Any injuries can be a frustrating time for both children and parents. Some injuries are unpreventable however there are some that with the right approach can be prevented. In this article we look at what parents can do to help prevent growth plate injuries in their children.
Thank you to Peak Physiotherapy who posted this in their blog section(www.peakphysiotherapy.com).
Taking part in sport is a fantastic thing for children to do – it develops strength and co-ordination skills and helps them to make friends. It also teaches them about fitness and health and how to enjoy themselves in different ways away from the PlayStation and iPad. Their young bodies seem to have endless amounts of energy, so it’s important that injuries are prevented as far as is possible and activities are avoided that may impact on the way their bodies grow and develop.
Growth plate injuries are such injuries that can alter the way in which a child’s limb develops, and depending upon the area affected, can shorten a bone, cause incomplete growth and in more severe cases long term limb deformity.
What is a growth plate?
A child is born with cartilage that later develops into bone, the cartilage being more soft, springy and therefore more susceptible to bending and bowing. The growth plate, or ‘epiphyseal plate’ is the area in a growing bone where new bone is formed which enables it to lengthen. The new bone tissue above the growth plate is soft, whilst the bone below the growth plate becomes harder as it calcifies over time, and this occurs at both ends of a bone. When growth is complete, the growth plate is replaced with harder, calcified bone and activity no longer affects the bone in the same way.
Damage to a growth plate can therefore impede the development and alignment of a child’s bone, which ultimately affects the development and function of the limb involved.
How do growth plates become damaged?
In order for a child to develop strength in their limbs, activities such as weight-bearing, lifting and gripping are an essential part of everyday life as their skeletons grow and mature. However, overuse of their limbs in intensive and competitive sports such as football, long distance running, gymnastics and climbing can over-stress the bones and cause pathology to develop at the growth plates involved. About a third of all growth plate injuries occur as a result of children taking part in competitive weight-bearing sports. There is also a risk of developing a growth plate issue whilst taking part in fast-moving repetitive sports such as skiing and skateboarding. Many childhood fractures are growth-plate fractures, sometimes occurring from a single incident or fall, but often from repeated stresses through the limbs – the fingers, the forearm and the lower leg bones being the most commonly affected.
Interestingly, boys are often more susceptible than girls in developing growth plate injuries, as their body matures much slower than a girl’s body with a growth spurt occurring age 13-15 compared with 12-13 in girls. Coupled with the fact that boys tend to train harder and more intensively than girls in sports such as football, basketball and rugby, boys are twice as likely to develop growth plate issues.
There are some common areas of growth plate disruption in sporty children that occur following a growth spurt, where the intensity of activity combined with the growing bone can lead to irritation of the growth plate. This causes pain, inflammation and swelling of the bone in that area. Abnormal biomechanics (e.g. flat feet or high arches of the feet) of the affected lower limb can contribute to developing this condition, as altered alignment of the foot and ankle can impact on the stresses placed through the lower limb. Abnormal bony stresses during growth spurts and in conjunction with high levels of activity can play a large part in a child developing these disorders. Two such conditions are Severs Disease, affecting the heel of the child, and Osgood Schlatter’s Disease which affects the bony area at the front of the tibia (lower leg bone), just below the knee cap. These conditions, whilst they may sound serious, are well managed if diagnosed early. Often physiotherapy and podiatry management can deal with these bony issues fully, so it’s important to arrange an assessment of your child with a professional who specialises in this area as soon as you suspect there to be symptoms relating to these problems.
Calcaneal Apophysitis – Sever’s Disease
Signs and symptoms of growth plate pathology
So what should you look out for? If your child is complaining of persistent aches and pains in the same area of a limb and they seem reluctant to weight-bear or put pressure through that limb then you should take them to see their GP to discuss your concerns. Children tend to bounce back quickly from minor injuries and are often not keen to miss out on an opportunity to play sport so if your child is trying to avoid activity and it seems out of character, then it’s worth paying attention to this and seeking a medical assessment.
Pain may be intermittent, and linked to specific growth spurts in pre-adolescent children, or coincide with increasing levels of activity and intensity of sports. As the growth plate is a relatively weak area of bone near to a joint, when a child falls or twists their limb awkwardly the growth plate in that area may be susceptible to fracture, whereas in adults a similar mechanism of injury may simply result in a sprain to the joint and soft tissue.
What should you do as a parent to help to prevent growth plate disruption?
Sport and physical activity are important for a child’s physical and mental development, particularly in a time where childhood obesity is on the rise. It’s a good thing to encourage active participation in sports, and to support your child’s progress if they appear to have a natural flare or ability for a specific activity. It’s worth however acknowledging that their bodies are developing and are influenced by many external factors, and they shouldn’t be considered as simply little adults.
Participation in sport before the growth spurts have come to a standstill (around age 13 for girls and 15-16 for boys) should be kept to a moderate intensity and sensible level so that their growing bones and soft tissues can cope. Seriously competitive sports and high-intensity training should really be avoided before these ages. If your child is desperate to be constantly active, encourage them to vary the type of sport they take part in so that different areas of the body are used and other areas are allowed a rest.
If symptoms do develop, make sure that they are checked out as soon as you are aware that something may not be quite right. It’s far easier to nip things in the bud early if a correct and timely diagnosis is made and help is sought from the correct health professionals.
Early intervention with bony and soft tissue abnormalities in children and adolescents can often prevent issues from developing later in life. It also enables them to continue to be physically active without too much disruption. Unfortunately we’ve seen many children who have had to take long periods out of sport because action was not taken early on in the injury process, some medical professionals labelling their symptoms as ‘just normal growing pains’. Extensive periods of not being able to play sport can be heart-breaking for a child, particularly when they see all of their friends playing sport, and they risk missing out on satisfying their physical needs as children.
If your child is complaining of aches and pains in specific areas, it’s worth getting an early assessment of their symptoms. It’s likely that there’s nothing to worry about, but if problems are detected early, they can be dealt with swiftly allowing the budding Mo Farah’s and Jessica Ennis’ to continue to blossom in their sport.
