Being a kid is great and I bet we all wish sometimes that we still were, however, kids do get the rough end of the stick when it comes to injury. Compared to adults they are at a much higher risk of injury, which comes down to the fact that they are still growing. And not growing evenly to make it worse!
Bones and muscles growing at different rates to each other lead to all types of issues. Combine this with decreased coordination, sports skills they are yet to development and a lack of body awareness and you’ve got a recipe for injury. Kids are also doing more training sessions, and with increased intensity. I often see kids involved in u12 sports teams that have spent most of training doing fitness followed by a lack of cooling down or warming up.
Why do growing bones contribute to injury?
Not only are kids at an increased risk of injury, but they also differ in the types of injuries they experience in comparison to adults. Growing bones are very different to adult bones in their anatomy and makeup. Having growing bones does have a few advantages. The outer layer of bone in kids (the periosteum) is thicker and has a better ability to heal. The articular cartilage that covers the bone where it forms a joint (such as in your knee or hip joint) is thicker and has the ability to remodel.
However, the biggest difference in growing bones that makes them unique is the presence of a growth plate. These sit at either end of long bones, such as your thigh bone (femur), shin bone (tibia) and upper arm bone (humerus). Interestingly growth plates within a singular bone grow at different rates, as in the top part of the bone may be growing faster than the lower part of the bone! As you can imagine this can throw all sorts of things out of proportion! The growth plate is also a weak spot in the bone, in particular where the growth plate attaches to the rest of you bone, making it vulnerable to disruption.
Another weak point in kids is where tendons attach to bone. This often results in what’s called an avulsion fracture, where the tendon or ligament pulls a piece of bone with it rather than damage to the tendon or ligament sprain occurring. A simple ‘rolled’ ankle seen in the clinic might mean a sprained ankle for an adult but a fractured ankle for a kid!
The cortex or middle part of long bones are also more resilient and elastic which results in incomplete fractures, also named greenstick fractures that are only seen in children.
Like you might expect kids are at particular risk during growth spurts as structural changes occur. The growth plates becomes thicker and more fragile, resulting in an increased incidence of fractures during puberty.
Types of Injuries: Adults vs Kids
| Mechanism of injury | Adult injury | Child injury |
| Shoulder joint force at end of range | Dislocation | Fracture humerus growth plate |
| Acute thigh/hip force/muscle contraction | Quad/hamstring muscle strain | Fracture of pelvis (ASIS or Ischial tuberosity) |
| Overuse knee | Patellar tendinopathy | Osgood Schlatters or Sinding Larsen Johansson |
| Acute trauma knee | Meniscus/ligament injury | Fractured shin bone (tibia or fibula) |
| Heel overuse | Achilles tendinopathy | Severs |
So what does this all mean and what can be done about it?
Due to all these differences in bone structure, younger athletes and kids are more likely to injure bone and cartilage or for a ligament to break off a piece of bone, than to sprain a ligament, strain a muscle or suffer a tendinopathy like an adult would.
This is why it is important that injury risk is minimised as much as possible. A decent warm-up should be implemented at the start of training and games, involving dynamic movements and skill based activities related to the sport. This should be followed by a cool down involving a light jog and dynamic or passive stretches after sessions. Depending on the age of the child general strength and mobility are also significant factors that can contribute to injury if not adequate!
If you’re child is in pain for any of the above reasons (bone, muscle, tendons or even growing pains), get them assessed! Many people try and “wait for the pains to pass”, but there is always something that can be done to reduce the amount of pain or reduce the time it takes to settle down. Don’t sit back and wait, get your children back to being happy and healthy kids again, running around pain free like they should be!
