Dunsborough Physiotherapy Centre Introduces Injury Prevention Program for Juniors

Dunsborough Physiotherapy Centre SPRIG program (Stretch Proactively to Reduce Injury to Growth-plates)

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Junior sports

Dunsborough Physiotherapy Centre has recently released a program aimed at reducing growth-plate injury rates in children and adolescents in Dunsborough and surrounding areas: the SPRIG program.  Three common growth plate injuries are addressed by the program: Osgood Schlatter disease, Sinding-Larsen-Johansson syndrome and Sever's disease.  The program focusses on inflexibility of muscles groups related to growth-plate injuries.  At present Dunsborough Physiotherapy Centre is targeting junior football, soccer, netball, and basketball players: supplying information to the associated junior sports committees, coaches and parents in relation to appropriate stretching methods to help reduce growth-plate injury incidence.

At Dunsborough Physiotherapy Centre we are committed to reducing injury rates in children / adolescents in our community.  Physical activity is a vital part of a well-rounded lifestyle.  By reducing the rates of growth-plate injuries we are helping to keep the children / adolescents of Dunsborough and surrounding areas active, and lessening the risk of long-term issues related to these growth-plate injuries which can hamper the ability to remain active in the future.

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What is a Growth-Plate?

Growth-plate

 The epiphyseal plate (growth-plate) is a hyaline cartilage plate in the metaphysis, at each end of a long bone.  This is where bone growth occurs until the growth plate closes (13-15 for girls, and 15-17 for boys).

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Growth-Plate Apophysitis / Osteochondrosis: What is it?

Apophysitis / Osteochondrosis

At the site of a tendon attaching muscle to bone tractioning (pulling) occurs which stresses the bone.  The growth-plate is a weakened point of bone which is susceptible to this tractioning force: swelling and micro-fracture can develop at the site of the growth-plate, hence the painful bump often seen in those sufferers of a growth-plate injury.  Growth-plate injuries often occur during growth-spurts (most common in children between 9-15 years old).  During a growth-spurt bones grow at a rate faster than muscles can lengthen, leading to increased pulling at the site where the muscle attaches to bone (via a tendon).  20% or more of children will suffer from Osgood Schlatter disease.  2-14% of children presenting with a musculoskeletal injury will have Sever's disease.  These conditions create pain and dysfunction (limping, weakness, pain with activity such as running, kicking and jumping, and tenderness to touch at the affected site) for 12 months or more.


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3 types of growth-plate injuries addressed by SPRIG program

Osgood Schlatter Disease

Osgood Schlatter disease: affecting the growth-plate of the upper shin bone (tibial tubercle) where the quadriceps tendon attaches.  A bump is often seen with Osgood Schlatter disease, and pain is noted when attempting kneeling.

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Sinding-Larsen Johansson Syndrome

Sinding-Larsen-Johansson syndrome: affecting the growth plate at the lower end of the patella (knee-cap): this condition presents similarly to Osgood Schlatter disease: pain with kneeling, running and kicking.

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Sever's Disease

Sever's disease: affecting the growth-plate of the calcaneum (heel bone) where the achilles tendon attaches: painful during running-children often limit push-off when walking / running.

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How do I know if my child has a growth-plate injury? The Warning Signs

Obvious hump: Osgood-Schlatter disease

Tenderness to touch at the growth-plate site: top of the shin where the quads tendon inserts, lower tip of the knee-cap, or at the back section of the heel bone.  There may be obvious swelling / thickening at the site.

Pain with activity including running, kicking, and jumping.

Loss of pace, particularly acceleration on the playing field.

Pain with stretching of the quadriceps / calves.

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Growth-plate injuries: Risk Factors

Inflexibility: during growth-spurts bones lengthen at a rate faster than muscles can accommodate and therefore inflexibility develops. This increases pulling (tractioning) at the growth-plate site.

Poor footwear / poor arch support: footwear with a lack of cushioning / a lack of arch support increases the load through the growth-plates.  Greater shock is absorbed through the growth-plate on landing. Over-pronation of the foot also increases load through the growth-plates.

Age (growth-spurts): Osgood Schlatter disease affects boys aged 13-15,  and girls aged 11-12.  Sinding-Larsen-Johansson syndrome affects 10-15 year olds.  Sever's disease affects 10-12 year old boys and girls aged 8-10 years old.

Gender: boys are 2-3 times more likely to suffer a growth-plate injury.

Prior injury: around half the children presenting with a growth-plate injury have had a prior injury to the affected area.

Lack of conditioning: poor muscle tone / endurance and being overweight increases risk of growth-plate injury.

Exercise: active children involved in running, jumping and kicking sports are at greater risk.

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Long-term implications

Avulsion fracture

Ongoing pain: pain with kneeling / painful rubbing of the heel in closed-in footwear.

Arthritic change: behind the knee-cap.

Long-term loss of muscle bulk / strength.

Avulsion fracture: a rare complication if not managed correctly

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How to Prevent Growth-Plate Injuries

The SPRIG program focusses predominantly on stretching as an injury prevention strategy, though other prevention strategies are documented here.

Stretching: stretching the quads and calves effectively and regularly to relieve the pulling force on growth-plates.

Gastrocnemius stretch

Gastrocnemius (calf) stretch: with front knee bent and toes pointed forward, leaving your back heel on the ground: lean forward to create a stretch in the calf muscle. (Sever's disease preventative stretch).

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Soleus stretch

Soleus (calf) stretch: with both knees bent and toes pointed forward attempt to lower the back kneecap to the ground without the heel coming off the ground. (Sever's disease preventative stretch).

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Quadriceps stretch

Quadriceps stretch: pull heel to bottom keeping your knees together. Don't arch your back and keep your tummy muscles tightened during the stretch. (Sinding-Larsen-Johansson / Osgood Schlatter disease preventative stretch).

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Rectus Femoris stretch

Rectus Femoris stretch: in kneeling pull your heel towards your bottom. Don't arch the back and keep your bottom tucked under, and tummy muscles tightened.  (Sinding-Larsen-Johansson / Osgood Schlatter disease preventative stretch).

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Orthotics

Good arch support / footwear: to absorb shock, and lessen pronation of the foot.  This in turn lessens load through the growth-plate.

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Straight leg raise

Conditioning: improving muscle strength with resistance work. Most growth-plate injuries occur in the first half of a sports season.  As muscles fatigue increased load is transferred through the growth-plate.

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Contact Dunsborough Physiotherapy Centre

If you have any queries, or think that your child may have a growth-plate injury please call Dunsborough Physiotherapy Centre:  phone: 97553600

To visit the Dunsborough Physiotherapy Centre website (http://www.dunsborough physio.com.au) click / tap here

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