Understanding Risk, Prevention, and Evidence-Based Management of Growth Spurts
Growth spurts are a defining feature of childhood and adolescence. For young athletes, periods of rapid growth can bring exciting improvements in height and athletic performance, but they also carry a temporary increase in injury risk. Growth-related injuries occur when the musculoskeletal system struggles to adapt to rapid bone growth, changing biomechanics, and increasing training demands.
This article explains how growth spurts can cause a range of injuries, why injuries tend to cluster during adolescence, and how parents, coaches, and clinicians can reduce the risk through evidence-based injury prevention and treatment strategies.
Adolescent Growth Spurt and Peak Height Velocity
During adolescence, children experience periods of rapid growth in stature known as growth spurts. The most critical window is peak height velocity, the point at which growth in stature and bone growth occur at their fastest rate. For most children, this occurs earlier in girls than in boys, but the timing varies widely.
Rapid bone growth can temporarily outpace the ability of muscles and tendons to lengthen and adapt. This mismatch between bone growth and soft tissue adaptation is a key contributor to growth-related injuries. Growing bones, especially at the growth plate and apophyses, are more vulnerable to overload and traction injuries during this stage of physical development.
Why Growth Spurts Increase Injury Risk
Research in youth sport consistently shows that injury rates rise during periods of rapid growth. Several factors contribute to this increase in injury risk.
- Growth plate vulnerability
The growth plate is a region of developing cartilage near the ends of long bones. Growth plate injuries are more likely than ligament injuries in children and teenagers because these areas are structurally weaker than the surrounding bone. Fracture risk, including stress fractures, increases when repetitive loading exceeds the tissue’s capacity.
- Mismatch between bone growth and soft tissue
Rapid bone growth can lead to relative tightness in muscles and tendons. Factors include poor flexibility of the quadriceps, hamstrings, and calf muscles. This imbalance increases strain on tendons, ligaments, and apophyseal regions.
- Overuse and overload
Overuse injuries and burnout are common in youth sport, especially when training volume increases without adequate recovery. Overuse injuries that often occur during adolescence often involve repetitive running and jumping, such as in soccer, basketball, volleyball, and track.
- Changes in coordination and velocity
During periods of rapid growth, coordination can temporarily decline. Changes in limb length, center of mass, and movement velocity can increase non-contact injuries and acute injuries during sports and physical activities.
Common Growth-Related Injuries in Young Athletes
Growth-related injuries include both acute and overuse injuries. Injuries observed during adolescence often involve the growth plate, tendon, or bone-tendon junction.
Osgood-Schlatter disease:
Osgood-Schlatter disease is a traction injury at the tibial tuberosity and is one of the most well-known growth-related conditions. It is a serious overuse injury seen in running and jumping sports. Pain occurs where the patellar tendon attaches to the growth plate of the shin bone.
Sever’s disease:
Sever’s disease involves the calcaneal growth plate in the heel. It is common among children and teens who participate in high-volume running sports. It is classified as an apophyseal injury and is linked to rapid bone growth, tight calf muscles, and high training loads.
Apophyseal injuries:
Apophyseal injuries occur where muscles and tendons attach to bone. These traction injuries are common during periods of rapid growth when muscular strength increases faster than tendon adaptation.
Stress fractures:
Stress fractures are overuse injuries caused by repetitive overload. Injury rates increase during adolescence when rapid bone growth temporarily reduces bone strength relative to loading demands.
Muscle strains and soft tissue injuries:
Muscular strain and ligament injuries can occur when strength, flexibility, and neuromuscular control lag behind physical changes. Injuries in young athletes often involve the lower limb during growth spurts.
Evidence on Injury Rates in Youth Athletes
High-quality studies in sports medicine show that injuries in youth athletes are not evenly distributed across age groups. Injury rates are higher around peak height velocity compared to pre-pubertal or post-maturation stages. Injuries compared across age groups consistently show a higher risk of developing both acute and overuse injuries during adolescent growth spurts.
Research also suggests that injuries occur more frequently in athletes who specialize early, train year-round, or experience rapid increases in training volume without adequate recovery.
Injury Prevention During Growth Spurts
Prevent injuries by focusing on load management, physical preparation, and education.
Monitor growth and maturity:
Tracking stature growth helps identify periods of rapid growth. Awareness of peak height velocity allows coaches and clinicians to proactively adjust training loads.
Manage training load and overload:
Reduce the risk by avoiding sudden spikes in volume or intensity. Overuse injuries and burnout are strongly linked to excessive load without recovery.
Strength and conditioning:
Evidence supports the use of appropriately supervised resistance training for children and adolescents. Strength training improves tendon and ligament capacity, enhances neuromuscular control, and reduces injury risk when performed correctly.
Address flexibility and imbalance:
Factors include poor flexibility of the quadriceps, calves, and hamstrings. Targeted mobility work can reduce strain on growth plates and soft tissue structures.
Emphasize movement quality:
Strength and conditioning programs should focus on technique, coordination, and control rather than maximal loading during periods of rapid growth.
Injury prevention and treatment strategies:
Early recognition is key. Pain that persists, worsens with activity, or affects athletic performance should not be ignored. Injury prevention and treatment should prioritize relative rest, gradual return to sport, and addressing contributing factors such as overload, imbalance, and poor movement patterns.
Soft tissue massage may help relieve symptoms, but it should be used as part of a broader management plan that includes load modification and strength training.
Key takeaways for Parents, Coaches, and Young Athletes
- Growth-related injuries occur most commonly during adolescent growth spurts and peak height velocity
- Rapid bone growth can increase injury risk due to a mismatch between bone growth and muscles and tendons
- Overuse injuries, apophyseal injuries, stress fractures, and growth plate injuries are common during adolescence
- Injury prevention strategies that focus on load management, strength and conditioning, and flexibility can reduce injury risk
- Understanding and managing growth and development is essential for long-term athlete development and athletic performance
Injury Prevention and Care During Growth Spurts
If your child or teen is experiencing pain, recurring injuries, or performance changes during a growth spurt, early assessment and guided management can make a significant difference. At South Island Physiotherapy, our team provides evidence-based physiotherapy, injury prevention programs, sport-specific rehabilitation, and strength and conditioning support tailored to growing athletes. We work closely with young athletes and families to manage load, restore movement quality, and support a safe return to sport during periods of rapid growth. Book an appointment today to ensure your athlete stays healthy, confident, and active through every stage of development.