GROWTH PLATE INJURIES IN CHILDREN: A PARENT'S GUIDE TO SEVER'S, OSGOOD-SCHLATTER AND OTHER GROWING PAINS 

Your child comes home from practice limping. Their heel hurts, or their knee aches just below the kneecap. They can still run, but it is getting worse. You are not sure if they should push through it or stop altogether.

This is one of the most common scenarios we see in practice. The good news is that these conditions have a name, a clear explanation and a predictable path to recovery. They are growth plate injuries, and while they can be painful and frustrating, they are manageable.

What is a growth plate injury?

Children’s bones grow from specialised areas of cartilage called growth plates (or apophyses). These are the points where tendons attach to developing bone, and they are softer and more vulnerable than the surrounding tissue. When a muscle-tendon unit pulls repeatedly on an apophysis that has not yet fully hardened, the growth plate becomes irritated and inflamed. The medical term for this is apophysitis (Achar and Yamanaka, 2019).

These injuries are almost always overuse conditions rather than sudden traumatic events. They tend to show up during growth spurts, when bones are growing faster than the muscles and tendons can keep up with. That mismatch creates tightness, which increases the pulling force on the growth plate. A 2024 scoping review in the British Journal of Sports Medicine confirmed that injury incidence generally increases with maturity status and that more rapid growth of the lower limbs is associated with greater injury risk (Parry et al., 2024).

Sever’s disease (heel pain)

Sever’s disease is the most common cause of heel pain in children. It typically affects children between the ages of 8 and 14, with boys more commonly affected. The Achilles tendon and plantar fascia both attach to the calcaneal apophysis (the growth plate at the back of the heel bone), and repetitive traction from running, jumping and landing irritates that developing bone.

A 2023 systematic review by Nieto-Gil and colleagues found that the most consistent risk factors are limited ankle dorsiflexion (tight calves), increased plantar pressures, higher BMI and the volume and intensity of sports activity. Soccer, basketball and any sport involving running on hard surfaces are common triggers.

What you can do at home

• Reduce the load. Your child does not need to stop all activity, but cutting back on the volume or intensity that triggers the pain makes a significant difference. If they are playing three sports, consider prioritising one during a flare-up.
• Stretch the calves. Tight calf muscles are the number one modifiable risk factor. Gentle, sustained stretches of the gastrocnemius (straight knee) and soleus (bent knee) for 30 seconds, two to three times a day, help reduce the pull on the heel.
• Heel raises or cups. A simple gel heel cup in their school shoes and sport shoes can offload the calcaneal growth plate by slightly shortening the Achilles tendon’s resting length.
• Ice after activity. If the heel is sore after sport, 10 to 15 minutes of ice wrapped in a cloth can help settle the irritation.
• Supportive footwear. Avoid flat, unsupportive shoes. A shoe with a slight heel-to-toe drop and good cushioning reduces the strain on the heel.

Osgood-Schlatter disease (knee pain)

Osgood-Schlatter disease is the most common osteochondrosis of the lower limb in sport-practising children (Corbi et al., 2022). It affects the tibial tuberosity, the bony bump just below the knee where the patellar tendon attaches. The quadriceps muscle pulls through the patellar tendon onto this growth plate with every jump, sprint, squat and landing.

It typically presents between ages 10 and 15 in boys and 8 and 13 in girls, coinciding with the adolescent growth spurt. A systematic review by Lucenti and colleagues (2022) identified rectus femoris tightness, decreased quadriceps and calf flexibility and repetitive loading from explosive sports as the primary risk factors.

Your child will usually have a tender, sometimes swollen bump below the kneecap that hurts during and after activity. It may be sore going up or down stairs, kneeling or during any explosive movement.

What you can do at home

• Stretch the quads and hamstrings. Quadriceps tightness is the biggest contributor. A standing or side-lying quad stretch held for 30 seconds, done two to three times daily, helps reduce tension on the tibial tuberosity. Add hamstring stretches too, as tightness there changes how the knee loads.
• Strengthen around the knee. Once the acute pain settles, gentle strengthening of the quadriceps and glutes helps the muscles absorb load more effectively. Wall sits, mini squats and glute bridges are good starting points.
• Manage activity, do not stop it completely. Complete rest often leads to deconditioning, which makes the return to sport harder. The goal is to find a level of activity that does not significantly aggravate symptoms.
• Ice and patellar straps. Ice after activity helps manage inflammation. A patellar tendon strap worn just below the kneecap can redistribute the force away from the tibial tuberosity during sport.

Sinding-Larsen-Johansson syndrome

This is the less well-known cousin of Osgood-Schlatter. Instead of the bottom of the patellar tendon being affected (at the tibial tuberosity), the top attachment at the inferior pole of the kneecap becomes irritated. The mechanism is the same: repetitive traction from the quadriceps on a developing growth plate.

It tends to affect slightly younger children (typically 10 to 12 years) and presents as pain at the bottom of the kneecap rather than below it. Management follows the same principles as Osgood-Schlatter: quad and hamstring flexibility, load management and progressive strengthening.

Other growth plate injuries to know about

Growth plate injuries can occur wherever a strong muscle-tendon unit attaches to developing bone. A few other common ones worth knowing about (Achar and Yamanaka, 2019):

• Iliac crest apophysitis. Pain along the top of the hip bone, common in runners and field sport athletes. The abdominal and hip muscles attach here, and repetitive sprinting or change of direction can irritate the growth plate.
• Ischiogluteal apophysitis. Pain at the sit bone (ischial tuberosity) where the hamstrings attach. Common in sprinters and athletes who do a lot of kicking. This one can be mistaken for a hamstring strain.
• Throwing-related shoulder and elbow apophysitis. Repetitive overhead throwing can irritate the growth plates at the proximal humerus (shoulder) or medial epicondyle (inner elbow). These are common in young cricket bowlers and tennis players. Workload management is critical.

Why growth spurts matter

The link between growth spurts and these injuries is not a coincidence. When bones lengthen rapidly, the muscles and tendons that cross those bones have not yet adapted. The result is increased tension across every growth plate in the chain.

This is why a child who has been fine for years of sport can suddenly develop heel or knee pain over a few weeks. It is not that they are doing too much (although load is a factor). It is that their body has temporarily outgrown its capacity to absorb that load. Parry and colleagues (2024) found that apophyseal injuries follow a distal-to-proximal pattern consistent with how adolescents grow: feet and ankles first, then knees and hips. That is why Sever’s disease often appears first, followed by knee conditions like Osgood-Schlatter.

How chiropractic care helps

These conditions respond very well to conservative, hands-on management. At our practice, we take a combined approach that addresses both the symptoms and the underlying biomechanical factors.

Offloading the growth plate. Soft tissue work on the muscles and tendons that attach to the affected growth plate reduces the traction force directly. For Sever’s disease, that means working through the calf complex and plantar fascia. For Osgood-Schlatter and Sinding-Larsen-Johansson, we focus on the quadriceps, ITB and surrounding structures. Neuhaus and colleagues (2021) confirmed that conservative management is universally recommended as first-line treatment for these conditions.

Joint mobilisation. Stiff ankle joints contribute to Sever’s disease by limiting dorsiflexion, which forces the Achilles tendon to work harder. Stiff hips can overload the knee in Osgood-Schlatter. Mobilising these joints restores normal movement and distributes load more evenly.

Strengthening and rehabilitation. Once the acute phase settles, we introduce targeted strengthening to build the capacity of the muscles and tendons around the affected area. Stronger muscles absorb more force before it reaches the growth plate. This is the key to reducing flare-ups and getting back to sport safely.

Load management guidance. We help you and your child work out the right balance between staying active and allowing the growth plate to recover. That might mean modifying training volumes, adjusting the types of activity or planning rest days around match schedules.

Growth plate injuries are a normal part of growing up in sport. They are not a sign that your child is broken or that they need to stop playing. With the right management, most children stay active through these conditions and come out the other side stronger. One thing to note: if your child suddenly cannot weight-bear after a specific incident, that is different from the typical gradual onset of a growth plate injury and should be assessed promptly, as it may indicate an avulsion fracture where the growth plate has pulled away from the bone.

If your child is dealing with heel pain, knee pain or any persistent ache that is limiting their sport, we can help. You can read more about the conditions we treat on our growth plate injuries page. A proper assessment identifies exactly what is going on and gives you a clear plan to manage it.

Get in touch or book an appointment.

References

1. Achar S, Yamanaka J. Apophysitis and Osteochondrosis: Common Causes of Pain in Growing Bones. American Family Physician. 2019;99(10):610-618.
2. Parry GN, et al. Associations between growth, maturation and injury in youth athletes engaged in elite pathways: a scoping review. British Journal of Sports Medicine. 2024;58(17):1001-1010.
3. Nieto-Gil P, et al. Risk factors and associated factors for calcaneal apophysitis (Sever’s disease): a systematic review. BMJ Open. 2023;13(6):e064903.
4. Lucenti L, et al. The Etiology and Risk Factors of Osgood-Schlatter Disease: A Systematic Review. Children (Basel). 2022;9(6):826.
5. Corbi F, et al. Osgood-Schlatter Disease: Appearance, Diagnosis and Treatment: A Narrative Review. Healthcare (Basel). 2022;10(6):1011.
6. Neuhaus C, Appenzeller-Herzog C, Faude O. A systematic review on conservative treatment options for Osgood-Schlatter disease. Physical Therapy in Sport. 2021;49:178-187.
7. Hernandez-Lucas P, et al. Conservative Treatment of Sever’s Disease: A Systematic Review. Journal of Clinical Medicine. 2024;13(5):1391.