Growth Related Sports Pain in Young Athletes

Daniel Smit | APA Titled Paediatric Physiotherapist

Pain around the knee, heel or hip can appear during a young athlete’s growth years. Growth can change how the body responds to training, but pain should not automatically be dismissed as “growing pains.” Repetitive sport loads, a recent training increase, recovery, strength and other health factors may all matter. A clear assessment helps identify the likely cause and lets the athlete stay as active as is safe.

What does growth-related sports pain mean?

Some young athletes develop irritation where a tendon or muscle attaches to a growth area of bone. These attachment growth areas are called apophyses. Repeated running, jumping, kicking, throwing or other forceful actions can irritate them, particularly while the skeleton is still maturing. These problems are often called apophysitis. They are different from ordinary muscle soreness and from growth in height itself.

Growth is one part of the picture, not a diagnosis. A young person can have sport-related pain for many reasons, and similar symptoms may need a different response. Growth-related pain is more often gradual and localised, and tends to increase with the activity that loads the area. A sudden injury, pain at rest or other concerning symptoms should be assessed.

Common examples in young athletes

• Osgood–Schlatter: pain and tenderness at the bony bump just below the kneecap, often worse with running, jumping, squatting or kneeling [1, 2].
• Sever’s disease (calcaneal apophysitis): pain at the back or underside of the heel, commonly during running and jumping [1, 5, 6].
• Sinding–Larsen–Johansson: pain at the lower edge of the kneecap, often related to jumping or running.
• Pelvic apophysitis: pain near the hip or pelvis where powerful muscles attach; a sudden forceful kick or sprint can occasionally cause an avulsion injury.

These are examples, not a checklist for self-diagnosis. Pain location, the way it began, the athlete’s age and development, training history and examination findings all help guide the diagnosis.

Why can symptoms show up during a busy season?

A change in growth and maturation can coincide with changes in coordination, muscle–tendon flexibility and how training feels. At the same time, athletes may add team sessions, school sport, competitions, gym work or extra practice. A rapid change in the type, frequency or intensity of loading can leave less time to adapt. This does not mean sport is harmful during growth; it means symptoms and the whole training week deserve attention.

What to do when pain starts

1. Tell someone early. The athlete should tell a parent or guardian and coach. Note where it hurts, what activity brings it on and whether it is changing movement or daily activities.

2. Adjust the painful load. Temporarily reduce or modify the actions that clearly aggravate symptoms, such as repeated sprints, jumps, hills, kicking or deep knee loading. Do not push through pain that causes a limp, changes technique or worsens as the session continues.

3. Keep suitable activity where possible. Depending on the site and symptoms, pain-free or less-irritating training may be possible. A physiotherapist or doctor can help decide what to modify and what can continue. Complete rest is not automatically required, and the best option varies by athlete and condition.

4. Build back progressively. When everyday movement and sport-specific tasks are settling, increase the amount and intensity in stages. Strength and conditioning may help restore capacity, but exercises should match the athlete’s symptoms, sport and development.

For some adolescents with Osgood–Schlatter, a prospective cohort study found improved function after education, temporary activity modification and progressive strengthening [3]. Evidence for the best treatment is still limited, particularly across different conditions [2, 5]. For Sever’s disease, a trial comparing heel raises and orthoses found that several options could help, with no single approach clearly best for everyone [4]. A tailored plan and symptom response matter.

When should an athlete be assessed?

Arrange an assessment if pain is recurring, persists, is getting worse, causes a limp, limits training or everyday activities, or is accompanied by swelling or a marked loss of movement. Assessment is also useful when the cause is unclear or the athlete is trying to plan around competitions. A physiotherapist or doctor can examine the area, consider other causes and advise whether imaging or referral is needed.

Please seek prompt medical assessment. Sudden severe pain after a forceful movement or fall, inability to bear weight, a large or rapidly developing swelling, a hot/red joint, fever or feeling unwell, or pain that is persistent at rest or wakes the athlete at night.

How Strides Performance can help

A sports physiotherapy assessment considers the athlete’s symptoms, growth and development, sport demands, recent training changes, recovery and goals. We can help clarify what activities to modify, maintain useful training where appropriate, develop a progressive rehabilitation plan and coordinate with parents, coaches or the treating doctor when suitable.

Download the growth related sports pain in young athletes handout (PDF)

References and further reading

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