subject: All About Apophysitis Injuries In Adolescents [print this page] In a growing adolescent the area of rapid bone expansion occurs at the epiphyses - near the ends of the long bones such as the tibia in the lower leg. In fact it has been estimated that up to 30percent of their eventual height growth will occur at just one of these sites.
Whilst these areas are expanding and growing there is a change of tissue type as softer cartilage is replaced by bone. In a quirk of nature it is often the most powerful muscles that attach right on top these sites, thus you have a perfect storm scenario of very strong muscle to tendon units pulling on soft cartilage to bone.
Now if you add really active sport kids into the mix you have the potential for trouble. They can be very disabling and severe in pain with children often having problems with everyday activities such as climbing stairs or even walking. Playing sport therefore becomes almost impossible.
There are a number of apophysitis injuries that occur. The most common is just below the knee called Osgood to Schlatter s disease. Here is the attachment of the quadriceps muscle via the patella tendon. This affects youngsters between the ages of 9 to 14, girls earlier than boys due to their earlier development. It represents about 20percent of any overuse injuries that occur to this age group and is most prevalent in the kicking, jumping and sprinting sports such as football, basketball and gymnastics.
Another common apophysitis syndrome is Sever s disease which occurs at the heel bone (calcaneus). Here the Achilles tendon attachment is the site of the condition with children complaining of moderate to severe pain during and after sport. Not surprisingly the sports involving jumping are the main culprits so we see young basketballers, netballers and gymnasts as the main patients.
Just above the site for Osgood to Schlatter s disease is the upper attachment of the patellar tendon at the tip of the patella bone. This is called Sinding to Larsen to Johansen and is far less common than Osgood s and may occur in sports with a higher jumping component.
Apophysitis injuries can also occur at the top of the hip on the front of the pelvic bone. This is where the top of the main quadriceps (rectus femoris) originates and attaches. This doesn t have a formal name but is described as apophysitis of the AIIS . It seems to affect sports where large hip movements associated with kicking and sprinting occur, and so we see footballers and track athletes suffering the most.
There have also been a few apophysitis injuries occurring with the hamstring origin attachment on the bone at the bottom of your pelvis where you sit. Mainly sprinters seem to be affected but there is not much written about this presentation.
Apohysitis doesn t just occur in the leg though. There is a condition called Little Leaguers Elbow that affects the inside of the elbow in throwers. This was first recognised in young baseball players hence its name. Again it occurs at the soft site for a strong muscle attachment used to whip pace onto the ball when throwing or when hitting a tennis ball.
Traditional treatment for all these conditions is to treat the symptoms (pain, swelling and inflammation) and allow the child to grow out of it, as they will eventually do, but this can take 2 or even 3 years.
A more active approach called the Strickland Protocol has been scientifically shown to have much faster results in as little as 3 weeks before returning to sport. This takes the attitude of treating part of the cause, not just the symptoms and has been successful in the treatment in over 350 patients world to wide to date.
by: Suzy Powell
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