Adolescents Only!

By Nadine George (Physiotherapist – Sydney West Sports Medicine)


Traction Apophysitis is a very common sporting injury experienced predominantly by athletes between the ages of 8 and 18. These injuries are extremely unique, and this is because this injury ONLY occurs in adolescents!

Traction Apophysitis

Traction Apophysitis is an irritation of the bony growth centres where the body’s major tendons attach. This only occurs in adolescents because in this age group the growth plates are still not fully closed. It usually only occurs in very active adolescents who are continually loading their tendons, and typically these athletes are playing more than one sport, or are attending multiple training sessions per week.

Traction Apophysitis is usually characterised by pain and inflammation at the point where the tendon attaches to bone. Pain can often be quite high, and can build quickly without any apparent reason, and this is often a concern for the athlete and their parents.

Unfortunately, when a person experience significant pain it can often create misunderstanding about the causes of pain and management.

How do I know if my child has a Traction Apophysitis?

No matter where the Traction Apophysitis is in the body, the general symptoms are the same;

  • Pain and inflammation on a bone where a major muscle attach
  • Tenderness to touch
  • Pain on activities that stress these muscles – usually running, jumping and landing when symptoms are in the legs
  • Residual aching and pain after activity

Should I be concerned?

Whilst the symptoms of a Traction Apophysitis can seem quite serious, they are actually self-limiting conditions that tend to settle down quickly if managed well. Here are a few pointers that might help;

  • A reduction in aggravating activities will usually allow symptoms to settle
  • Complete rest is not necessary, but might be recommended if symptoms are severe or have been persistent
  • Anti-inflammatory medications are usually not required if activity levels are managed well
  • Massage to the affected muscle may assist in providing temporary relief
  • It is not usually recommended to stretch the affected muscle/tendon as this may further irritate the bony attachment point

Do I need to get a scan?

Traction Apophysitis can be easily diagnosed in the clinic through a thorough patient interview ad physical examination. Therefore, in most cases, scans such as X-rays and Ultrasounds are completely unnecessary. This is because;

  1. They do not add any information to what is already known from a thorough examination, and therefore do not change the way in which a Traction Apophysitis is managed
  2. They can pick up incidental findings which are not relevant to the athletes’ symptoms
  3. They can cause unnecessary anxiety for parents and athletes
  4. They expose the athlete to unnecessary radiation (X-rays only)
  5. By the time scans are performed and reported on, valuable time is lost that could have been spent on effective rehabilitation.

Will there be any long-term negative effects if my child has a Traction Apophysitis?

The short answer is no!

These are self-limiting conditions characterised by pain.

Once the pain settles down, your child no longer has a Traction Apophysitis. There are no long-term negative effects of these conditions. Despite the fact that the growth plates may get irritated, they are not affected in any other way and will not impact on your child’s growth and development.

The most common types of Traction Apophysitis’ are listed below:

Apophysitis Location Description
Sever’s Disease The back of the heel Pain and inflammation at the point where the achilles tendon attaches, usually aggravated by running, jumping and landing
Osgood-Schlatter’s Disease The bony protuberance at the front of the knee, underneath the kneecap Pain and inflammation at the point where the patella tendon attaches to the leg bone. Adolescents often have a big bony bump at this point that is quite tender to touch. This condition is usually aggravated by running, jumping, and contact on the front of the knee
Sinding-Larsen-Johansson Syndrome The bottom of the kneecap Pain and inflammation at the point where the patella tendon attaches to the kneecap. This is the same condition as Osgood Schlatter’s but in a slightly different location.
Rectus Femoris At the front of the pelvis Pain and inflammation at the point where the rectus femoris (quad muscle) attaches to the front of the pelvis. This is usually aggravated by high speed running, acceleration and deceleration, and activities requiring hip flexion
Little Leager’s Elbow On the inside of the elbow Pain and inflammation at the point where the forearm flexor muscles attach. This is primarily aggravated by throwing/racquet or club sports or with activities requiring gripping


Physiotherapists are perfectly placed to assess and treat all types of Traction Apophysitis, so give SWSM a call on (02) 9851 5959 to book an appointment today


Posted: 28 August 2018