While muscle pain from training or minor injuries is common, joint pain in children is a sign that something else is going on. The specific joint and type of pain may mean there is an acute (one-time) injury or a chronic (over time) injury.

The importance of growth plates

Children are not small adults. Kids have growth plates all over their body. Growth plates are part of children’s bones, but they’re made of cartilage. As the child grows, the growth plates make the bones grow longer and bigger. After a child is done growing, the growth plates calcify, or turn into regular bone. As an adult, growth plates have been incorporated into your existing bones. Growth plates are present until people are college-aged.

The growth plate is the weakest part of the muscle-tendon unit that helps joints to move, so it’s often the part that gets injured first.

If a child’s growth plate is injured, it can affect their bone later. For the majority of injuries, the growth plate stays in position and looks normal on x-rays. For those injuries, the area will hurt but there will be no long-term damage to the growth plate.  However, if the growth plate is pulled away from the bone, the bone may grow too quickly or too slowly. Often with this type of injury, the doctor will have x-rays taken every 3 or 6 months to make sure that the injured area is growing at the same rate as the uninjured area on the opposite side of the body. If an x-ray doesn’t give enough detail, a doctor may order a CT scan. If the growth plate is out of position, surgery may be necessary.

Causes of injuries

Many times, growth plate injuries are caused by the way that a child moves. As a sports medicine physician, I’m often thinking about how we can improve the function of the joint so that we minimize the risk of arthritis down the road and maintain normal growth through the bone and joint. We have to determine if it’s safe for athletes to return to play, which often involves correcting the underlying mechanics that may have helped cause the injury.

For example, teaching someone how to bend over with a flat back instead of a curved back, or correcting a squat so the back is flat, weight is in the heels and the joints are aligned without the ankles and knees going inward, will help prevent future injuries.


One of the screening tools is the long sit position. This screening test shows patients some of the restrictions within their body that can cause problems like an improper squat.

  • Patient sits on the ground or exam table, sitting up straight through their lower back and pelvis with legs straight out in front of them.
  • Ask patient to straighten their knees as much as they can.
  • If they can’t straighten their knees, their hips and knees are tight.
  • If they can straighten their knees, ask them to pull their ankle back to their shin to at least a 90-degree angle (needed for walking).
  • Patient may be given exercises or referred to physical therapy for help with tight muscles.

Stable feet

The arch of your foot provides shock absorption and energy transfer to push the energy from your foot up through your leg. A non-straight foot wastes that energy and makes jumping, running and walking less efficient, causing the rest of your joints and muscles to work harder.

Patients will ask about orthotics to correct their foot position. Orthotics can be used, but a longer-term result is to get the muscles in your foot and ankle to correct the position of your foot and ankle on your own. The muscles are called your foot core, and someone without a strong foot core will have lost the arch of their foot and their Achilles tendon will bend. When standing, there should be a visible arch in your foot and your Achilles tendon should be neutral and straight.

If you see a physician or a physical therapist, you can be given exercises that will make your feet stronger and increase the motion in your foot and ankle.

Your whole body

While this blog is focused on the lower body, there are similar issues with growth plates in the upper body, especially around the shoulder blade and neck.

If you’re building a house, you want a stable foundation to build your house above. The foot core and your foot mechanics are the foundation of your legs and your shoulder blade mechanics are the foundation of your arms. If the foundation is not adequate, especially with children, you can develop pain through your growth plates and pain inside your joint.


How do you tell if a child has a problem like a minor sprain that will heal on its own with rest and a more serious growth plate issue?

If your child seems to have a minor issue but it’s not improving over a couple of days, they should be looked at to make sure that they haven’t injured the growth plate. If they’ve had an injury where the joint itself is swollen or hurts a lot when they try to move the joint, they should be seen sooner. We can tell with our exam and with imaging such as X-rays and CT scans if the growth plate is injured.

How does specialization in sports affect joint pain in young athletes?

Ideally, kids will follow the American Academy of Pediatrics guidelines for sports participation:

  • No organized sports two days a week
  • No organized sports two months a year (can be broken up into weeks and does not need to be two months at a time)
  • One team at a time
  • One sport at a time
  • Rotate sports throughout the year

Many children nowadays do one sport all year long and then do additional sports seasonally, but this does not give their bodies time to recover. Adult athletes, including professional and semi-pro athletes that we take care of, don’t train all year. They take breaks and let their body recover. Having young athletes continue training and competing without a break does a disservice to them in both skill development and in risk of injury.

Until the junior or senior year of high school, kids should do a variety of sports. They should take breaks from running sports and do things like swimming so they can recover from the impact. Specialization at the end of high school and approaching college is acceptable, but children who are five or six years old and doing a single sport year-round may have problems.

What are some exercises for Sever’s disease?

Sever’s disease is when the growth plate in a child’s heel gets inflamed and aggravated. The child’s calves are often too tight. They may not have the strength within their hips to support their legs correctly, causing them to twist the growth plate. Physical therapy exercises will loosen up the muscles and make sure the mechanics are correct through their feet and through their hips.

My guideline for children with Sever’s or other growth plate issues is often limping. If the child can do their sport with a little bit of discomfort but nobody can see them favoring the joint or limping, then they’re safe to keep playing. If the child is limping during the sport or continuing to limp after the sport, then the child should stop playing temporarily and do physical therapy to fix the problem.