Growing athletes and adolescent physiotherapy in Milton Keynes

How we manage growing athletes

Most of the young people we see are not dealing with a specific paediatric diagnosis. They are school or club-level athletes who have picked up a sports injury and need the same structured rehabilitation an adult would get, adapted for a body that is still growing. Nick Allen and Simon Jones both worked pitch-side with adolescent athletes at Stowe School, and Simon continues to work with Cambridge University sport, so this is territory they know from years of seeing it in person.

Training advice and education sit alongside treatment, not after it. Where an injury is linked to how a young athlete is training, loading or recovering, that gets addressed directly, because reducing the chance of it coming back, and building habits that carry them safely through the next growth spurt and the next season, matters as much as resolving what brought them in.

For the smaller number of adolescent patients whose pain is coming from the growth plate itself rather than a specific injury, we assess and manage that too, and explain the difference clearly to both the young person and their parents. What that looks like is below.

What this usually is

This section looks specifically at growth-plate conditions, the smaller group where pain is coming from the growth plate itself rather than a sports injury.

Growth plates (physes) and their attachment points (apophyses) are areas of active growing cartilage, not yet solid bone, and they are a genuine site of relative weakness in a growing skeleton — which is why the same load that would just strain an adult's tendon can instead irritate the bone attachment itself in a child or teenager. According to PubMed (Nguyen & Caine, Seminars in Musculoskeletal Radiology, 2024, DOI: 10.1055/s-0044-1786151).

Osgood-Schlatter disease is pain and a bony lump at the top of the shin bone, just below the kneecap, where the thigh muscle's tendon attaches. It is the most common growth-related overuse condition we see, typically ages 10 to 15, worse with running, jumping and kneeling, and it tracks closely with growth spurts and rapid increases in training load. The adult equivalent of this anterior knee pain pattern is covered in our Insights explainer on runner's knee and patellofemoral pain.

Sever's disease (calcaneal apophysitis) is heel pain at the back of the growth plate in the heel bone, typically ages 8 to 14, worse with running and jumping sports — the most common cause of heel pain in this age group, and, because this is our subspecialty, an area we assess with particular attention to the whole foot and ankle mechanics, not just the sore spot.

Sinding-Larsen-Johansson syndrome is a close cousin of Osgood-Schlatter, affecting the growth plate at the lower tip of the kneecap rather than the shin, with the same underlying mechanism and a similar approach to managing it.

The growth spurt itself changes injury risk, independent of any single condition. As girls move through the adolescent growth spurt, longitudinal studies have found measurable changes in landing technique, knee laxity, and the balance between quadriceps and hamstring strength, changes thought to contribute to the well-documented rise in ACL injury risk during and after this period. According to PubMed (Wild, Steele & Munro, Medicine & Science in Sports & Exercise, 2013, DOI: 10.1249/MSS.0b013e31826a507e; Wild, Munro & Steele, American Journal of Sports Medicine, 2016, DOI: 10.1177/0363546516629419). This is one of the reasons we pay close attention to where a young athlete is in their growth, not just their age.

None of the conditions above are "damage" in the way an adult tendon tear is — they are a normal skeletally-immature response to load, and the overwhelming majority resolve completely once the growth plate closes. That does not mean they should be ignored, run through, or self-diagnosed at home — see the section below.

How we treat it here

Assessment first — including, as standard, a hip screen for any young person presenting with hip, groin, thigh or knee pain, because of how often hip pathology in this age group is mistaken for a purely local knee problem. According to PubMed (Katz, Pediatric Annals, 2006, DOI: 10.3928/0090-4481-20060201-10).

For Osgood-Schlatter disease and Sinding-Larsen-Johansson syndrome, the mainstay is load management, not blanket rest: reducing the specific activities that are provoking it while keeping the young person moving and training in the ways that do not, alongside quadriceps and hip strengthening as symptoms allow. High-quality trial evidence specifically for this condition is limited, which we say plainly rather than overstate — the consensus approach across paediatric sports medicine is activity modification and education, and the natural history is genuinely reassuring: near-universal resolution once the growth plate matures.

For Sever's disease, a systematic review of the available evidence found it is generally low-quality, but the limited data available suggested orthotic support gave better short-term pain relief than heel raises alone. According to PubMed (James, Williams & Haines, Journal of Foot and Ankle Research, 2013, DOI: 10.1186/1757-1146-6-16). Because this is our subspecialty, we bring a fuller foot and ankle assessment to it — looking at the whole mechanics of the foot, not treating the heel in isolation.

For the growth-spurt injury-risk window itself, particularly in adolescent girls in jumping, cutting and change-of-direction sport, we use this evidence to justify targeted landing mechanics and neuromuscular control work during this period specifically, rather than only reacting once an injury has already happened.

Throughout, education is a genuinely large part of the treatment — for the young person and for parents. Being told plainly that this is a normal, well-understood, self-limiting part of growing, not damage, and not something that means stopping sport altogether, changes how families approach it and, often, how quickly things settle.

Where something does not fit this pattern — a hip finding on the screening exam, a presentation that is not settling as expected, or anything from the red flags above — we refer you on promptly to the right specialist rather than continuing to treat it as straightforward growth pain.