Growth plates are the soft cartilage zones at the ends of children’s bones where new bone forms during growth. They are weaker than the surrounding bone and ligament, which is why kids’ bones heal fast (high growth-plate activity) and also why certain spots hurt during growth spurts.

The two most-common growth-plate-related conditions in youth athletes are Sever’s disease (heel) and Osgood-Schlatter’s disease (knee). Despite the word “disease,” both are normal growth-related conditions, not infections or chronic illnesses. The medical term is “apophysitis” — inflammation at the spot where a tendon attaches to a growth plate.

Sever’s disease (heel pain). Most common in kids 8-12 doing impact sports (soccer, basketball, gymnastics, running, baseball with sliding). Pain is at the back of the heel, worse with activity and after running, often present in both heels. The cause is rapid growth combined with calf tightness and Achilles tension pulling on the heel growth plate. Treatment: ice after activity, calf stretching, heel cups in shoes, modified activity if pain is significant. Resolves on its own once the growth plate fuses (around 14-15).

Osgood-Schlatter’s (knee pain). Most common in kids 10-14 during the rapid-growth phase, especially in jumping and running sports. Pain is at the bony bump just below the kneecap, often visibly enlarged and tender. The quad pulls on the patellar tendon, which pulls on the still-soft tibial growth plate. Treatment: ice, quad stretching, patellar tendon strap during activity, modified activity if severe. Bump usually stays even after pain resolves; that’s the body’s adaptation.

Other growth-plate sites worth knowing. Sinding-Larsen-Johansson (top of the kneecap, similar to Osgood-Schlatter’s). Little League shoulder (proximal humerus growth plate, in throwing kids). Little League elbow (medial epicondyle in pitchers). Iselin’s disease (base of the fifth metatarsal in soccer kids).

The “play through it” question. Growth-plate apophysitis is not a do-not-play situation in most cases, but it is a manage-the-load situation. The pain itself is a signal of overuse. Ignoring it for weeks usually leads to a longer recovery, occasionally to a real growth-plate fracture, and almost always to a worse season. Most pediatricians and sports medicine docs recommend reducing intensity and volume by 30-50% during a flare, with full activity returning as pain resolves.

When to worry about something more serious. Pain that doesn’t improve with rest. Pain at a single point with significant swelling. Pain that limits range of motion. Pain with a popping or grinding sensation. Any of these warrants imaging. The question to bring to the doctor is whether this is apophysitis (normal) or a true growth-plate fracture (serious).

What parents do wrong most often. Two things. They dismiss the pain as growing pains and let the kid play through. Or they panic and assume it’s a tear or break. The middle path is the right one: take it seriously enough to see a pediatrician, modify activity, ice and stretch, and check in over a few weeks.

The strength training question. Carefully done, age-appropriate strength training (especially calf raises, hamstring work, quad activation) helps prevent and recover from growth-plate apophysitis. The “no weights before puberty” rule was based on outdated guidance. Body-weight and light resistance work is fine and helpful at any youth age, with proper form and supervision. Heavy lifting is the part that should wait.

The honest part: most middle school athletes will go through at least one growth-plate-related pain episode. It’s normal. It’s manageable. It’s not the end of the season. Read the pattern, modify the load, ice after practice, and keep moving.

Last updated April 2026.