Essential facts

Introduction

Although children can suffer with the same exercise-associated problems as adults, there are conditions specific to the growing skeleton. Acute fractures in children are covered in Chapter 11. This chapter concentrates on the chronic exercise-associated complaints that commonly present to the paediatric sports clinic. Limitation of sporting participation can be very significant to many children. Sports clinic attendees present with a variety of sports injuries and, importantly, can present with non-sports-related musculoskeletal conditions such as juvenile idiopathic arthritis (JIA). As with sport-associated injury in adults, there is rarely a need for complete rest. Avoidance of the precipitating activity is usually required, but other forms of sport and exercise may be continued and encouraged to maintain condition and fitness.

Traction apophysitis (apophysitis)

An apophysis is a layer of bone over a growth plate; it is an area of structural weakness in a growing child or adolescent. Powerful tendons attaching to these areas can cause chronic traction injuries. Although benign and self-limiting, these cause significant disability, limitation of sporting activity, and concern for both children and parents. Once the growth plates fuse the problem will disappear, but this can take months or even years. Common locations of apophysitis and the associated tendons are shown in Table 28.1.

Table 28.1 Common locations of apophysitis and associated tendons

Most cases of apophysitis can be diagnosed on clinical grounds alone. If the diagnosis is in doubt, plain radiography will often show fragmentation of the growth plate, and magnetic resonance imaging (MRI) or ultrasonography will exclude other pathology, e.g. enthesitis, bone stress. Management principles are education and reassurance of the patient and parents, activity modification, and unloading of the affected growth plate. This can be achieved by correcting biomechanical problems, sometimes with the use of orthotics, increasing flexibility of the relevant muscle groups and improving strength of the surrounding musculature to improve its shock-absorbing capacity. Return to sport is dictated by the level of pain.