Growth Injuries or Training Load Injuries?

Understanding pain in busy young athletes

If you’re a parent, coach, or GP working with young athletes, this scenario is probably familiar.

A motivated young player is training several times a week. They might be in club sport, school sport, academy programs, or representative teams. At some point, pain starts to appear — often in the heel, knee, hip, or lower back.

It’s common to hear this described as a “growth injury.”

Sometimes that label can be reassuring. Growth is a normal part of adolescence, and many young athletes do develop pain around growth spurts. But it can also leave families and coaches unsure what to do next.

A more useful question is often:

Is the pain purely a growth-related issue, or is it a sign that the athlete’s training load has outpaced what their body can currently tolerate?

In reality, the answer is often a combination of both.

What are “growth injuries”?

The term growth injury is commonly used to describe conditions affecting growth plates or apophyses — areas where tendons attach to developing bone.

In young athletes, these structures are still maturing and can be more sensitive to repeated loading.

Common examples include:

·       Sever’s disease – heel pain

·       Osgood-Schlatter disease – pain at the front of the knee

·       Sinding-Larsen-Johansson syndrome – pain at the lower kneecap

·       Pelvic apophysitis – hip or groin pain

·       Throwing-related elbow pain in overhead athletes

These conditions are well recognised in adolescent sport. They often occur around the pubertal growth spurt, when the body is changing rapidly.

However, an important point often gets missed:

Growth itself doesn’t cause injury.

Growth is normal and expected. What changes during growth is how the body responds to load.

Why the growth spurt can make tissues more sensitive

During adolescence, young athletes can experience rapid changes in height and limb length over a relatively short period.

This can temporarily affect several things:

·       Muscle–tendon tension

·       Coordination and movement patterns

·       Force distribution across joints

·       Tolerance to repetitive loading

In many cases, bones grow slightly faster than surrounding muscles and tendons adapt.

That can increase tension through areas where tendons attach to bone.

As a result, the growth plate or apophysis becomes the “weak link” in the system.

Instead of the tendon becoming painful (which is more common in adults), the stress is often felt at the bone attachment site.

This is why conditions like Osgood-Schlatter or Sever’s disease tend to appear during adolescence rather than adulthood.

But growth alone doesn’t usually explain the whole picture.

The other major factor: training load

Many of the young athletes we see are doing a lot of sport, often across multiple teams or programs.

That enthusiasm is fantastic. Sport provides enormous physical, social, and psychological benefits for young people.

However, the total training load across the week can sometimes build faster than the body has time to adapt to.

Overuse injuries are typically described as injuries that occur when repetitive stress accumulates faster than the body can recover and adapt.

Unlike a sprained ankle or muscle tear, there’s usually no single moment when the injury occurred.

Instead, symptoms develop gradually as the body struggles to keep up with the demands being placed on it.

Common contributing factors include:

·       Rapid increases in training volume or intensity

·       Multiple teams or competitions overlapping

·       Early sport specialisation (lots of repetition of the same movement patterns)

·       Limited recovery between sessions

·       Fatigue, poor sleep, or high academic stress

·       Athletes continuing to train through persistent pain

None of these factors are anyone’s fault. Most families and coaches are simply trying to support a young athlete who loves their sport.

But when training load climbs quickly — especially during periods of rapid growth — the body sometimes sends a signal that it needs a slightly different balance.

Growth plus load: the real interaction

Research into youth sport injuries increasingly suggests that growth and training load interact with each other.

Growth may temporarily reduce tissue tolerance.

Training load determines how much stress is placed on those tissues.

When both occur at the same time — for example, during a growth spurt while an athlete is also increasing training — symptoms are more likely to appear.

This is why we often see certain injury patterns during adolescence.

For example, heel pain can appear in younger athletes, followed by knee pain in early adolescence, and sometimes hip or pelvic pain later during growth.

These patterns are thought to reflect how the body adapts to growth and changing loads over time.

The key takeaway is that these injuries are rarely caused by growth alone.

More often, they reflect a temporary mismatch between load and capacity.

Early sport specialisation and repetitive loading

Another factor that has received increasing attention is early sport specialisation.

This refers to young athletes focusing on one sport year-round from an early age.

While many athletes enjoy specialising, research suggests early single-sport participation may increase the risk of overuse injuries.

This is mainly because the body is exposed to the same movement patterns repeatedly without the variation that different sports provide.

For example:

·       A soccer player repeatedly loading the knees and hips through kicking and sprinting

·       A gymnast repeatedly loading the wrists and spine

·       A swimmer performing thousands of overhead shoulder movements

·       A cricketer bowling high volumes during growth phases

Variety in sport tends to spread load across the body in different ways.

For younger athletes in particular, movement variety can be protective and often supports better long-term athletic development.

Signs that load may be getting ahead of recovery

Most young athletes will have occasional aches and pains.

But there are some patterns that suggest training load may need to be reviewed.

These include:

·       Pain that appears during or after training and returns repeatedly

·       Pain that builds across the week or season

·       Reduced performance or early fatigue

·       A young athlete saying they feel “sore all the time”

·       Mood changes, irritability, or reduced enjoyment of sport

·       Pain that settles with rest but returns quickly once activity resumes

None of these mean sport needs to stop entirely.

They simply suggest the body may benefit from a slightly different balance of training, recovery, and progression.

What tends to help young athletes recover

One of the biggest misconceptions about growth-related pain is that the athlete must stop all sport until symptoms disappear.

In many cases, a complete shutdown isn’t necessary.

Instead, management usually focuses on modifying load rather than eliminating it.

This might include:

·       Temporarily reducing training volume or intensity

·       Avoiding specific movements that provoke symptoms

·       Adjusting the weekly training schedule

·       Gradually building strength and capacity

·       Improving recovery habits such as sleep and nutrition

For many athletes, the goal is simply to keep them participating in ways their body currently tolerates, while gradually increasing capacity again.

This approach often allows the athlete to stay connected to their team and maintain confidence in movement.

Practical considerations for parents and coaches

Supporting young athletes doesn’t mean limiting their ambition or enthusiasm for sport.

But a few simple principles can help reduce the risk of overload during growth.

1.    Avoid large spikes in training

Sudden increases in training sessions, competition, or tournament schedules are a common trigger for symptoms.

Gradual progression allows tissues to adapt.

2.    Build recovery into the week

Rest days are not a sign of weakness in training programs — they’re part of how the body adapts.

Sleep, nutrition, and recovery time matter just as much as training itself.

3.    Encourage movement variety

Participating in different sports or activities can help spread load across the body and develop broader athletic skills.

4.    Pay attention to pain patterns

Pain that appears consistently in the same area during activity is worth paying attention to early, rather than waiting until it becomes more limiting.

5.    Keep communication open

Young athletes often push through pain because they don’t want to miss out or let their team down.

Creating an environment where they feel comfortable speaking up about symptoms can help address issues early.

Helping young athletes move forward with confidence

Perhaps the most important message for young athletes is this:

Pain during growth does not mean something is permanently wrong.

In most cases, it simply reflects a temporary mismatch between the demands of sport and the body’s current capacity during a period of rapid change.

With the right guidance, adjustments to training, and gradual strengthening, most young athletes return to sport fully and continue to enjoy the activities they love.

How physiotherapy can help

At Body Fit Physiotherapy, we take the time to understand the whole picture around a young athlete’s injury.

That includes:

·       Their training schedule

·       Growth and development stage

·       Movement patterns and strength

·       The demands of their sport

From there, we work with athletes, parents, and coaches to develop a plan that supports recovery while keeping the athlete as active as possible.

If this sounds familiar for someone in your team or family, a physiotherapist can help guide the next steps and support a confident return to sport.