Overuse Injuries in the Growing Athlete

The future of the hockey club is reliant on junior development. As a result junior hockey
players are often playing and training multiple times during the week. While managing a
developing body there is a greater risk of overuse injuries due to areas of weakness in the
bones. As parents it’s important to be able recognise signs and symptoms of overuse
injuries and when to act.

Bones are able to grow in length through an area at each end of the bone called a growth
plate. Over time this growth plate turns into bone tissue as it expands in length, to
eventually become all bone tissue. However bones grow in length, before they become
strong, while the growth plates are the weakest link in the bone. As a result, injury to
bone and cartilage (including growth plates) are much more likely than ligament, muscle
and tendon injuries in the growing person, but these certainly do occur.

While bones grow quickly during a growth spurt, muscles take much longer to stretch
and adapt to the change in bone length. As a result, muscles are already tight even before
activity and need time to develop their new length. When participating in sport regularly
our muscles grow in strength and become tighter as result of activity. So when a growth
spurt occurs during a period of increased of sporting activity, the resulting effect is far
greater muscle tightness than either of these events happening individually. This directly
results in an increased risk of injury.

The most common overuse injury in this phase is called traction apophysitis. Meaning the
muscle/tendon causes excessive traction over the growth plate (apophoseal plate), an
inflammatory reaction occurs over the area, resulting in swelling and pain. In the lower
limb the 2 most common are Osgood–Schlatter disease in the knee and Sever’s disease in
the heel.

In the case of Osgood–Schlatter disease, the quadriceps muscles have tightened during a
growth spurt, while this is occurring the child/teenager is playing an increased amount of
sport, causing the quadriceps muscles to strengthen and become tight again. Subsequently
there’s a stronger pull at it’s insertion below the knee cap and producing an inflammatory
reaction over the growth plate.

This is common in both boys and girls, but the impact of the condition tends to be
proportional to the level of activity. There is not a cure to this problem, except time,
however there are important management strategies that help assist with recovery, along
with preventing further damage.

Clinical diagnosis can be performed by a physiotherapist or GP, symptoms may include
limping, swelling over the affected area, loss of strength and pain. Symptoms tend to vary
over 12-24 months, often becoming worse during winter (potentially a relationship to
Vitamin D deficiency).

Initially treatment is simply RICER (Rest, Ice, Compression, Elevation and Refer), while
physiotherapy treatment may consist of massage, stretching, maintenance and restoration
of strength of the affected muscles, along with core stability exercises. The severity of the
condition will obviously determine the how aggressively the condition is managed. If the
child is limping during activity and fine afterwards, then reducing activity load and icing
after activity would be appropriate. However in more extreme cases, if pain is causing a
severe limp, then using crutches and splinting, along with stopping activity may be
necessary.

These types of overuse injuries can often be avoided or severely diminished if diagnosed
early. Being cautious and seeking advise helps ensure a more rapid rate of recovery
during this period in the developing body, when injuries are more common.

Anthony Selby is available to discuss any queries you may have in regard to injuries and
physical management. You can directly contact via the e-mail aselby@sspc.com.au or at
Farm road on alternate Thursday nights.