Condition Guide · Brighton & Hove
Young athletes and active adolescents experience injuries that are distinct from adults. Growing bones, apophyseal injuries and hypermobility require a different clinical approach.
Why Adolescent Injuries Are Different
In adolescents, the bones are still growing. At the ends of long bones and at the attachment points of major tendons, growth plates (physes) and apophyses are present that are significantly weaker than the surrounding bone and tendon. These are the structures that fail first under load, producing injury patterns that simply don't occur in adults.
Osgood-Schlatter disease, Sever's disease and other apophyseal conditions are the adolescent equivalent of tendinopathy — but the management differs because the tissue involved is different. Treatment appropriate for an adult with patellar tendinopathy may be too aggressive for a 13-year-old with Osgood-Schlatter.
Similarly, adolescent hypermobility is significantly more common than in adults, and the sporting demands placed on young athletes are increasingly intense. The combination of lax connective tissue, rapid skeletal growth and high training loads creates a specific injury risk profile that requires specific clinical knowledge.
For patients under 16, a parent or guardian must be present for the initial assessment and ideally for subsequent appointments. This is standard clinical practice and ensures that parents are fully informed about the assessment findings, treatment approach and any activity recommendations made.
Conditions Treated
These conditions are specific to or significantly more common in the adolescent population, requiring a tailored clinical approach.
Pain and swelling at the tibial tubercle, the bony bump just below the kneecap, where the patella tendon attaches. Caused by repetitive traction stress on the apophysis during rapid growth. Extremely common in active adolescents, particularly those involved in running, jumping and football. Often presents bilaterally. Characteristically worse during growth spurts.
Heel pain in active children and adolescents caused by traction stress on the calcaneal apophysis where the Achilles tendon attaches to the still-developing heel bone. Typically presents during growth spurts when the calf musculature becomes relatively tight relative to the lengthening bone. One of the most common causes of heel pain in this age group, yet frequently underdiagnosed.
Pain at the iliac crest where the abdominal muscles and tensor fasciae latae attach to the still-unfused apophysis. Common in young runners and field sport athletes, particularly with sudden increases in training load. Can mimic hip flexor strain or stress fracture and warrants careful assessment.
A structural form of thoracic kyphosis caused by irregular ossification of the vertebral end plates during adolescence, producing wedging of thoracic vertebrae and a characteristic rounded upper back posture. Often painful during the active growth phase. Postural intervention, thoracic extension exercises and soft tissue work to the thoracic extensors and pectorals form the core management approach.
Pain at the lower pole of the patella, where the patella tendon attaches to the still-developing kneecap. The adolescent equivalent of patellar tendinopathy. Distinct from Osgood-Schlatter, which affects the tibial end of the same tendon. Common in jumping athletes, gymnasts and football players during growth spurts.
Lateral curvature of the spine developing during adolescence, most commonly in girls during the pubertal growth spurt. Ranges from mild curves requiring monitoring to significant curves affecting cardiopulmonary function. Soft tissue therapy and exercise cannot correct scoliosis but can meaningfully reduce pain, improve posture and maintain spinal mobility alongside appropriate medical monitoring.
Joint hypermobility is significantly more prevalent in children and adolescents than adults. Many young athletes presenting with recurring soft tissue injuries, joint pain or "growing pains" are hypermobile. The same principles apply as in adults, with emphasis on stability over flexibility, but the approach must account for the developing neuromuscular system and the psychological impact on young athletes.
The intensification of youth sport, including year-round single-sport specialisation and increasing training volumes from young ages, has significantly increased overuse injury rates in adolescents. Stress fractures, tendinopathy, apophyseal injuries and burnout all reflect inadequate recovery relative to training load. Managing load intelligently in young athletes is one of the most important and most undervalued clinical skills.
Clinical Approach
Assessment and treatment with adolescents requires a modified approach that accounts for the developing body, the psychological context of sport and the involvement of parents and coaches.
Clinical assessment adapted for the adolescent patient, with clear explanation of findings to both the young person and their parent or guardian.
Treatment intensity and exercise loading is calibrated to skeletal maturity. What is appropriate for a 17-year-old differs significantly from a 12-year-old in the same sport.
Assessment of total training load across all sports and activities, with clear guidance on appropriate modifications during injury and growth periods.
Clear communication with parents and where appropriate with coaches, to ensure activity recommendations are understood and implemented in the training environment.
A clear, criteria-based return to sport plan that protects the young athlete while getting them back to what they love as quickly and safely as possible.
Clear guidance on when paediatric orthopaedic or GP review is needed, with appropriate referral letters. Some adolescent conditions require imaging to rule out serious pathology.
For Parents
Usually not entirely. The goal is to find the right level of activity that allows healing while maintaining fitness and sport participation where possible. Complete rest is rarely the best answer and can significantly impact a young athlete's mental health and development.
Most adolescent musculoskeletal conditions resolve fully with appropriate management. Apophyseal conditions like Osgood-Schlatter and Sever's disease resolve completely with skeletal maturity. Early accurate management prevents complications and long-term issues.
True growing pains are poorly understood and typically bilateral, occurring at night, without local tenderness. Pain that is localised to a specific structure, worsens with activity and is tender to palpation is more likely to have a specific diagnosis that warrants assessment.
For patients under 16, a parent or guardian should be present for the initial assessment. For follow-up appointments, this is at the discretion of the patient and parent, with clinical judgement on a case-by-case basis.
The same fee structure applies for adolescent patients as adults. Initial appointment £55 (45 minutes), follow-up £35 (30 minutes). A free 15-minute telephone consultation is available if you'd like to discuss whether an appointment is appropriate before booking.
Any previous medical correspondence, scan results or GP letters relating to the injury. A brief note of the training schedule, sports involved and how symptoms relate to activity. Comfortable clothing suitable for a physical assessment.
Most adolescent musculoskeletal conditions are not urgent. However the following warrant prompt medical assessment rather than a routine appointment.
Early accurate assessment makes a significant difference to recovery time and the risk of the injury becoming a recurring problem. A free 15-minute consultation is available to discuss the situation before booking.