As parents, it is not uncommon to hear our children complain about growing pains during their developmental years. While these pains are a common childhood experience, many parents may not fully understand the difference between typical growing pains and a specific medical condition called traction apophysitis — which requires active management.
What Are Growing Pains?
Growing pains are a specific, benign phenomenon most common between the ages of 3–12. They typically present as bilateral aching in the limbs (most commonly the shins or thighs), occurring at night or in the evening after a day of activity. Growing pains are not associated with specific tenderness at any single point, do not cause limping, and resolve completely with rest and simple analgesia. The exact cause remains debated but is not related to bone growth itself.
What Is Traction Apophysitis?
Traction apophysitis is a different condition entirely. It occurs where a major tendon inserts onto a still-developing bone at a growth plate (apophysis) — and the repetitive traction force of the tendon on the cartilaginous growth plate causes inflammation and pain.
The most common presentations in the lower limb are:
- Sever's Disease (calcaneal apophysitis): Achilles tendon and plantar fascia traction at the heel growth plate — ages 8–14
- Osgood-Schlatter Disease: Patellar tendon traction at the tibial tuberosity — ages 10–15
- Sindig-Larsen-Johansson Syndrome: Patellar tendon traction at the inferior patella — ages 10–13
How to Tell the Difference
Growing pains: bilateral, evening/night onset, no specific tender point, resolves with rest, no activity limitation.
Traction apophysitis: activity-related, specific tender point on palpation, associated with limping or activity avoidance, may worsen over a season, does not resolve without load management.
If your child has a specific tender point at the back of the heel, the front of the knee, or the tibial tuberosity — particularly in the context of an active sporting season — it is traction apophysitis until proven otherwise. Consult a physiotherapist or podiatrist.
Management of Traction Apophysitis
Management is centred on load reduction and tendon offloading, not rest alone. Brief periods of rest followed by an abrupt return to sport will result in recurrence — the growth plate has not had time to adapt. Structured load management, progressive exercise, and offloading tools like the Orthopaedic Sleeve (which reduces Achilles traction at the calcaneal apophysis in Sever's Disease) allow children to remain active while the apophysis heals.
From Pain to Performance — The Orthopaedic Sleeve Society (TOSS)