Growing Pains
Growth plate conditions such as Osgood-Schlatter’s and Sever’s disease can be incredibly frustrating and restrictive for growing kids. Sore knees, heels and shins regularly present in kids from ages 9-15, and can often lead to extended periods of time spent away from sport.
During periods of rapid growth, there is a delay between bone growth and muscle/tendon lengthening. This is why growing kids often have very tight muscles – the muscles can’t keep up with the rapidly lengthening bones.
When muscles are too tight they put extra strain on the tendons, which can pull on the bones they are connected to. This repetitive strain leads to inflammation through the tendon-bone junction and associated growth plates, in turn causing severe pain and weakness.
While these conditions can be frustrating and often take a while to fully recover, appropriate management will ensure young athletes can to return to their sport as soon as possible…
Load management
Like any tendon issue, recovery from growth plate conditions relies on appropriate load management. In severe cases kids may need to fully rest from their sport, but often they can continue playing with a modified load. It is important to prioritise the most important sporting activities while they progress back to a full training load. For example, club training can be prioritised over school sport. Alongside an appropriate rehabilitation program, gradually progressing load will ensure the tendon is stronger than ever.
Day-to-day load management is also an important consideration. Tendons need time to rest and recover, so it is better to do one day of high loading activities (e.g. gym and training on the same day), followed by a day of much lighter loading to promote tendon recovery. This also allows you to monitor the tendon’s response to the load.
Rehab
Building strength and length through the affected tissues is paramount to an effective recovery from growing conditions. However, it is important to be mindful of the positions the joints and muscles are being exposed to.
While strengthening is key, care must be taken to avoid doing this in an excessively stretched position. For example, doing a calf raise off a step requires the calf muscle to contract while in a fully stretched position, creating friction over the tendon insertion and potentially causing more inflammation and pain. A mid-range strength exercise such as a calf raise from the floor will be more appropriate for early-stage rehab, with plans to gradually progress to outer range positions as the tendon recovers.
The same principles apply to stretching and mobility. Stretching increases muscle length, which reduces tension through the tendon and resultant inflammation. However it’s important to avoid putting the tendon into a fully stretched position and find ways to increase muscle length without getting into aggravating positions. Eccentric strength training can be a great way of doing this, and also mobility work to build control and body awareness.
Wrapping Up
Growing pains and growth plate conditions can be tough—for both kids and their parents—but with the right approach, they don’t have to mean long stints on the sidelines. A combination of smart load management, targeted rehab, and gradual progressions helps reduce pain, support recovery, and build stronger, more resilient young athletes. With patience and consistency, most kids can get back to doing what they love—pain-free and more confident in their bodies.
Written by:
Jess Bell - Physiotherapist