Tendon injuries in children - What are they and how do we fix it?

The last thing we want our active and growing children to experience is growing pains. Growing pains can be a very broad term, but it generally refers to injuries experienced by adolescents as they advance in both height and weight during puberty. Typically the injury and pain is not caused by a single ‘strain’ or ‘sprain’, but a gradual and insidious onset.

Common injuries that affect tendons in children:

Osgood schlatters disease (pain at the front of the knee)

Osgood schlatters disease

Sever’s disease (heel and Achilles pain)

Sever’s disease (heel and Achilles pain)

Traction apophysitis – rectus femoris (front of the hip joint)

Traction apophysitis – rectus femoris (front of the hip joint)

These conditions all have a few things in common:

  1. All lower limb based
  2. Linked to muscles that provide power when running

The injury process for these conditions is based at the tendon to bone attachment at the site of the growth plate. It relates to the excessive pull of the muscle from the bone, via the tendon. This creates a microtrauma close to the growth plate, a structure that is busy building new bone. This process will only become a problem when the rate of tendon injury is faster than the body's ability to heal the structure. This is often the case in very active children, who are playing multiple sports throughout the week. The tendon simply does not have adequate time to heal itself.

Causes of tendon injuries in children:

Unfortunately its not as simple as just a ‘growth spurt’. The following factors will lead to an increased chance of experiencing these injuries:

  1. Tight muscles

As we grow, our skeleton grows slightly faster than the muscles that attach to it. Essentially, our bones grow quicker than our muscles. This leaves us with tight muscles, relative to the longer bones. This will increase the physical pull and tension from the muscle into the tendon, attaching onto the bone.

  1. Poor biomechanics

Any number of biomechanical faults will increase the load on different tendons.

  1. Sports specific repetition

Simply put, the more sports played, the higher the risk of sustaining such injuries. I often see children who engage in 6-7 sessions per week of running/weight-bearing activity. This is not to say that children should stop doing this amount of activity - my advice to patients and their parents is to listen to your body. If you start to feel any isolated ache or pain in the hip, knee or foot, then seek treatment to remedy the situation. If not, lengthy delays in returning to sports are often required - patients need to be most diligent when monitoring excessive running loads before and after growth spurts.

  1. Weight gain

Part of growing is also increasing your body weight. This will naturally place extra gravitational load through all structures in the body. Continued sports and exercise while this weight is increasing is one of the risk factors for growing pains.


  1. Reduce inflammation around the tendon to bone attachment

This is crucial in the early stages to reduce pain and to reduce the excessive inflammation that can slow healing. Taping is also very helpful. Icing and anti-inflammatories are  commonly used, but have a debatable effect, as shown by literature.

  1. Activity modification

It may be as simple as reducing the amount of exercise that involves running, jumping and other power-based sports. This allows time for the body to heal the affected structures, while corrective massage and strength exercises take hold.

  1. Massage

Reducing the tension on the tendon to bone structure is paramount. This will include a mix of therapist massage and self massage at home with a foam roller and release ball.

  1. Stretch program

Massage mixed with a stretch program will provide the best way to lengthen muscle. This will be a mix of static (very short duration only) and dynamic stretches.

  1. Strengthening to correct biomechanics

Depending on what the physiotherapist assesses as the main muscles that need strengthening, an individual plan will be provided to target the muscles that need the most work. This could include gluteal, core, quads or calf muscles. This will all then come together with exercises that are specific to your sport, to best train the body to return to full fitness.

Overall, the treatment is very successful for children with tendon injuries. If managed correctly, no long-term effects should be experienced. If there's a delay to the treatment or poor management early in the process, lengthy time on the sidelines can be a common and frustrating part of tendon injuries in children.

Problems with tendon injuries in children?

Please get in touch with us today and book a physiotherapy session with Joel and the team.

Thanks for reading!

This post has been written by PhysioActive physiotherapist Joel Bates.

Thoughts or questions?

Leave a comment below, say hello on Twitter (@physioactivesg) or visit us on Facebook (Facebook.com/physioactivesg).

Golf and shoulder pain: Know your treatment options

Recently I have had an influx of shoulder based injuries suffered by golfers. Now, not all injuries have been a result of their golf swing. Many patients have actually been recovering from other injuries and even surgery, simply wanting to return to the game that they love. I thought this would be a good opportunity to discuss the main causes of golf related injuries and what you can do to prevent them.

The most common shoulder injuries for golfers:

  1. Rotator cuff tear or inflammation
  2. Impingement (soft tissue swelling)
  3. Bone spurs
  4. Cartilage damage
  5. Arthritis


I feel sorry for the shoulder, especially for golfers' shoulders. It's often not the shoulders' fault that someone is experiencing debilitating pain. After screening these golfers, it’s pretty easy to see that the problem is often coming from somewhere else.

Golfers have a thirst for information, be it the latest technology, the recent PGA results, or simply an analysis of their own game. Most will know what a good golf swing looks like. It’s reproducing that swing ourselves that provides the challenge. We all know that movement should follow this basic sequence:

  1. Hips/pelvis
  2. Torso (thoracic spine)
  3. Shoulders/arms
  4. Clubface

Professional golfers from Rory McIlroy to Jim Furyk maintain this same sequence, despite looking drastically different. When we fall foul of this sequence, problems occur. These problems may include:

Golf Ball

The shoulder is a common site of injury for golfers

It is the main structure that transmits the force and power from the torso to the arms and club. Too often I see people in my clinic who use ‘too much arms’. This refers to an excessive reliance on the arms for power and distance. These people always have one (if not all) of the following results on a physical screen:

  1. Poor hip rotation trail leg
  2. Reduced torso rotation to the right (backswing)
  3. Poor core and glutes strength

This is often matched with:

  1. Poor shoulder and back flexibility
  2. Weak back/shoulder blade muscles

These issues create unnecessary loading and stress on structures in the shoulder joint. If the hips and back are not moving the way they should, then how on earth will the shoulder ever cope?

 Gary Player

How to fix shoulder pain

Screening is the priority. Knowing exactly what your body is unable to do is paramount to finding a fix. I see patterns as I have mentioned above, but everyone presents a slightly different case. By knowing exactly what a golfer needs to work on, I can eliminate the unnecessary exercises and focus on the most important.

Hip and back stretching will be a great start. Here are two excellent stretches to get started on better hip and back mobility:

  1. Thoracic rotation stretch with club
  2. Dynamic hip rotations

The next aim will be to control and transfer energy with a stronger core and glutes. Here are two exercises to begin to improve core and glute strength:

  1. Bridge with leg extension
  2. Bird/dog

Of course the shoulder needs special attention as well. Despite causes potentially coming from other areas of the body, the shoulder isn’t always so innocent. Here are two exercises to help the shoulder become more reliable in the golf swing:

  1. Pec stretch/external rotation stretch
  2. Rotator cuff strength and shoulder blade control (theraband row with ER in abdn)

These exercises are a great start. Of course, once you achieve a more efficient body, good coaching is paramount to improving skill. This is where good coaching can take your game to the next level - not only when it comes to injury management, but also to lower that handicap.

Good golfing!

Working on mastering your swing?

Please get in touch with us today and book a performance golf session with Joel and the team.

Thanks for reading!

This post has been written by PhysioActive physiotherapist Joel Bates.

Thoughts or questions?

Leave a comment below, say hello on Twitter (@physioactivesg) or visit us on Facebook (Facebook.com/physioactivesg).

Pain during golf - brave or silly?

As a 12 handicapper, I feel I can play some good shots mixed in with some OK shots, all rounded out with some shockers. My body is getting better at controlling my golf swing, so I can be more consistent and less injury prone. However, at this stage I am one of the lucky ones. I don’t feel any pain during or after a game of golf.

As a physio who treats many golfers, I am staggered by how many people simply put up with pain. Maybe it’s male bravado combined with that great Aussie attitude of ‘I’ll be alright’. It simply doesn’t make sense. The easiest time to fix something is now. It only gets harder as we get older.

30% of golfers feel back pain during or after every round of golf. This is crazy. This tells me two things:

1. Golfers are willing to put up with pain to do something they love – very admirable (however silly in my eyes)
2. 30% of all golfers are hitting way too many shots every round (some may see that as value for money golfing)

Golf Ball

There is a strong relationship between pain in the body and poor ball striking. Pain is a fascinating thing. Nerves rightly or wrongly send an extremely strong message to the brain that interprets this information in a split second, causing varying levels of emotional response. What also happens is a subconscious change to the operating system that controls our muscles, joints and our movements. This means that like it or not, we move differently as a response to pain.

If we feel pain during our golf swing, we will compensate accordingly. I have never seen a golf swing that has changed for the better. No one has felt pain and hit the ball further. This is why I find it staggering that people will put up with pain and not do anything about it. It may be as simple as having good warm ups and great stretching, or slightly changing your weekly exercise routines to help reduce these major roadblocks to better golf.

I screen many people and find numerous things that their bodies could do better. This may be the result of sitting in an office for 8 hours a day. It may be a history of serious injury. Whichever it is, it is never too late to change. See a golf specialist physio and you may just surprise yourself. You may start beating your mates.

Good golfing!

Working on mastering your swing?

Please get in touch with us today and book a performance golf session with Joel and the team.

Thanks for reading!

This post has been written by PhysioActive physiotherapist Joel Bates.

Thoughts or questions?

Leave a comment below, say hello on Twitter (@physioactivesg) or visit us on Facebook (Facebook.com/physioactivesg).