines
 

• American Academy of Pediatrics (AAP)

• American Academy of Orthopaedic Surgeons (AAOS)

• American Medical Society for Sports Medicine (AMSSM)

• American Orthopaedic Society for Sports Medicine (AOSSM)

• STOP Sports Injuries / youth sports overuse-injury recommendations

This information is intended for general patient education and does not replace an individualized medical evaluation, diagnosis, or treatment plan.