All parents of growing athletes, as well as coaches and trainers who work with youth athletes, should fully understand the function and importance of growth plates. This article will explain:

• What growth plates are
• Where growth plates are located
• How growth plates become injured
• How to recognize growth plate injuries
• Treatment of growth plate injuries

RELATED: Growing Bones and CrossFit Kids: Biology Every Kids Coach Should Know

What Are Growth Plates?

The growth plate determines the future length and shape of the mature bone. Also known as the epiphyseal plate or physis, growth plates are the developing tissues at the end of long bones.

Long bones are bones that are longer than they are wide, such as in the legs, arms, toes, and fingers. Each long bone has at least two growth plates at each end, which sit between the metaphysis (the wider end of the bone) and the epiphysis (the rounded end of the bone). The long, middle part of the bone is the diaphysis.

“Injuries to the growth plate are called fractures and can be caused by a traumatic event, such as a fall, or from repetitive motions and overuse that place stress on the bone.”

When a child’s bones have completed growing, the growth plates harden and cause the epiphysis to fuse with the metaphysis, forming one complete bone. Contrary to common belief, bone growth occurs at the ends of the bone around the growth plate, rather than from the middle of the bone.

Growth Plate Fractures

According to the Pediatric Orthopaedic Society of North America, approximately fifteen to thirty percent of all childhood fractures involve the growth plate. Because girls tend to reach skeletal maturity earlier than, their growth plates usually close around ages thirteen to fifteen, while boys’ growth plates close around ages fifteen to seventeen. As a result, girls’ bones finish growing sooner and their growth plates are replaced by stronger, solid bone. Accordingly, growth plate fractures occur twice as often in boys than in girls.

Growth plates are located at the end of the following bones:

• The long bones of the hand and fingers (metacarpals and phalanges)
• Both bones of the forearm (radius and ulna)
• The bone of the upper leg (femur)
• The lower leg bones (tibia and fibula)
• The foot bones (metatarsals and phalanges)

“One-third of all growth plate fractures occur during participation in competitive sports such as football, basketball, baseball, or gymnastics.”

Growth plates are the weakest areas of a child’s growing skeleton and are even more susceptible to injury than nearby tendons and ligaments. Injuries to the growth plate are called fractures and can be caused by a traumatic event, such as a fall, or from repetitive motions and overuse that place stress on the bone. This stress can cause growth plates to become inflamed, producing pain and swelling. If use of the injured area continues, the growth plate may begin to separate from the rest of the bone.

One of the more common repetitive growth plate injuries, medial epicondyle apophysitis, also known as Little League elbow, can actually occur in many different sports, such as volleyball, tennis, or any other sport that significantly stresses the elbow. Little League elbow is aptly named though, as statistics from Nationwide Children’s Hospital state that in the over two million children who participate in Little League activities per year, elbow pain occurs in up to twenty percent. Further studies show that 26% of elbow pain occurs in baseball players between the ages of nine to twelve.

READ MORE: The Real and Present Danger of Overtraining Youth Athletes

While all children are at risk for growth plate injuries, there are certain factors that put a child at a higher risk:

• One-third of all growth plate fractures occur during participation in competitive sports such as football, basketball, baseball, or gymnastics.
• About twenty percent of all growth plate fractures occur during participation in recreational activities such as biking, sledding, skiing, or skateboarding.
• The incidence of growth plate fractures peaks in adolescence.

Working Through the Pain?

No, not in this case. A child who has pain that affects his/her athletic performance should never be allowed or expected to “work through the pain.” Medical assistance should be sought, whether an injury is acute or due to overuse. This is particularly true if any of these symptoms are present:

• Persistent or severe pain
• Visible deformity (crookedness in the limb)
• An inability to move or put pressure on the limb
• Swelling, warmth, and tenderness in the area around the end of the bone, near the joint

“If not treated properly, growth plate injuries could result in a limb that is crooked or unequal in length.”

Touching upon, but not delving into the various classifications of growth plate fractures, the Salter-Harris system is the most commonly used method to describe growth plate fractures. Many growth plate injuries are minor and involve rest and non-weight bearing of the affected area. But, dependent upon the severity of the fracture, more in-depth medical procedures may be needed ranging from a cast, splint, or brace to reduction (manipulating the growth plate back into place) to surgery.

GAIN PERSPECTIVE: Strength Programming for the Adolescent Athlete

Take All Reports of Pain Seriously

Growth plate injuries can be scary, but the bottom line is this: complaints of pain in children and adolescents, especially those who have had a recent fall or who play competitive sports, should be taken seriously and be checked by a doctor.

Because the growth plate helps determine the future length and shape of the mature bone, this type of fracture requires prompt attention. If not treated properly, growth plate injuries could result in a limb that is crooked or unequal in length. Fortunately, serious problems are rare, and with proper treatment, most growth plate fractures heal without complications.

References:

1. “Elbow Injuries in Young Throwers.” Nationwide Children’s Hospital. Accessed 26 January 2015.

2. “Growth Plate Fractures.” The Pediatric Orthopaedic Society of North America. Reviewed by members of the Pediatric Orthopaedic Society of North America, Oct 2014. Accessed 26 January 2015.

3. “Growth Plate Injuries.” Kids Health. Reviewed by Kevin M. Neal, MD. Date reviewed: June 2013. Accessed 25 January 2015.

4. “Growth Plate Injuries.” National Institute of Arthritis and Musculoskeletal and Skin Diseases. NIH Publication No. 14–7845, May 2014. Accessed 26 January 2015.

5. “Preventing Musculoskeletal Sports Injuries in Youth: A Guide for Parents.” National Institute of Arthritis and Musculoskeletal and Skin Diseases. NIH Publication No. 12-4821, June 2013. Accessed 25 January 2015.

Photos courtesy of Shutterstock.

The post More Than Just a Funny Bone: Preventing Growth Plate Injury appeared first on Breaking Muscle.

Maybe you’re thinking that is a ludicrous thought. I mean, your feet are something that take you from point A to point B, right? You don’t need to train them. Oh, but how wrong you are. 

RELATED: Understanding and Caring for Your Feet

If you don’t believe me, read on – because I’m going to tell you the two most important reasons you should be training barefoot and how to safely transition to ditching those socks and shoes. But first, I’m going to explain what you’re doing right now that’s got your feet so messed up to begin with.

Your Feet Are Your Foundation

Your feet are your foundation, your base of support. Think about it: your feet are the only part of your anatomy that comes in contact with the ground. All of the force that you transmit through your entire body goes through your feet. Your feet help transmit these forces, balance you, and are also key to movement.

But what do you do to our feet all day? You cram them in shoes. You limit their mobility and take away the sensory input they provide you. And you try to correct issues you think you have such as flat feet or high arches.

 “All of the force that you transmit through your entire body goes through your feet.”

Here’s the thing. There are 28 bones in your foot, twenty muscles, and over thirty joints. Simply picking the “right shoe” isn’t the end of what you need to do for your feet. Remember, the body doesn’t work in isolation. It is all connected. Any decrease in strength, mobility, or proprioception in your foot doesn’t end there. It impacts your leg, your hip, your pelvis, and so on. And just like with any other muscle, disuse can lead to atrophy and decreased muscle activation.

RELATED: 4 Common Foot Injuries in the Athlete

So, you need to work on your feet. And one of the best ways to do this is to do your strength and conditioning training barefoot. Lift weights barefoot. Do your conditioning barefoot. Warm up and cool down barefoot.

Now, here are the two reasons you should be training barefoot, specifically as it relates to your performance (and getting better performance).

Training Barefoot Increases Sensory Input

When you are wearing a shoe, or even a sock, you are changing the sensory input your brain receives from the ground. When you are barefoot, you get tons of input all about the surface you are standing on, the position of your joints, and the tension of your muscles.

RELATED: At the Core of It: Creating Strength and Tension in the Body 

Put on a sock or a shoe, and you lose a significant amount of this information. This then means your foot can’t work efficiently. Some muscles shut off because they don’t have to work due to the support of the shoe, while others work too hard or at the wrong time. This influences how the rest of your muscles work up the entire kinetic chain, effectively changing your entire movement pattern throughout your lift.

Imagine wearing gloves all day while you are working. Think of typing with those gloves on. You wouldn’t feel the keys under your fingers, so you wouldn’t know exactly how much force to apply and would likely apply too much.

The same thing happens when you wear shoes on your feet. You can’t sense the ground beneath you, so you end up working inefficiently and compensating with other muscles. This not only affects the strength and mobility of your feet, but it will also influence your entire lift and the force you are able to exert.

Training Barefoot Prevents Injury

By training barefoot, you are improving the strength, mobility, and proprioception of your feet. Proprioception refers to the knowledge of the position and movement of the body, and the ability to react accordingly.

When you wear shoes you lose this proprioceptive input. This means if something unexpected happens – you hit a piece of uneven ground or you make a quick cut while playing sports – your body won’t be able to perceive this change and react accordingly to protect itself from injury.

“The body works as a unit, and an issue in the foot can lead to an injury at a completely different part of your body.”

Try something for me right now. Take off your shoes, stand on one foot with your other in front of you, and close your eyes. Can you stand there fairly easily without falling or flailing all over the place? If not, we need to work on your proprioception.

Beyond proprioception, training barefoot will further prevent injury by improving your foot strength and mobility. This is key because it will prevent your body from compensating with other muscles that will create imbalances, improper muscle recruitment, and poor joint alignment. The body works as a unit, and an issue in the foot can lead to an injury at a completely different part of your body.

Okay, that sounds all fine and good, but won’t I get stress fractures, you ask? Or what if I drop a weight on my foot? Let’s break down these questions so you don’t have to fear these myths anymore.

Myth #1: You Will Get Stress Fractures

Gym folklore says this happens due to increased load and lack of cushion. But this is just not true. Sure, if you go from training in cushioned shoes to running 10km a day barefoot outside, you might have some problems. But that isn’t what I’m telling you to do.

RELATED: Shoes or No Shoes: How and Why to Build Up to Barefoot Running

For all of you who believe you will get stress fractures if you train barefoot, let me remind you of something called Wolff’s Law of Adaptivity. This law was developed by German anatomist and surgeon Julius Wolff (1836-1902) and states that bone in a healthy person or animal will adapt to the loads under which it is placed.

The law explains that if loading on a particular bone increases, then the bone will remodel itself over time to become stronger to resist that sort of loading. The inverse is also true. If loading on a bone decreases, the bone will become weaker, as it is metabolically costly to maintain bone and there is no stimulus for the continued remodeling required to retain that bone mass.

“So basically, if you train barefoot, you will improve the strength of your bones, making them able to withstand more load. But if you constantly wear cushioned shoes, you will make your bones weaker.”

So basically, if you train barefoot, you will improve the strength of your bones, making them able to withstand more load. But if you constantly wear cushioned shoes, you will make your bones weaker. Seems like a no-brainer to train barefoot.

Myth #2: You Will Drop a Weight and Hurt Yourself

Short and sweet here. First, try not to drop a heavy weight on your foot and you will be just fine. I work in a training studio that is almost exclusively barefoot and we have yet to have someone drop a heavy weight on his or her foot and get injured. Why? Because our clients watch what they are doing.

But even still, if you were to drop a weight on your foot, the small amount of fabric provided by a shoe is not going to make a difference. That little cushion isn’t going to be the difference between a fracture and no fracture. Sorry to break it to you, but this reason for wearing shoes is invalid.

How to Transition to Barefoot Training

I implore you try barefoot training. My only rule is that you have to transition slowly. Don’t go from zero to 180. Start with doing your warm up and cool down barefoot. Do that until you feel comfortable. Then, start lifting barefoot. Again, do that until you feel comfortable. Then, when you’re ready, transition your conditioning (sprinting, jumping, etc.) to barefoot.

Not only will you feel the difference in your lifts, but your body will thank you for doing this. And if you’re unsure of how to make the transition, work with a professional who can help you move from stage to stage without risk of injury.

References:

1. Verstegen, M.. “Sport Performance”. A Meeting of the Minds. Perform Better. Phoenix, AZ, US. October 29 2011.

2. Wolff J. The Law of Bone Remodeling. Berlin Heidelberg New York: Springer, 1986 (Translation of the German 1892 edition).

Photo courtesy of Shutterstock.

The post Train Barefoot to Increase Your Lifts and Avoid Injury appeared first on Breaking Muscle.

Resistance training is known to benefit bone health. The forces required to move heavy weights without collapsing encourage the activity of osteoblasts, the type of cells that make up bone. In fact, while impact exercise is generally considered superior to resistance training for building bone, the latter seems to better able target more of your bone. However, high acceleration of the weights is important for this goal.

In the Journal study, the researchers hypothesized that prevention was the best strategy for maintaining healthy bones. Since bone mineralization peaks in your twenties, they suspected that this is the best time to work at maximizing bone health to prevent problems later on. Since women are at higher risk for bone problems, the participants of the study were all young women in their early twenties.

The researchers focused on maximal strength training, paying special attention to how it might affect the spine and hips. Maximal strength training requires high loads and relatively high acceleration, making it a solid candidate for bone development. Because of these goals, the researchers used the hack squat for the test. The hack squat is a quick and short exercise working with heavy, whole-body loads.

The participants did the hack squat three times per week. Each workout included a warm up and four sets of three to five reps at 85%-90% of their one-rep-max. The participants focused on accelerating during the concentric phase. The loads used were evaluated in every session to ensure they were progressing steadily. The program was performed for twelve weeks – a rather short time frame – to see if it would be beneficial.

After the program, the mineral density of the spine increased by 2.2% and the hip increased by 1%, which were pretty good gains. These improvements were accompanied by a doubling of their hack squat one-rep-max, and nearly as much of an improvement in acceleration.

The women in this study had not trained extensively in lower-body exercises prior to this program. As a result, it’s not possible to say if these results would continue, especially at this pace. With bone, there may well be a beginner’s gains effect, just like we saw with the huge strength improvement. That said, since they were able to use much heavier weights by the end, their potential to encourage new bone development might actually have increased.

While we still don’t know if this is the best strategy, we do know that it’s effective. As with most things, it seems that prevention is the best medicine when it comes to bone health. Spend some time with heavy weights and fast reps to keep your bones healthy.

References:

1. Mats Mosti, et. al., “Maximal strength training improves bone mineral density and neuromuscular performance in young adult women,” Journal of Strength and Conditioning Research, DOI: 10.1519/JSC.0000000000000493

Photo courtesy of George Stepanek via Wikimedia Commons.

The post Women: Lift Heavy and Fast While You’re Young appeared first on Breaking Muscle.

Bone mineral content and bone density are two of the major measurements scientists and doctors use to determine bone health. Being too low or too high in either of these categories may make you more prone to injury at any age. In a recent study in the Journal of the International Society of Sports Nutrition, researchers looked at which behaviors affect the bone density and content of young healthy individuals.

In the study, researchers compared what a group of young men did for activity and how they ate to a host of other factors, including bone mineral content and density. When it came to diet it should be no surprise that the men who consumed more than one gram of calcium every day had better overall bone health than those who ate less. The men who consumed higher amounts of calcium were also taller on average.

There were a few more associations the researchers examined. If the subjects who ate a lot of calcium were taller, they should also have more bone mineral by default, since they were subjected to greater forces on a daily basis. This hypothesis proved to be true. The greatest correlation for dietary calcium intake to bone health was when the researchers divided bone mineral content by body mass index (BMI). It seems that when we factor out size, there still seems to be a relationship between calcium intake and bone health.

When it came to physical activity, the relationship was even more dynamic. When comparing moderate and vigorous physical activity to bone health, the men who spent more than twenty percent of their daily energy exercising intensely didn’t show significant results – until the researchers factored out weight. Once they took body mass out of the picture, there was a strong association between bone health and physical activity. The researchers based their definition of ‘vigorous activity’ on energy expenditure over fifteen minutes, and not on the type of activity that was done. Bear in mind from a previous article that some activities, such as cycling, may reduce bone health if done vigorously over a long period of time.

Now that we have a study that shows such a strong association between bone health, exercise, and diet, it would be nice in the future to establish causation. Also, vitamin D may need to be accounted for as well. This study was done in Australia, a country with a lot of sunlight populated by northern Europeans. The results may not be the same in other locations or with other populations.

Hopefully another study will put these findings to the test. As far as we can tell from this review, a well-rounded diet and exercise win the day when it comes to bone health. Not much of a surprise ultimately, but good to hear anyway.

References:

1. Selma C Liberato, et. al., “The role of physical activity and diet on bone mineral indices in young men: a cross-sectional study,” Journal of the International Society of Sports Nutrition 2013, 10:43.

Photo courtesy of Shutterstock.

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Indeed evidence is conflicted over what percentage of 1RM actually allows the greatest expression of power. In fact, it seems that from exercise to exercise and even person to person, the best weight to use for power output is variable. A recent study in the Journal of Strength and Conditioning covered why this might be.

The researchers looked at each athlete’s anthropomorphic measures, meaning their actual unchangeable physical characteristics like arm length, and some changeable measures like arm girth. They tested each athlete, in this case rugby players, for their 1RM and then determined at which percentage of that weight each athlete could produce the most power.

What they determined was that limb length was negatively correlated with the weight at which the greatest power was produced. That sentence was a bit heavy, so let me break it down a bit better. The biggest correlation was in upper arm length, basically your humerus – from shoulder to elbow. The longer the humerus bone, the lower the weight you need to express the greatest power. People with long humeri averaged maximal power output at about 22% of their 1RM, where people with shorter humeri expressed the most power at an average of 38%.

The same negative correlation applied to muscle size and experience. The bigger and stronger the athlete was, the less weight was needed to achieve the greatest power output.

The recommendation by the researchers is to use this information to determine what weight is appropriate for a lifter who wants to train for the development of power in the upper body. The longer limbed the person, or the bigger and stronger they are, the less weight will be necessary to accomplish this goal. It’s a bit surprising just how little weight was necessary. The average for all the athletes was right around 30%.

Now, you may have seen powerlifting protocols recommending heavier weights than this. That advice might still be good. In the study the researchers actually used a “bench throw” exercise, which was a bench exercise inside a Smith machine in which the athletes would actually release the bar, trying to launch it well above themselves. Because with a regular bench press this would not be safe, you would likely need to press a weight up as fast as possible and hang on to it at the end. As this will slightly slow the movement, a heavier weight would be required to achieve the peak power at that reduced velocity.

With this evidence, athletes interested in developing upper body power production might want to reduce their loads, or even look into alternative methods in which their weighted implement can be released. It seems these lighter loads are the best for the expression of power, and similarly are probably best for the development of power.

References:

1. Christos K. Argus, et. al, “Assessing the variation in the load that produces maximal upper-body power,” Journal of Strength and Conditioning, DOI: 10.1519, 2013

Photo courtesy of Shutterstock.

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Recent research found a higher frequency of stress fractures in female athletes. Research in the American College of Sports Medicine, investigated bone quality, bone strength, and muscle strength in female athletes diagnosed with stress fractures.

Researchers tested female athletes with lower limb stress fractures, premenopausal athletes, and healthy athletes. The bones of these athletes were assessed at the distal tibia of the dominant leg. The tibia bone is the most common area for stress fractures in female runners. Researchers concluded that there was significant difference in impaired bone quality in the posterior region of the distal tibia in these female runners. There was also decreased muscle strength in the lower limbs female athletes which could lead to more risk for stress fractures.

Prevention Tips:

• Initiate any new training programs slowly.
• Maintain rest and recovery periods.
• Wear appropriate running shoes or shoes for your sport.
• Try shock absorbent insoles and/or orthotic shoe inserts.
• Maintain good nutrition habits and a healthy weight.
• Seek medical attention for any abnormal or irregular menstruation issues.
• Do not train through pain seek medical advice early.

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