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Apophysitis: 3 Ways Physical Therapy Improves Overuse Injury

Author: CHKD Sports Medicine, Beth Ackerman, PT, DPT, SCS
Published Date: Wednesday, April 24, 2019

Children growing up today often play only one sport with little break in between seasons. As a result, many children experience an overuse injury at some point in their playing years.

In fact, more than half of the pains that occur while children are growing are caused by overuse and lead to a condition called apophysitis – an inflammation and stress injury that affects where a muscle and tendon attach to a child’s growth plate.

In children, the tendons attach to bones at a growth center called the apophysis. The apophysis is not quite as strong as the other areas of the bone. As kids grow, the bones grow first and the muscles lag behind causing the muscles to be shorter and tighter. When these muscles contract or stretch, it pulls on this weaker area of bone, resulting in pain. Children often feel this type of pain in the knee, heel, and elbow.

Four common types of apophysitis:

Osgood-Schlatter’s disease

Occurs on the shin, just below the kneecap. Some children may have a bump on the shinbone. Osgood-Schlatter’s usually affects adolescents ages 11 to 14. Children with Osgood-Schlatter’s typically feel a sharp pain over the front of the knee when running, jumping, negotiating stairs, or squatting. Kneeling or touching the affected area of the knee may be painful as well.

Sinding-Larsen-Johannsen (SLJ) disease

Typically affects children ages 8 to 10 in the lower portion of the kneecap. Like Osgood-Schlatter’s, running, jumping, using the stairs, and squatting can cause pain.

Sever’s disease

Also called calcaneal apophysitis, this condition happens when the calf muscle pulls on the back of the heel, causing pain. Younger children ages 8 to 10 get this more commonly than older children. They usually feel a sharp pain with any activity that causes the calf muscle to work; this includes walking, running, hopping, or jumping.

Little League Elbow

A condition that affects many baseball players when the forearm muscles that attach to the inside of the elbow pull on the apophysis. Athletes often feel a sharp pain on the inside of the elbow that is usually only associated with throwing. It’s important to discontinue any throwing until the pain subsides because children can develop long-term elbow and shoulder injuries.

Physical therapy sessions help improve healing.

Fortunately, most children feel better if they rest from their specific sport or activity. Your child’s doctor may recommend physical therapy to help speed up the healing process and prevent the overuse injury from occurring again.

Here are three ways physical therapy helps children with apophysitis:


Sometimes, the solution is as simple as learning how to properly stretch. One of the first things a physical therapist will consider is whether your child has any muscle tightness. Stretching the muscles helps lengthen them.


Strengthening specific muscles can also help alleviate pain. If your child has muscle weakness surrounding their area of pain, this could be intensifying their pain. A physical therapist can teach your child how to build muscle strength safely by using proper form.

Anti-inflammatory medication.

Your child’s physician may recommend an anti-inflammatory medication for your physical therapist to apply directly to the source of pain. This technique -- called Iontophoresis or Ionto -- uses a patch to deliver the medication. The medicine has a negative charge and is placed on the negative side of a patch, which produces a low-level electrical current. The negative charge on the patch and the negative medicine repel each other, pushing the medicine into the skin and toward the source of pain. This technique is not painful, however, children may feel a slight prickling sensation while the patch is in place. The patch usually stays in place two to four hours.

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About CHKD Sports Medicine

About CHKD Sports Medicine  CHKD's sports medicine program offers the most comprehensive care for your young athlete. From diagnosis and treatment to customized rehabilitation plans, we specialize in physical therapy and injury prevention programs for active children and teens. Our team is composed of pediatric orthopedic surgeons, sports medicine specialists, physician assistants, certified athletic trainers and pediatric sports medicine physical therapists.