Overuse Injuries in Youth Sports: Apophysitis


My wife (Ali Bauer) and I are both health practitioners and parents of 3 kids. We understand the importance of encouraging a healthy lifestyle for our children, which includes smart diet and plenty of exercise. I think it is safe to say that most parents know how important regular levels of physical activity are for children, especially with the increased incidence of childhood obesity. Most kids who like to stay active are typically involved in organized sports through their school, church, and/or local clubs.

Unfortunately, I have observed an alarming trend through my interactions with younger patients, specifically with young athletes. There is an increase in specialization of youth sports leading to higher physical demands placed on young musculoskeletal systems. This has also led to the rise of the “one sport athlete. In my opinion, there are some positives as a result of this phenomenon; including the acceleration of skill and performance development. However, I have seen an increase in overuse injuries in youth sports, and the “one sport” model may be a contributing factor. 

We’re going to focus on one particular type of overuse injury in young athletes involving growth plates: apophysitis. Apophysitis is a relatively common condition where an apophysis—a type of growth plate where muscles attach—becomes inflamed. This occurs because of increasing tension on the apophysis during rapid growth spurts caused by the differing growth rates of muscles, tendons, and bones. They are a normal part of musculoskeletal development. 

Because of thisrepetitive stress or increases in physical activity can cause these areas to become inflamed. This inflammatory process leads to complaints of localized pain around the area of the irritated apophysis and therefore can be diagnosed as apophysitis.” 

Three common sites of apophysitis that I have encountered throughout my practice are:

  • Osgood-Schlatter Disease: the tendon in a knee that connects thigh muscles to the knee and shin bone becomes injured and inflamed.
  • Sever’s Disease: the tendon that attaches to the back of the heel (the Achilles tendon) pulls on the growth plate (the apophysis) of the bone of the heel.
  • Iliac Apophysitis: the iliac crest (arching bones on either side of pelvis) and pelvis characterized by inflammation of the growth plate, the muscle will pull the bone away from the growth plate.


Apophysitis can also occur in other areas of the body such as the elbow or knee cap.  Unfortunately, it is common for apophysitis to be mistaken for a muscle strain. Therefore, active adolescents who complain of recurring musculoskeletal pain, especially after participation in physical activity, should be examined by a licensed health practitioner. Fortunately, most children feel better if they rest from their specific sport or activity. Your child’s doctor will likely recommend physical therapy to help speed up the healing process and prevent the overuse injury from occurring again.

If a child or young adult is diagnosed with apophysitis, treatment will typically involve rest and activity modification to help decrease the overall stress to the irritated area. Physical therapy treatments can be helpful to provide symptom reliefincrease flexibility, improve muscle balance, maintain strength, and provide education regarding symptom management strategies.  

Again, all children should be encouraged to stay active and get plenty of exercise. However, sometimes excessive physical demands that are put on immature musculoskeletal tissue can lead to real injury. As parents we need to be aware of this and facilitate the proper care when warranted.

If any of these pain points sound familiar to you – we encourage you to request a free injury screening with a physical therapist at one of our 12 Greater St. Louis are locations.

We can design an individualized program tailored to your child’s particular needs. With rest, activity modification, and an exercise program to improve flexibility and strength, your young athlete can soon be back in the game.


To schedule an appointment with Ray or any of our expert physical therapists, request an appointment online today.