Why growth and injury risk should be on your radar
Growth and injury don't get enough airtime in most coach education programmes. The adolescent growth spurt is one of the few periods where an athlete is genuinely more vulnerable to specific injury types, and the mismatch between what a young body can tolerate and what a squad programme asks of it can cause real harm if nobody is paying attention.
The core issue is tissue mismatch. During rapid growth, bone elongates faster than tendons, muscles, and ligaments can keep pace. Growth plates, the cartilaginous zones near the ends of bones that allow growth to happen, are mechanically weaker than the mature bone that will replace them. Coordination drops temporarily as the nervous system recalibrates to longer limbs.
These conditions are transient. But they last long enough to matter, typically 6-18 months around Peak Height Velocity (PHV), and they respond to load management in ways that can either prevent injury or compound it.
Pre-PHV: low risk, not zero
Before the major growth spurt, tissues are reasonably well-matched and most injuries are traumatic: sprains, fractures from falls and collisions, the things you'd expect from active young people. Growth plates exist but they're not under the stress they'll face at peak growth.
The main pre-PHV risk factor is early specialisation. Athletes doing more than 10 hours per week in a single sport before age 13 or 14 accumulate asymmetric loading well before the relevant structures are ready for it. A young cricketer bowling heavy volumes year-round, a gymnast in full training from age 8, a junior tennis player doing hundreds of serves a day — these patterns produce stress fractures and growth plate issues that simply wouldn't appear in a more varied programme.
Keep weekly organised sport volume broadly in line with the athlete's age in years, maintain variety across activities, and treat this phase as the time to build a robust movement base. Catching poor landing and cutting mechanics now costs almost nothing. Waiting until they're 14 and fast is much harder.
Around PHV: the high-risk window
This is the stage that warrants the most attention in your injury management. During and around PHV, bone grows faster than surrounding soft tissue can adapt. Tendons get tighter relative to bone length. Growth plates are weaker than the cortical bone that will eventually replace them. Coordination dips as the nervous system adjusts to new proportions.
Injury incidence in this window runs roughly 1.5 to 2 times higher than in pre- or post-PHV athletes. The specific conditions that cluster here are almost exclusive to this developmental window. A coach who can recognise them early genuinely changes outcomes.
Expect movement quality to look worse before it improves. That's not a training problem; it's biology. The right response is to reduce load and maintain skill work, not to push through on the assumption that technique will sort itself out.
Injuries to recognise
These are the growth-related conditions most likely to appear in squads during and around PHV. Recognising them early means fewer athletes managed incorrectly and fewer that end up missing extended time.
Osgood-Schlatter disease
The patellar tendon attaches to the tibial tuberosity, an area of bone that is not fully ossified during rapid growth. Repetitive traction from jumping and sprinting causes irritation at that attachment. Athletes report anterior knee pain that is worse during or after training and eases with rest. It is often bilateral, and it typically appears between ages 11-14 in girls and 13-15 in boys.
Managing it usually means reducing repetitive jumping volume and high-intensity sprint density, not stopping sport entirely. Keep the athlete training; just reduce the specific loading that provokes symptoms.
Sever's disease
The Achilles tendon attaches at the calcaneal apophysis, another cartilaginous area vulnerable to traction during growth. Common in football, athletics, and any sport with a lot of acceleration. Heel pain towards the end of sessions or the morning after is the typical presentation. Footwear review, temporary heel inserts, and reduced sprint volume usually resolve it.
Lumbar stress fractures (spondylolysis)
The lumbar spine is particularly vulnerable in sports with repeated extension loading: gymnastics, fast bowling, backstroke swimming, and Olympic lifting during rapid growth. Pain with lumbar extension that does not settle after a week of relative rest needs imaging. Loading through a stress reaction turns it into a full spondylolysis. Refer early.
Elbow and shoulder apophysitis
Less common, but worth knowing in cricket, baseball, tennis, and throwing events. Medial elbow pain in a young thrower during rapid growth should trigger load reduction immediately, with imaging if symptoms persist beyond two weeks. One-sided rotational volume caps matter more than most coaches realise in these sports.
ACL and acute ligament injury
Acute injury rates rise around PHV because size and speed increase faster than neuromuscular control. ACL injuries become more frequent, particularly in adolescent girls, partly due to anatomical changes at the hip and knee during maturation. Landing mechanics and change-of-direction technique need reinforcing during this phase, not softening. The research on injury prevention programmes like FIFA 11+ is reasonably clear: these athletes need more neuromuscular work during growth, not less.
Post-PHV: different risk, not lower
Growth plates close in late adolescence, so the specific vulnerabilities of the PHV window wind down. Injury rates do not necessarily fall. Training and competition intensity increase at this stage, and the primary risk shifts to overuse from rapid load increases.
The injury profile moves towards what you would see in adult sport: hamstring and adductor strains, patellar and Achilles tendinopathy, shoulder impingement in overhead athletes, and ankle and knee sprains from higher-intensity competition. Athletes who move into a higher-level programme and see a sudden jump in session volume or frequency are particularly susceptible.
This is also the phase where structured strength work can be genuinely loaded. Progressive overload with compound lifts, higher-intensity plyometrics, and resisted sprint work are all appropriate once technique is solid and established. The increased load tolerance is real. But it still requires a periodised approach, including actual deload weeks built into the programme rather than treated as optional extras.
Monitoring for early warning signs
Most serious injuries at these ages become serious because coaches hear about them after they have already progressed. A few consistent habits prevent a lot of this.
Ask before every session, not just when something goes wrong. A quick check-in before warm-up catches more than any formal questionnaire. Athletes who flag the same site two or three sessions in a row need attention before it becomes a formal injury report.
Session RPE (a simple 1-10 effort rating at the end of training) functions well as a monitoring tool around PHV. A pattern of high RPE at loads that would normally feel moderate suggests the athlete is not recovering properly between sessions. That is worth acting on before load accumulates further.
Track growth. Athletes gaining 6-8cm or more in a calendar year are likely around PHV. Use that as a practical cue to reduce repetitive high-impact volume and add targeted mobility work, particularly for hamstrings and calves, which get tight quickly during a growth spurt and are often at the root of knee and heel pain.
Watch movement quality. Form breakdown in well-established patterns is usually the first visible sign of overload during growth. An athlete who normally lands cleanly starting to collapse at the knee in cutting drills is either fatigued or struggling to coordinate longer levers. Either way, reduce load within the session rather than waiting until it finishes.
When to stop and refer
Most growth-related complaints can be managed conservatively within a coaching environment. Some things need medical input without waiting.
Pull the athlete from training and refer if you see:
- Bony pain that does not settle after two weeks of relative rest
- Night pain around a joint or along the spine
- Swelling at a joint that was not caused by a specific contact or trauma
- Back pain with any neurological signs: tingling, radiation down a leg, or weakness in the foot or lower leg
- Acute locking or giving way at the knee or ankle
- Visible deformity after contact
Do not rush returns to full training when growth plates are still open. One extra week of patience is considerably cheaper than six weeks out with a stress fracture. The pressure to have a player back for a big fixture is real at this level. At these ages, it is almost always the wrong call.
Coach's checklist
- Identify which athletes in your squad are likely around PHV: look for rapid height gain, coordination dips, and tight hamstrings or calves
- Reduce repetitive jumping and sprint volume during peak growth windows
- Review footwear and loading patterns for any athlete reporting heel or anterior knee pain
- Check in about pain before every session, not just after injuries happen
- Use session RPE as a monitoring tool across the squad
- Refer any spinal extension pain that does not settle within a week
- Reinforce landing and cutting mechanics during and after PHV
- Build genuine deload weeks into the programme, particularly when athletes move into post-PHV training ramp-ups
- Do not rush returns from injury when growth plates are still open