Apo-What? Making Sense of Knee and Heel Pain in Tweens and Teens.

The combination of active children and a rapid growth spurt can be a painful and confusing experience. When your child is in pain, it’s stressful, particularly if they are unable to do what they love.

Lower extremity pain in children can be the result of a number of things. In a sports medicine setting, we often see kids with traction apophysities. There are three main types seen in the lower extremity: Sever’s Disease, Sinding Larsen Johansson, and Osgood Schlatters Diseases. While the names themselves can be scary, each of these merely describes an inflammation of an area on a bone where a tendon (and its muscle) is attached. For example, the calf muscle at the base of the heel, the quadriceps muscle at the bottom of the kneecap, or the front of the shinbone.

When this occurs, children often begin to complain of knee or heel pain that becomes progressively worse over a period of weeks. It can sometimes be puzzling to the family because the parent and child are unable to identify an actual injury that occurred. The knee or foot doesn’t look different than normal, so initially, there isn’t much cause for concern. Parents typically tend to seek advice when children begin limping or they are unable to participate in their favorite activities.

Commonly, traction apophysities appear in children who participate in activities that involve a lot of running and jumping (for example soccer or gymnastics) and have recently had a growth spurt. In the growing body, there is a tendency for the long bones to grow quickly, while the soft tissues (muscles and tendons) take longer to adapt to the new length in the leg. Sometimes the pain begins gradually, and other times, pain can occur quickly after not engaging in sports for a period of time.

When we assess children with this condition, we typically find short muscles and strength imbalances, and a weekly schedule that includes lots of physical activity! Often things will begin to settle down with some basic stretching and strengthening, as well as local treatments like icing. Moreover, it’s important to review the volume of running and jumping.

The best news is that traction apophysitis eventually resolve with no lasting adverse effects. Furthermore, the better news is that most kids can get back to some, if not all, of what they love relatively quickly once they have a few strategies to help them get back on track.


Andrea Reid, Physiotherapist
Sport Physiotherapy Diploma
Fellow of the Canadian Academy of Manipulative Physiotherapists, ChanGunnIMS,
Allan McGavin Sports Medicine Clinic,
Email: andrea@allanmcgavinphysio.com
LinkedIn: linkedin.com/in/andrea-reid-766b011b