Just like adults, children can injure themselves during sports and exercise. However, children are not just miniature copies of adults when it comes to sports injuries. Adults and children have the same anatomy of ligaments attaching bone to bone and tendons attaching muscle to bone. The difference is that children are growing. In particular, their bones are still growing. New bone is laid down over time in specific areas called growth plates. This process makes bones longer and bigger. By late adolescence and early adulthood, growth plates fuse closed as the bones finish growing.
In addition to the usual injuries seen in sports, the following three common injuries are specific to children. They directly or indirectly involve growth plates of the bone. They are:
An avulsion fracture happens when a fragment of bone is pulled off from the main part of the bone. Avulsion fractures usually occur at sites where a tendon or ligament attaches to the bone. In children, these areas of attachment are often on or near a growth plate. Tendons and ligaments in children are stronger than the growth plates. This means that the growth plate is the weakest link in a joint. A sudden, forceful movement can cause the tendon or ligament to pull so hard that an avulsion fracture occurs at the growth plate. Sprained ankles or pulled hamstrings are examples. This type of fracture happens only to children, since adults do not have growth plates.
Avulsion fractures of growth plates can happen anywhere. The hip, pelvis and elbow are common sites for this injury. For instance, a sprinter may suddenly feel a sharp pain at the front of the hip. There may or may not be bruising with the injury. In children, this type of injury suggests a possible avulsion fracture. The likely injury is to one of the quadriceps tendons which attaches at a growth plate on the pelvis, just above the hip joint.
Treatment for avulsion fractures ranges from rest and ice for mild injuries to casting, crutches, or even surgery for serious injuries. If you suspect your child’s sports injury might involve a tendon or ligament, have a doctor examine it. This will rule out an avulsion fracture. Sometimes X-rays are needed to assess the injury.
A second childhood sports injury involving the growth plate is apophysitis, an overuse injury causing inflammation and pain. It often starts with mild pain during activity, and gets worse as activity increases. As no one particular event or injury usually sets off the pain, such injuries are considered chronic overuse injuries. Rest from activity eases the pain. Repetitive activities like prolonged running or throwing a ball often cause apophysitis. With repetitive movements, tendons constantly pull on the growth plates. This creates irritation and inflammation over time. Tight muscles can also result in tendons pulling too much on a growth plate.
Sever’s disease is an example of apophysitis in the heel. A child with Sever’s disease may complain of aching in the heels that comes and goes. This overuse injury is often seen in children who do a lot of running, jumping or other high impact activities.
Osgood-Schlatter’s disease is another example. It affects the growth plate of the lower leg bone (tibia). In this condition, the pain is usually just below the kneecap. There may be a bump at the site of pain. Osgood-Schlatter’s disease is seen most often in children who do a lot of jumping and running.
Apophysitis of the elbow may be seen in throwing sports, especially in activities like repetitive baseball pitching.
Treatment for apophysitis includes relative rest from activities that aggravate the condition. Other treatments include stretching, icing, and sometimes shoe inserts or braces. Children may continue with their activities once the pain has eased. Aggravating activities like running and jumping can make it return. For this reason, use pain as the guide when returning to activities. If the pain does not improve with rest, or wakes the child at night, have a doctor examine your child. Bruising or swelling in a painful area also are also good reasons to visit a doctor. The pain will subside once the growth plates fuse in late adolescence or early adulthood.
Adults do not have growth plates and so do not get apophysitis. Instead, repetitive movements inflame the tendon. This is called tendinitis or tendinosis. An example in adults is tennis elbow.
The third injury associated with growth plates in a growing child has to do with tight muscles from a recent growth spurt. Bones lengthen from the new bone that is made at the growth plates. The muscles attached to the bone by tendons must then stretch to the new length of the bone.
During a growth spurt, the bone grows so fast that muscles can be stretched very tight. Tight muscles put children at risk of muscle strain during exercise. In addition, tight muscles may also cause apophysitis.
To prevent muscle strains, a good stretching program is very important. Daily stretching, and stretching before and after exercise, may avoid injury. This is especially true when a child is going through a growth spurt. Coaches, gym teachers, and physiotherapists are just a few community resources who can teach children basic stretches.
Physical activity is part of healthy living for people of all ages, including children and adolescents. Sport and exercise injuries can happen to active people of any age. However, injuries in children can be different from the injuries that occur in adults. The bony growth plates in children’s bones put them at risk of avulsion fractures of the growth plate, apophysitis, and tight muscles leading to muscle strains.
Being aware of injuries specific to children can help to prevent them. If one does happen, know how to treat the injury properly.