apophysitis

Apophysitis is an overuse injury of the apophysis, the secondary ossification center at a tendon or ligament insertion. It occurs when repetitive traction forces on a growing bone exceed the capacity of the growth plate to adapt, leading to inflammation and pain at the affected site. It most often affects children and adolescents during periods of rapid growth.

Common sites include the tibial tubercle (Osgood-Schlatter disease), calcaneal apophysis (Sever’s disease), distal patellar pole (Sinding-Larsen-Johansson syndrome), and apophyses of the hip such as the iliac crest, greater trochanter, and ischial tuberosity. Involvement at multiple sites or generalized overuse can occur in athletes who participate in running, jumping, or kicking sports.

Symptoms are typically localized pain and tenderness at the apophysis, exacerbated by activity and resisted muscle contractions. Swelling may be present, and pain often improves with rest. Diagnosis is mainly clinical, based on history and examination; imaging is used to rule out other conditions or to assess fragmentation or displacement if suspected.

Management emphasizes activity modification and relative rest, ice, and nonsteroidal anti-inflammatory drugs as needed. Physical therapy aims to stretch tight muscle groups, strengthen supporting musculature, and correct biomechanical factors. Most cases resolve as the growth plate matures, with a gradual return to sport. In rare cases, significant displacement or persistent symptoms may require immobilization or surgery.

Prevention focuses on gradual conditioning, avoiding abrupt increases in activity, proper footwear, and addressing biomechanical abnormalities to reduce repetitive traction.