Apophysitis is a common condition which can affect children and adolescents. Throughout the skeleton, there are bony regions known as apophyses, which are sites of muscle attachment via our tendons. During our younger years, these sites have an ‘open’ growth plate that can be susceptible to irritation in developing bodies. This is known as apophysitis.
The ages which it may affect individuals vary, although will typically affect individuals between 8-14 years old. As we age, the growth plates at these sites ‘fuse’ and become significantly stronger, hence why we don’t see apophysitis in adults.
There are many different sites which may be affected within the body and can include:
- Calcaneus (heel bone)
- Tibial tubercle (attachment site for the patellar tendon)
- Patella
- 5th metatarsal (outside bone in the foot)
- Pelvis (this may occur across a number of different locations of the pelvis)
- Elbow
Historically, terms such as ‘Sever’s disease’ or ‘Osgood Schlatter’s disease’ have been used to describe apophysitis of the heel and tibial tubercle respectively. There has been a push to now refer to these conditions as ‘calcaneal apophysitis’ or ‘tibial apohysitis’, as the term ‘disease’ tends to have negative connotations associated with it and may evoke unnecessary fear around what are quite manageable conditions.
What causes apophysitis?
Apophysitis typically occurs in active adolescents, as the condition develops due to repetitive traction forces at the site from muscular contraction. As such, we tend to see apophysitis in those who:
- Play multiple sports in a single season
- Specialise in a single sport from a young age
- Are involved in multiple teams for the same sport (e.g. playing club, representative and school sport)
- Have a lack of rest or down days
- Have minimal down time between sporting seasons
Signs of apophysitis?
- Pain which gradually worsens with activity and eases with rest
- Swelling around the affected site
- Tenderness to touch
- Potential limping
Management
Apophysitis is a very manageable condition and long term outcomes are overwhelmingly good. For locations such as the heel and tibial tubercle, continuing to exercise and play sport with some discomfort or manageable pain is usually okay and the condition is self limiting. Continuing to push through higher levels of pain may prolong and worsen symptoms, and as such, is generally not advisable. Overall, key management strategies below may include:
- Assessment from a physiotherapist to confirm the diagnosis
- Load management: prioritise most important activities or sports, reduce unnecessary or less important activities (e.g. intense physical activity at school/lunchtime), rescue training load or play in positions in match play which require less running
- Footwear modification: the use of heel lifts in calcaneal apophysitis may take load off the affected site
- Rehabilitation: the prescription of range of motion, strengthening and motor control exercises may assist in improving biomechanics and reduce load through the affected site.
A rare complication which may occur through certain sites is the development of an apophyseal avulsion injury. This is where a fracture occurs at the apophysis due to forceful contraction of the joining musculature. As such, it is important to consult a physiotherapist when managing apophysitis.
Summary
Apophysitis is a common and very manageable condition. It may require monitoring and modification of load during adolescent years, however will no longer occur when the growth plate ‘fuses’. Most adolescents can continue participating in physical activity, although may need to modify the amount of activity they are completing.
Our Geelong physiotherapists are experienced in managing adolescent sporting injuries. So if you’re looking for treatment, advice and a management plan, please don’t hesitate to contact us.
References
Achar, S., & Yamanaka, J. (2019). Apophysitis and osteochondrosis: common causes of pain in growing bones. American family physician, 99(10), 610-618.
Hendrix, C. L. (2005). Calcaneal apophysitis (Sever disease). Clinics in podiatric medicine and surgery, 22(1), 55-62.
Maruszczak, K., Madej, T., & Gawda, P. (2024). Lower Limb Osteochondrosis and Apophysitis in Young Athletes—A Comprehensive Review. Applied Sciences, 14(24), 11795.
