Treatment for Growing Pains in Adolescents: Treatment for apophysitis & treatment for avulsion fracture?

To Understand Treatment for Growing pains, Firstly What are Growing Pains?

In looking at the treatment for growing pains, the treatment for apophysitis and the treatment of avulsion fracture you firstly need to understand what these conditions are and why they occur – check out our previous blog – CLICK HERE – for all the answers to these questions.

In this blog we will look at ways these conditions can be managed and the ways in which your hip pain professional can help you. 

The bones of the hip and pelvis viewed from the front. Growth centres (apophyses) are delineated by the dotted red lines.These are sites of apophysitis and avulsion fracture where a small bit of bone may dislodge and the muscle that attaches there. Most common sites are depicted on the right and less common on the left of the picture. ASIS: anterior superior iliac spine. AIIS: Anterior inferior iliac spine

Treatment for Growing Pains, Specifically Treatment for Apophysitis 

Treatment for Apophysitis is conservative, meaning non-surgical.  Apophysitis is generally managed well with good education around temporary activity modification, icing after activity and an exercise program. Taping to support the muscle-bone interface may sometimes be successful in providing some pain relief and can be a useful adjunct in treatment for Apophysitis.  

An exercise program aims to: 

  • optimise trunk and pelvic control to avoid unnecessary stresses and strains across the pelvic region  
  • gradually restore muscle strength and length as pain settles 
  • restore full sporting function as pain allows   

Treatment for Growing Pains, Specifically Treatment for Avulsion Fracture 

change of direction training can aggravate groin pain

Non-Surgical Care in the Treatment for Avulsion Fracture

When considering treatment for avulsion fracture lets first look at the non-surgical options.  

Adolescents with a minimal displacement of the bony fragment are generally treated non-surgically. Most will require a period of protected weightbearing, where crutches as used during walking to allow the pain to settle and the fracture to heal. Icing in the acute period can assist with pain relief. There is some evidence that non-steroidal anti-inflammatory medications should be avoided or limited where a bony injury is involved, due to the possibility that these medications may interfere with the bony healing process2. 

Rehabilitation is initiated at an early stage to prevent unnecessary levels of muscle weakening and reduced mobility. An exercise program will have similar aims as for apophysitis, but the progress and recovery will be slower.  

Return to sport requires:  

  • bony healing 
  • restoration of range of motion and muscle strength 
  • restoration of agility and sport specific skills 
  • restoration of confidence to return to sport (sport readiness) 

Surgical Care in the Treatment for Avulsion Fracture

Now let’s consider the surgical treatment for avulsion fracture.  Surgical intervention to reattach the fragment are rare in the immediate post-injury phase. This is generally reserved for athletes who sustain an avulsion fracture of the ischial apophysis (hamstring insertion at the sitting bone), where the bony fragment has been displaced more than 2cm.   

Later stage surgery may be considered in those with: 

  • failed bony healing (non-union of the fractured segment) 
  • persistent pain 
  • inability to restore full muscle function with non-surgical measures.  

An intensive rehabilitation program will be required following surgery. 

 Visit our Pain Locator Map to learn more about soft tissue related pain in different regions around the hip and pelvis, or other causes of groin pain. 

Need Help? How Can A Hip Pain Professional Help?

Your Hip Pain Professional can:

  • provide a thorough assessment of all the soft tissues and boney points around the site of injury
  • refer you for appropriate scans, if necessary 
  • provide or refer you for rehabilitation of this area,  
  • provide advice and/conditioning for successful return to sport 
  • refer you to a surgeon or provide surgery (if your HPP is a surgeon) – this is rarely required but may be necessary – read the “Surgical Care” paragraph above in treatment for avulsion fracture.

Always seek out a health professional with extensive experience and up-to-date knowledge in this area. Visit our directory to find a Hip Pain Professional near you. 

Search For A Hip Pain Professional Here.


This blog was written by Dr. Alison Grimaldi, with contribution from one of our Hip Pain Professionals, Kirsty McNab, experienced physiotherapist.

Dr. Alison Grimaldi is a globally recognised expert physiotherapist, researcher, and educator, who has over 30 years professional clinical experience helping patients recover from a wide range of hip and pelvic conditions.

Dr Alison Grimaldi - Hip Pain Professional

Dr. Alison Grimaldi  BPhty, MPhty(Sports), PhD, FACP 

Dr Grimaldi has completed Bachelor of Physiotherapy, Master of Physiotherapy and  Doctor of Philosophy (Physiotherapy) degrees. She is a fellow of the Australian College of Physiotherapists, Practice Principal of PhysioTec Physiotherapy, an Australian Sports Physiotherapist , an Adjunct Senior Research Fellow at the University of Queensland, as well as an author and global educator. Her passion is helping people with hip pain, and educating other health professionals around how to help more people with hip pain.

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Check Out More You Can Read on this Area at HipPainHelp:

  1. What are Growing Pains around the Hip & Pelvis: Apophysitis and Avulsion Fracture: And Why What are growing pains? Might there be apophysitis or an avulsion fracture? Learn what these terms mean, usual symptoms and causes

  2. Anterior Hip Pain Pain at the front of the hip may be related to Apophysitis and avulsion fractures in kids and adolescents, but there are also many other possible reasons – learn more here.

  3. Low Buttock Pain  Pain over the sitting bones may be related to Apophysitis and avulsion fractures in kids and adolescents, but there are also many other possible reasons – learn more.

  4. Hip Pain Explained Explore more about possible causes of pain throughout the hip and pelvis region.

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