Growth Plate Injuries in Young Athletes: Little League Shoulder, Osgood-Schlatter, and Sever’s
Written by Dr. Josh Funk, DPT
If your young athlete has shoulder, knee, or heel pain, there’s a good chance it’s one of three common overuse injuries: Little League shoulder, Osgood-Schlatter, or Sever’s. They show up in different places but share one root cause, a growing skeleton under repetitive load. Each is an irritation of a growth plate, the area of developing cartilage where a child’s bones grow, at the spot where a tendon pulls: the shoulder, the knee, and the heel. The reassuring part: they’re common, usually manageable, and rarely mean your child has to stop playing. Here’s how to tell them apart and what actually helps.
This article is general education for parents and coaches, not a diagnosis of any child’s specific condition. Pain in a young athlete has several possible causes, and telling them apart accurately takes an evaluation. If your child’s pain is severe, follows a specific injury, causes limping, or comes with significant swelling, night pain, or pain at rest, have them seen by a licensed physical therapist or physician.
Why these injuries happen: a growing skeleton under load
Kids aren’t small adults, and their bones prove it. A child’s bones grow from areas of developing cartilage called growth plates, which are softer and more vulnerable than the mature bone and tendon around them. During a growth spurt, the bones lengthen quickly and the muscles and tendons attached to them get tight, which concentrates stress right at the growth plate where a tendon attaches.
Add repetitive load, throwing, running, jumping, especially with year-round single-sport play and not enough rest, and that spot gets overloaded. The medical term is apophysitis, which simply means irritation of a growth plate at a tendon attachment. It isn’t damage in the way parents fear. It’s a load problem: the demand outran what a growing body was ready to handle. Which is also why it responds so well to the right plan.
The three most common, and how to tell them apart
The clue is where it hurts and what the child plays.
Little League shoulder: shoulder pain in a young thrower. This is irritation of the growth plate near the top of the upper arm bone, driven by the repetitive rotational load of overhead throwing. It’s classic in youth baseball pitchers, usually ages 11 to 16, but shows up in any repetitive overhead athlete (tennis, volleyball, swimming). The signs: an aching shoulder or upper arm during throwing, especially hard throwing, often with dropping velocity or accuracy, and tenderness at the upper arm. This one deserves particular respect. A young thrower with persistent shoulder pain should be evaluated, not medicated and sent back to the mound, because the load falls on an active growth plate. Our complete guide to Little League shoulder goes deeper on pitch counts, the throwing break, and returning to the mound.
Osgood-Schlatter: a painful bump just below the kneecap. This is irritation of the growth plate at the tibial tubercle, the spot below the kneecap where the kneecap tendon attaches to the shinbone. It shows up in running and jumping athletes during a growth spurt, roughly ages 8 to 13 in girls and 10 to 15 in boys. Expect pain, tenderness, and often a prominent bump below the kneecap, worse with running, jumping, kneeling, and stairs, and better with rest. It’s benign and self-limiting, and most young athletes can keep playing with the load managed. Our complete guide to Osgood-Schlatter goes deeper on treatment, timelines, and returning to sport.
Sever’s: heel pain in an active kid. This is irritation of the growth plate at the back of the heel, where the Achilles tendon attaches. It’s the most common cause of heel pain in active children, roughly ages 8 to 15, common in soccer, track, basketball, and gymnastics. The tell: heel pain during and after activity, tenderness when you squeeze the sides of the heel, and sometimes a limp or up-on-the-toes running. A tight calf usually contributes. Like Osgood-Schlatter, it’s self-limiting and resolves as the growth plate matures. Our complete guide to Sever’s goes deeper on calf loading, footwear, and keeping your athlete active through it.
These are the three most common, but not the only options. Young-athlete pain can also come from other growth-plate sites (like the bottom of the kneecap), patellofemoral pain, or, less often, a fracture, which is exactly why a name you land on from an article isn’t a diagnosis. Confirming which one it is comes first.
What they share, and what actually helps
For all three, the root is the same: too much load, too soon, on a growing frame, usually amplified by a growth spurt and often by year-round single-sport play. So the plan rhymes across all three:
- Manage load, don’t just shut down. For most cases, that means relative rest guided by pain rather than stopping everything. Little League shoulder is the exception that needs a defined break from throwing before a gradual return.
- Address the prerequisites. Flexibility, strength, and movement quality are where the real fix lives. There are certain benchmarks that youth athletes should be able to hit to ensure they have a strong foundation for activity and sport.
- Return on a progression, not all at once. Rebuild toward full training rather than jumping straight back to game volume.
- Prevent the next one. Manage training volume (pitch counts matter), build in real rest, and encourage multiple sports. Research links multi-sport participation to lower injury risk than early single-sport specialization.
Framed in our method, it’s Movement Health scaled to a developing athlete: build the quality of how they move (competency), build how much load they can handle (capacity), and prepare them for the real demands of their sport (conditioning).
Why “push through it” and “just rest” are both wrong
Parents tend to hear one of two things: tough it out, or shut it down. Both miss.
Pushing through can drag the problem out, and in the case of the shoulder, it puts an active growth plate at risk. But total shutdown isn’t the answer either. It deconditions the athlete, stalls their development, and does nothing to fix why the injury started. The right path sits in between: confirm what it is, manage the load, build the athlete, and return them smartly. The goal isn’t to protect a kid from their sport. It’s to prepare them for it.
How Rehab 2 Perform works with young athletes
We start by confirming which injury it actually is and ruling out the things that look similar, because a heel, knee, or shoulder can hurt for more than one reason. From there we manage the load, address the flexibility, strength, and movement quality underneath it, and build a return-to-sport progression that gets the athlete back and keeps them there. That’s Assess, Don’t Guess, and it’s Movement Health applied to a body that’s still growing.
You don’t need a referral to start physical therapy. In Maryland and Virginia, direct access laws let a parent bring a young athlete in for an evaluation on their own decision.
When to get it checked
Most of these are safe to begin managing while keeping a child active, but some signs mean it’s time for an evaluation rather than wait-and-see: pain that persists beyond a couple of weeks, pain that causes a limp or changes how they run or throw, night pain or pain at rest, significant swelling, or pain that followed a specific injury. In addition, any young thrower with lingering shoulder or elbow pain should be assessed rather than pushed through. Getting it checked early is usually what keeps them in their season.
Why this matters to me
I played Division I and professional sport, and I’ve seen how easily a young athlete gets overloaded in a single sport played year-round, and how well they respond when you manage the load and build them properly. These injuries aren’t a reason to pull a kid out of what they love. They’re a signal to train smarter. Handled right, they’re a temporary setback, not the end of anything.
Frequently Asked Questions
They’re overuse injuries where a tendon repeatedly pulls on a growth plate, the developing cartilage where a child’s bones grow, causing irritation. The medical term is apophysitis. The three most common are Little League shoulder (shoulder), Osgood-Schlatter (knee), and Sever’s (heel). They’re usually manageable and rarely mean a child has to stop playing.
Little League shoulder is irritation of the growth plate near the top of the upper arm bone, caused by repetitive overhead throwing. It’s most common in youth baseball pitchers ages 11 to 16, and shows up as shoulder or upper-arm pain when throwing, often with dropping velocity or accuracy. A young thrower with persistent shoulder pain should be evaluated rather than pushed through, since the load falls on an active growth plate.
Osgood-Schlatter is an irritation of the growth plate just below the kneecap, where the kneecap tendon attaches to the shinbone. It appears in running and jumping athletes during growth spurts, and causes pain, tenderness, and often a prominent bump below the kneecap that worsens with activity. It’s benign and self-limiting, and most young athletes can keep playing with load managed.
Often yes, with the load managed rather than the season ended. Osgood-Schlatter and Sever’s are usually handled with relative rest guided by pain plus targeted neuromuscular control, flexibility and strength work. Little League shoulder typically needs a defined break from throwing before a gradual return. An evaluation sets the right plan for your athlete.
Treatment centers on managing load, addressing the control, flexibility, strength, and movement quality underneath the injury, and returning to sport on a progression rather than all at once. The goal is to resolve the pain and build the athlete so it doesn’t keep coming back, not just to rest until it quiets down.
Manage training volume (pitch counts for throwers), build in real rest and recovery, encourage participation in more than one sport, and pay attention during growth spurts when tissues are most vulnerable. Research links multi-sport participation to lower injury risk than early single-sport specialization.
In Maryland and Virginia, no. Direct access laws let you book a physical therapy evaluation for your young athlete without a physician’s referral.
Ready to Perform at Your Best?
If your young athlete is dealing with shoulder, knee, or heel pain, you don’t have to choose between their health and their season. Book an evaluation at one of our 15+ DMV locations. We’ll confirm what it is, manage the load, and build a progression that gets them back to their sport and reduces the risk of it coming back. No referral needed in Maryland or Virginia. That’s Ready 2 Perform, and Assess, Don’t Guess.