What Is a Growth Plate Injury?
At our baseball training programs and baseball training camps, we work with players of every age and experience level. It’s not uncommon to have a major league client on site, but it’s also not unusual to see a cool 9 year-old running around either.
And, as the arm pain management division of the Baseball Ranch® consortium, I field a lot of questions about growth plate injuries.
So what are growth plate injuries, and how do they occur?
First let me tell you what they are not… usually they are not catastrophic. So when you find that your son or daughter, or one of your players has suffered a growth plate injury there is no need to panic. Most of the time, a simple period of rest is all they need to get back on track.
Think of growth plates as little bone factories, manufacturing bone cells and depositing them on the bone to make it longer.There are several growth plates in the shoulder and the elbow. When an athlete is fully grown, these growth plates fuse and the factory shuts down. At younger ages, growth plates are highly active and vulnerable to stress.
When under stress, the body will usually break at its weakest link. In older athletes, the weak link is the connective tissue (rotator cuff, labrum, UCL). In the younger population the weak link is the growth plate.
Not all growth plate injuries are the same. In our baseball training camps and programs, we treat growth plate injuries very differently depending on the type of injury. This is why, if you’re healing from an injury, it’s good to understand the classifications before attending our baseball training camps.
The Nature Of Different Growth Plate Injuries
The Salter-Harris classification is a simple and easy to remember system to identify the nature and severity of a growth plate injury. It uses the name “Salter” as a pneumonic memory jogger. According to sketchymedicine.com, it goes something like this.
- SEPARATED(the bone and the growth plate have come apart) – but it actually looks normal on x-ray (you can only tell on physical exam)
- Fracture ABOVEthe growth plate
- Fracture LOWER(below) the growth plate – fracture extends to the articular surface
- Fracture THROUGHthe growth plate
- Fracture ERASING/compressing/squashing the growth plate – this is the worst kind because with disruption of the growth plate comes disruption of growth. Some odd things can cause these ones like frostbite, electric shock and irradiation. They’re hard to see on x-rays but show up on MRIs.
Depending on the classification of the injury, treatment could range from simple rest, to casting, to surgery.
Most of the growth plate injuries we see are of the S variety — the growth plate becomes separated, and manifests itself in the form of pain. This type of injury may or may not be seen on x-ray. But, if a young athlete experiences persistent pain in the shoulder or the elbow, you should be suspicious of a growth plate injury.
The same variables that contribute to soft tissue injuries in the older athlete, also place the growth plates at risk. I discussed these factors at great length in my book, Start With The Pain: The Complete Guide To Managing Arm Pain In The Elite Throwing Athlete, but as a review, here they are again in order of significance:
Type 1 contributors: structural/physical related (tightness, weakness, asymmetries, imbalances, etc…)
Type 2 contributors: movement pattern related.
Type 3 contributors: tissue preparation and recovery.
Type 4 contributors: training related factors.
Type 5 contributors: workload (pitch counts, innings limits).
Type 6 contributors: nutrition, hydration, sleep, and psychological stress.
What We Do For Growth Plate Injuries
Coaches at our baseball training camps know that, when you have a soft tissue injury (UCL, labrum, rotor cuff) that doesn’t result in catastrophic failure, it’s very important during the rehab process that you provide controlled stress to organize the healing tissue along the line of resistance. It’s a concept known as Davis’s Law – a physiologic precept stating that all connective tissue in the human body organizes itself to resist the stresses under which it is placed. For this reason, in the case of soft tissue injuries to the throwing athlete, rest may be the worst thing you can do. If the tissue is not completely disrupted, it needs a mechanical signal to guide reorganization as it heals. This is when we recommend light throwing or throwing in the Durathro® Training Sock for players in our baseball training programs.
What To Do While Healing
But when it comes to growth plate injuries, tissue reorganization is not the primary goal. Protecting the growth plate and preventing the injury from progressing to a more serious situations is the order at hand. In that regard, the growth plate injury is one of the few throwing disorders for which I would indeed prescribe rest. An acceptable amount of rest could range from 2-8 weeks depending on the nature and severity of the injury. By “rest”, we mean avoidance of throwing, not complete cessation of all training activities.
When working with injured players in our baseball training camps, one of our mantras is, “Never let what you can’t do keep you from doing what you can.” While the athlete is waiting for his growth plate aggravation to subside, he should work to eliminate any possible constraints in stability and/or mobility that might be contributing to the problem. He may also be able to work on improving lower half power and efficiency – traits that will help him attenuate stress on the arm once he’s read to resume throwing. During this time, the young athlete can also learn a quality warm-up and recovery process that will serve him well when he eventually resumes throwing activities.
After Rest Period
After the appropriate rest period has elapsed, it is extremely important to address all the movement pattern related variables that might have contributed to the injury. A video analysis of the throwing pattern should reveal any arm action of lower half inefficiencies that might have combined with structural, preparation, recovery, or training related factors that could have created an environment for his injury to occur. From this analysis, an individualized corrective throwing plan can be designed and executed.
Frequency, intensity and volume of throwing should always be ramped up gradually, monitoring the athlete for any report of pain.
If you are the parent or coach of a young thrower, awareness of the possibility of a growth plate injury could lead to early detection, intervention and avoidance of a more severe injury.
Do you need to get an x-ray or a MRI immediately if your adolescent thrower reports pain? Probably not.
Most growth plate injuries are relatively benign and respond well to brief rest. However, in the case of intense, intolerable pain, or if the pain persists even after a couple of weeks of rest, it may be helpful to seek out imaging to get a more clear picture of the situation and possible treatment options.
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