Growth Plate Injuries in Young Athletes: What Parents and Coaches Need to Know

Youth sports participation in Cary and Raleigh, NC has never been higher… and neither has the rate of overuse injuries in young athletes. For parents and coaches in Cary, understanding why growth plates make developing athletes uniquely vulnerable, and what early specialization and high training volumes do to young bodies, is increasingly important.

What Are Growth Plates?

Growth plates, also called physes, are areas of cartilage near the ends of long bones in children and adolescents. They are the sites where bone lengthening occurs during development. Because they haven’t yet been replaced by harder bone tissue, they are the weakest points in a young athlete’s musculoskeletal system.

This is a critical difference between adult and youth injury patterns. In an adult, a high-stress force to a bone-tendon junction is more likely to injure the tendon. In a skeletally immature athlete, the same force is more likely to injure the growth plate because cartilage is simply less resistant to stress than mature bone.

Growth plates typically close in girls between ages 14-16 and in boys between ages 16-18, though this varies by individual and by location in the body.

Growth Plate Conditions Common in Young Athletes

Apophysitis refers to inflammation at an apophysis – a growth plate where a tendon attaches, rather than where bone lengthens. These conditions are extremely common in adolescent athletes:

• Osgood-Schlatter disease: Pain at the tibial tuberosity (the bump below the kneecap), where the patellar tendon attaches. Very common in running and jumping sports.
• Sever’s disease: Pain at the heel, where the Achilles tendon attaches to the calcaneal growth plate. Common in soccer players and runners.
• Sinding-Larsen-Johansson syndrome: Pain at the inferior pole of the kneecap, again involving the patellar tendon. Often confused with patellar tendinopathy.

These conditions are not rare. They are among the most common reasons adolescent athletes present to physical therapy. They are also frequently undertreated and dismissed as “growing pains” or managed with rest alone, without addressing the underlying load factors.

The Early Specialization Problem

Single-sport specialization before age 12 has been associated in research with higher rates of overuse injury, burnout, and dropout from sport. The reasons are multiple:

• Repetitive loading of the same tissues without variety or recovery promotes overuse injury at growth plates and apophyses
• Young athletes who specialize early often accumulate training volumes appropriate for adult athletes before their bodies are ready
• Psychologically, the pressure associated with early specialization contributes to burnout at ages when sport should still primarily be enjoyable

Multi-sport participation through early adolescence, by contrast, develops broader athleticism, distributes loading across different tissue types, and appears protective against overuse injury. The evidence on this point has become sufficiently strong that most sports medicine organizations now issue guidance against early single-sport specialization.

Signs That Warrant Attention

Parents and coaches should not dismiss persistent pain in young athletes as inevitable or normal. Specific red flags:

• Pain that consistently worsens with activity and requires modification of participation
• Localized tenderness at or near a joint in a growing athlete
• Pain that alters the athlete’s gait or movement patterns
• Any pain that continues at rest or through the night

Growth plate stress fractures, while less common than apophysitis, can occur under high training loads, particularly in female athletes (where the interaction with RED-S is relevant) and in sports with high impact or repetitive mechanical stress. These require proper imaging and management and should not be played through.

What Physical Therapy Can Do

PT for youth athletes with growth plate conditions involves load management, addressing contributing biomechanical factors (hip and core strength, movement patterns, and footwear), and educating the athlete and their family about the nature of the condition and how to train through it appropriately.

Importantly, most apophysitis conditions do not require complete rest from sport. In many cases, modification of training load combined with targeted strengthening allows the athlete to continue participating while the condition is managed.

At Aureum Physio, we work regularly with young athletes and understand that keeping them in the sports they love – safely – is the goal. A proper assessment gives us a clear picture of what’s driving the symptoms and what adjustments are needed to protect the athlete while preserving participation where possible.

If your young athlete has been dealing with persistent pain that keeps flaring up around activity, it’s worth getting it properly assessed rather than waiting to see if they grow out of it. Early intervention usually means a faster return to full training.