APOPHYSITIS

Apophysitis is an inflammation or stress injury to the areas on or around growth plates in children and adolescents. This condition is usually caused by repetitive overuse activities like running, jumping, and throwing but can also occur as an acute injury with a fall or rapid, powerful movement.

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Apophysitis

Apophysitis, also known as Sever’s Disease, is an inflammation or stress injury that occurs in the areas on or around growth plates. And it is commonly found in children and adolescents, especially those who are involved in sports. This condition is generally the result of repetitive overuse of activities such as running, jumping, and throwing. However, it can also occur as a severe injury from a fall or accident.

“Apophysitis” is the medical term that indicates inflammation and stress injury in the growth plate. This is the bone where growth occurs in a child or adolescent. It can occur in different body parts, depending on the activity or sports a child is repeatedly doing.

Apophysitis is usually noticeable during the growth phase of a child. During this period bone lengthens faster than the lengthening associated muscle-tendon units. When it comes to treatment, surgery is hardly necessary for treating apophysitis.

Common Types of Apophysitis

Apophysitis can occur anywhere in the body where a growth plate is located. Here are the most common types of apophysitis:

Iliac crest apophysitis (upper hip bone area near the waist)
Sinding-Larson-Johansson syndrome (knee cap/lower part of the patella)
Iselin’s Disease (outside area of the mid part of the foot)
Sever’s Disease (at the back or under the heel)
Osgood Schlatter’s Disease (knee cap/bony area under the patella)
Little League Elbow (the bony part inside the elbow)
Little League Shoulder (upper part of the arm that is adjoined to the shoulder)

QUESTIONS AND ANSWERS

What is Apophysitis?

Apophysitis refers to a condition characterized by inflammation and irritation of the growth plate or apophysis in bones. It commonly occurs in children and adolescents during periods of rapid growth. The most well-known type of apophysitis refers to Osgood-Schlatter disease, which affects the knee area.

What causes Apophysitis?

Repetitive stress or overuse of a particular muscle-tendon unit during growth spurts will cause apophysitis. Physical activity can lead to excessive pulling on the growth plate, causing pain and inflammation. Factors such as improper training techniques, sudden increases in physical activity, or inadequate rest can contribute to the development of apophysitis.

How is Apophysitis treated?

Treatment for apophysitis involves a combination of rest, activity modification, and pain management. Resting the affected area and avoiding activities that exacerbate the pain remains crucial. Ice application and over-the-counter pain relievers can help manage discomfort. Doctors will recommend physical therapy exercises to strengthen the surrounding muscles and improve flexibility. In severe cases, a doctor may advise the use of braces or orthotics to provide support. It’s important to consult a healthcare professional for an accurate diagnosis and appropriate treatment plan tailored to the individual’s condition.

Schedule an Appointment with a pediatric Orthopedist at Medical City Children’s and Spine Specialists to treat children with a growth plate injury

Risk Factors

The common risk factors are the phases when bones undergo rapid growth where muscles and tendons can become tight. Young athletes involved in sports are mainly at risk. However, also, less active adolescents may experience this problem, especially those who wear flat shoes.

Hip apophysitis is common in children and adolescents who have growth spurts which can put stress on the muscle. When they have tight hips and thigh muscles or have been training or competing in sports for a long time, they are prone to getting hip apophysitis. Also, kids with knocked knees and pronation can have this problem.

Dancers, Hockey players, runners, soccer players, sprinters, etc. have more chances to develop a problem like this.

Commonly Injured Apophyses in the Hip

Apophysitis of The Ischial Tuberosity

This is the part of the pelvis bone that we sit on. The hamstring muscles that help the hip extend backward start in this area. Avulsion fractures are common at this location.

Apophysitis of the ASIS

This is the front part of the pelvis bone and is the large area right under the iliac crest. It is also roughly in line with the kneecap. The sartorius muscle begins at this part and flexes the hip. When you repeatedly stretch out this muscle, ASIS apophysitis may develop. Also, an avulsion fracture commonly develops in this location.

Apophysitis of the iliac

It is located on the iliac crest on the upper pelvis and connects muscles of the abdomen, back, and sides of the torso. Athletes participating in activities with repetitive twisting, bending, etc. are at higher risk for iliac apophysis. Common symptoms of Apophysitis of the iliac are pain and tenderness over the iliac crest.

Apophysitis of the lesser trochanter

It is located on the top, inside the femur. It has a strong muscle the iliopsoas which is the most powerful flexor of the hip. Injury in this part may occur while doing activities such as sprinting, kicking, and jumping. It is because during these activities the muscle is repeatedly overstretched.

Symptoms

Apophysitis symptoms can vary but there are a few key factors to check for:

Worsening pain during or after repetitive sports or activities such as jumping, running, and throwing
Pain, swelling, and/or tenderness at the growth plate areas at the elbow, shoulder, heel, knee, hip, or foot
A “bump” may appear at the knee, heel, elbow, hip, and pelvis areas. And it does not go away.
Pain that worsens with activity and improves with rest.
Pain with activity, sometimes causing problems in walking.

Diagnosis

If you think your child may have apophysitis, you must immediately consult an orthopedic doctor. They perform a detailed musculoskeletal examination. Also, they perform x-rays of the affected area to confirm any injuries, fractures, or apophysitis.

Thus, the typical clinical diagnosis of apophysitis is based on history and examination.

A thorough examination is done to find local swelling and pain in the problem area.
Doctors often do Radiography to check the severity of the injury. Also, it helps find other possible causes of pain. For example, stress fractures, avulsion, malignancy, fragmentation of the ossification center, etc.
Ultrasonography can show an expanded and fragmented apophysis. It also provides a contralateral comparison. Ultrasonography involves no radiation risk and is more sensitive than plain radiography. This method confirms the absence of a tendon and muscle injury.

Treatments

Apophysis is a self-restricting disorder that heals by enhancing a patient’s flexibility. Also, when the patient stops developing, the apophyseal centers fuse automatically. In most cases, patients recover well with traditional therapy. And, only a small minority needs surgeries.

Doctors treat apophysitis in various ways depending on the location and severity of the injury. However, the basic recommendation is always to rest. Other treatments that doctors recommend are:

NSAIDs or other medications that control pain and relieve inflammation
Ice massage to control pain and soothe inflammation of the affected area
Braces or any other medical equipment often help alleviate pain while protecting the area.
Rehabilitation including stretching, strengthening, and treatments help relieve pain and prevent future complications.
Sometimes, doctors recommend periods of non-weight bearing and/or immobilization by using a non-weight bearing, walking boot, crutches, and or cast.

Prevention

Coaches, parents, and young athletes can help prevent apophysitis. All that is needed is awareness. Your child needs to advise his parents of any activity-related pain. Also, children should recognize the symptoms of apophysitis in an early stage. This is how they can prevent the problem from getting worse.

When a child is having pain because of an activity, he/she should take rest until the pain completely resolves. Once the complications are gone, patients can again return to those activities.
One thing that contributes a lot to prevention is maintaining and improving the flexibility of muscles as your child develops. Make sure they never avoid doing proper warmups and stretching before doing strenuous activities.
Avoiding single sport specialization will let your child’s body take rest from strenuous and repetitive sports activities such as throwing or jumping. Thus, it will prevent overuse injuries.

Returning to Play

Before getting back to a normal activity schedule children should feel minimal pain while squatting and jumping. Thereafter, a progression through sports-specific movements should occur before a full return to sport.
If an athlete is limping or experiencing pain during activities, he/she should continue treatment and return to sports only after consulting the orthopedic doctor.

Follow-Up

After treatment, you must visit your doctor for regular follow-up. They can help you know the right time to return to sports or activities. They can advise you on a step-by-step return to exercise program over a couple of weeks. Also, they will advise on stretching exercises to prevent the chance of re-injury.

Advice to Parents

Proper rest, not rushing back to sports, and being in touch with regular physiotherapy/exercise programs is crucial. Returning to sports before complete recovery has the chances of problems coming back and delayed recovery.

Final Words

When returning to activity after any injury, any pain should call for an immediate stop the activity. Children should never try to push through because it can make the condition even worse. Remember, for complete and fast recovery from Apophysitis, having patience is important. However, for the best treatment available parents should bring their child to the Medical City Children’s Orthopedics Spine Specialists that have offices in Arlington, Dallas, Flower Mound, Frisco, and McKinney, TX. The practice is led by a team of highly qualified, experienced orthopedic surgeons. Our doctors are recognized as leaders in diagnosing and treating children for orthopedic and sports medicine injuries. Furthermore, the practice is well recognized for the scope of services it offers, as well as its doctors’ medical expertise.

The orthopedic surgeons at The Medical City Children’s Orthopedics Spine Specialists are board-certified, having completed rigorous training at the finest medical institutions in the country. Additionally, they specialize in all aspects of orthopedic care for children, including disorders of the knee, shoulder, elbow, hip, spine, foot, and ankle; trauma; and arthritis.

Each patient’s treatment program is tailored to the patient’s specific needs. Also, we continue to monitor patients with ongoing reevaluations and adjustments as the recovery progresses. Whether your child plays sports, just runs around with friends like kids do, or suffers an injury, The Medical City Children’s Orthopedics Spine Specialists is here to help. Furthermore, the team offers the most advanced treatment, which combines the latest in cutting-edge technology. The surgeons prioritize minimally invasive techniques. However, when necessary the surgeons will use sophisticated surgery to treat children and get them back to normal.

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Footnote:

Sports Medicine Today: Apophysitis

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