Recovery Matters: Helping Young Athletes Train, Play, and Recover Better
Participation in youth sports has exploded in recent years. And not only has it become more popular, it has become more competitive, with many youth athletes participating in year round schedules with multiple club and school seasons going at the same time. When combined with the push for earlier and earlier sport specialization, this increase in youth sports participation is not always increasing athletic capability, as intended. For many, movement repetition from participating in the same sports year round increases risk of injury -- including apophysitis.
Growing Pains
Apophysitis is defined as inflammation at the apophysis, or the growth plate. There are many names for these conditions, including:
Osgood-Schlatter's disease
Sinding-Larsson-Johansson syndrome
Sever's disease
Little leaguer's shoulder and elbow
Iliac crest apophysitis
Growth plates are made of cartilage, which is softer and more flexible than bone. They are located at the ends of long bones, allowing growth through childhood, and are commonly sites of muscle attachments via tendons. When a child enters a period of rapid growth, the bones lengthen faster than the muscles and tendons can adapt, which causes tension from the tendons at their attachments close to the growth plate and creates inflammation in the area. While this can happen with normal growth patterns, repetitive movements from sports can worsen inflammation because of the increase in tension and strain on the growth plates from the muscular demands of sports.
The two main risk factors for developing apophysitis are
recent rapid growth spurt
repetitive movement sports participation
This condition can occur anywhere that a tendon attaches close to a growth plate, but the most common sites for apophysitis to develop are the knee, foot, hip and upper arm.
"Self-limiting" doesn't mean leave it alone
Most cases of apophysitis resolve on their own in several months as muscle extensibility catches up to the more rapid growth of bone. Many will recommend self-limitation of activity based on pain level, so the athlete determines whether their pain is too intense to push through. And while self-limitation and load management are important for managing apophysitis, that doesn't mean load management is the only thing that can be done to manage symptoms.
We recommend that individuals:
1. Balance athletic participation based on pain levels
If pain is not too severe, it is possible to continue athletic participation with apophysitis. But it is important to decrease training load to control the condition. This can mean:
Decreasing participation to one sport per season
Decreasing the amount of games played per week
Limiting club team and out-of-season participation in the child's primary sport
Whatever the choice, the most important part of load management is minimizing pain during and after activity.
2. Prioritize recovery
Because bones grow faster than muscles and tendons can accommodate, muscles will get tight, stiff and sore as youth athletes grow. Recovery techniques like stretching and soft tissue work can be beneficial for managing muscle tension, decreasing pain and easing symptoms while the youth athletes grows.
Soft tissue work:
Soft tissue work refers to the use of hands-on techniques that put mechanical pressure on muscles, tendons and joints. This includes cupping, instrument-assisted soft tissue, massage and dry needling. When an individual is experiencing muscle tension, soft tissue techniques can be beneficial for releasing tension and stiffness by improving blood flow to the area. In individuals with apophysitis, the release in tension reduces pulling on the bone and can improve pain levels.
Stretching:
Muscle flexibility is important to maintain and improve while growing. Stretches should be pain free and completed in a comfortable range of motion. It is important to remember that static stretching is not recommended during activity because it can increase injury risk. Instead, prioritize dynamic stretching and short-duration stretching during activities and save your longer held static stretches for after activity to relax the muscle fully.
Soft tissue and stretching compliment one another and are most effective when done in conjunction.
Sports participation often involves repetitive, dynamic movements that are taxing for the musculoskeletal system. While game and practice exposure can be beneficial for developing sport-specific skills, they are not the only way to keep the body healthy for high-level sports participation. Taking care of our bodies outside of sports can actually improve sports performance in the long run. Even professional athletes take off-seasons and attend lifting sessions in the weight room.
Mobility:
With repetitive sports participation, our bodies get used to moving only in the positions demanded by the sport. But our joints need to be able to move through a full range of motion to move well. If they can't, limited mobility can cause imbalances in the body that lead to injury down the road for young athletes. By tackling mobility young and making it a habit, you can not only ease the symptoms caused by apophysitis but also ensure better playing longevity.
Strength:
Strength training may seem counter-productive during apophysitis because you are continuing to load the joint -- and if pain levels are severe, it can be. But as symptoms ease, strength training can help muscles that have lengthened become stronger and adapt to their new length. Isometric and eccentric exercises are particularly valuable because they build tendon strength. And strength training is not just for older athletes -- youth athletes can also benefit from strength training when working in a supervised environment with age-appropriate training.
The Bottom Line
Most importantly, we do not recommend playing through pain. If children push through, inflammation in the growth plate will worsen and can eventually lead to significant alterations in movement patterns and the potential for avulsion fractures where part of the growth plate detaches from the rest of the bone because of pressure from the tendon.
At FIXXED, our clinicians are skilled at working with youth athletes to reduce muscle tension, enhance mobility and improve movement quality. We understand that proper care demands more than cookie-cutter protocols so we look at each individual's unique biomechanics to make sure we address any underlying imbalances during youth growth spurts. Because we understand that athletic performance isn't just about playing now, it's about playing the long-game with high-quality play for years to come.
