Children’s pains – traction apophysitis
Osgood Schlatters, Severs, Sinding-Larsen-Johansen
This is a condition that is currently close to me and will also be common among many of my friends – not for ourselves but for our children.
Traction apophysitis occurs in adolescents, usually between 7 to 15 years and most commonly 10-14 years. It presents as pain at the points where tendons attach to bones, causing a traction on the bone following overuse. This can lead to local tiny avulsion fractures (where small pieces of the outer part of the bone are pulled away) resulting in a swelling at the point of insertion of the tendon which is often at an ossification site, the point at which the bone grows.
The commonest sites for the condition are at the insertion of the patella tendon into the tibial tubercle below the kneecap (Osgood Schlatters disease), at the insertion of the achilles tendon into the heel bone (Severs disease), at the bottom of the kneecap (Sinding-Larsen Johansson syndrome).
The pain will often be present during or after sport, particularly at the start of a season. For those that occur on the heel this can be due to running, in the knee due to repetitive loading such as jumping activity, and in the elbow due to throwing.
The pain can have a pattern of waxing /waning, meaning it comes and goes with activity, and can vary in severity. This means some children will be able to play through the pain but some will have to stop during the activity. The pain can be on one side of the body, but can be present on both sides in 20-30% of sufferers. (ref)
So what can be done?
In the past many people may have been told that this condition was “growing” pains and that they needed to rest from sport and activity until the pain had settled. This is partly true as bones can grow faster than soft tissue adapts, meaning that muscles can become tight after a growth spurt, which many parents will know can happen very quickly and in a short space of time. However there are some steps you can take to help the condition.
Pain can be helped by applying ice after activity
Stretches can help to lengthen the muscles affected. This would be the quadriceps on the knee, the gastrocnemius/soleus in the calf.
Strengthening exercises under the guidance of a physiotherapist can help at the right time.
Speaking to the GP regarding pain relief may be beneficial.
Sport specific strapping to offload the patella tendon in the knee, or simple heel raises in the shoe/trainer/boot to reduce the pull on the achilles tendon can help a lot.
Rest – This will depend on the severity of the condition. Sport / dance etc.. can be a very important part of an adolescents life both for the activity and the social side. The advent of football /rugby / cricket / dance academies and performing arts schools will also mean some children will feel they need to continue their activity so as not to lose ground on their peers.
My personal feeling is that the amount of rest will depend on the severity of the pain. If the pain is severe enough to have caused the sufferer to have to stop their activity, then they should have total rest from that activity (training and playing) for a short time before returning. However should the pain be mild enough to allow the sufferer to complete their activity, and it is not long lasting after activity, then limiting the amount of training and playing may suffice rather than complete cessation. I would advise that this is discussed with your physiotherapist / sports therapist for advice on each individuals case.
The condition will usually settle with the above measures, under guidance form your physio, along with time as the soft tissues catch up with the bone. It may recur at a later date as the child continues to grow, and the same advice should be followed. Rarely does the condition require more, such as cast immobilization, but again advice for this will come from your physio.
Chris Mallows MCSP Feb 2013
Contact us for advice and treatment on these and all other types of musculo-skeletal pain – High Quality Physiotherapy in Croydon