Rehabilitation for Growth Problems in Adolescence

Adolescence and the Importance of Growth in the Musculoskeletal System

During adolescence, the “growth plates” (epiphyseal plates) located at the ends of the bones, which are responsible for height growth, are extremely active. As bones lengthen rapidly, the muscles, tendons, and ligaments try to adapt to this pace. This rapid growth and change can make the musculoskeletal system more vulnerable to injuries and certain structural problems. Changes in the body’s center of gravity, temporarily reduced coordination, and increased physical activity can also contribute to the problems encountered during this period. For this reason, it is essential that pain occurring during adolescence not be dismissed simply as “growing pains,” and that a specialist evaluate whether there is an underlying problem.

Common Orthopedic Growth Problems in Adolescence and the Role of Rehabilitation

Prof. Dr. Murat Bozkurt lists some of the orthopedic problems he frequently encounters in adolescents at his clinic in Ankara, in which rehabilitation plays an important role, as follows:

• Spinal Problems:
  
  • Scoliosis (Spinal Curvature): Idiopathic adolescent scoliosis, in particular, is the most common spinal deformity in adolescence. In low-degree curves, special exercise programs (such as scoliosis-specific exercises like the Schroth method), together with brace treatment, play an important role in slowing the progression of the curve and improving posture. A comprehensive rehabilitation process is also required after surgical treatment.
  • Kyphosis (Hunchback): This may develop due to Scheuermann’s kyphosis (structural hunchback) or postural kyphosis (posture-related hunchback). Rehabilitation aims to strengthen the back and abdominal muscles, instill correct posture habits, and increase flexibility.
• Joint and Bone Growth Problems (Apophysitis): These are inflammatory conditions that develop due to excessive loading of the growth plates.
  
  • Osgood-Schlatter Disease: Characterized by pain and swelling at the bony prominence just below the kneecap (tibial tubercle).
  • Sever’s Disease: Causes pain at the growth plate at the back of the heel bone (calcaneus).
  • In these cases, rehabilitation includes measures to reduce pain, stretching exercises, strengthening to correct muscle imbalances, and activity modification.
• Slipped Capital Femoral Epiphysis (SCFE): This is a condition in which the growth plate at the head of the femur slips. It generally requires surgical treatment, after which an intensive rehabilitation program is applied to improve joint range of motion, muscle strength, and gait.
• Perthes Disease: Characterized by avascular necrosis (impaired blood supply) of the femoral head. Treatment and rehabilitation aim to preserve joint mobility, reduce pain, and prevent permanent deformities.
• Postural Disorders: These may develop due to reasons such as sitting in an incorrect position for extended periods or carrying a heavy backpack. Rehabilitation includes increasing postural awareness, strengthening the muscles responsible for correct posture, and education on ergonomic adjustments.
• Growth Plate Injuries and Overuse Syndromes: Especially in adolescents who actively play sports, injuries can occur due to impacts to the growth plates or excessive training. Rehabilitation aims to protect the injured area, achieve a gradual return to activity, and correct the underlying biomechanical problems.

What Are the Goals of Rehabilitation for Growth Problems in Adolescence?

Although the primary goals of a rehabilitation program vary depending on the type of problem, they generally include the following:

• Reducing or eliminating pain.
• Preserving or increasing joint range of motion.
• Improving muscle strength, flexibility, and endurance.
• Instilling correct posture habits.
• Slowing the progression of any existing deformity or helping to correct it.
• Increasing body awareness and coordination.
• Maximizing functional capacity in daily life activities and sports.
• Ensuring the adolescent and family are informed about the condition.
• Improving quality of life in the long term.

General Methods Applied During the Rehabilitation Process

In Ankara, Prof. Dr. Murat Bozkurt personalizes rehabilitation programs for adolescent patients according to the underlying problem, the adolescent’s age, developmental level, and individual needs. The methods frequently used are as follows:

• Personalized Exercise Programs:
  
  • Stretching Exercises: To stretch shortened and tight muscles.
  • Strengthening Exercises: To strengthen weak muscle groups (especially the core, back, hip, and leg muscles).
  • Balance and Coordination Exercises: To develop body awareness and motor control.
  • Special Exercises for Scoliosis and Kyphosis: Scientifically based exercise approaches such as Schroth and SEAS.
• Manual Therapy Techniques: Hands-on techniques applied by a physiotherapist, such as joint mobilization and soft tissue mobilization, can help reduce pain and increase mobility.
• Posture Training and Ergonomic Adjustments: Teaching correct posture and providing information about the ergonomic principles to be followed in daily life (at school, while studying at home).
• Activity Modification and Safe Return-to-Sport Planning: Temporarily avoiding activities that increase pain, and special programs for a gradual, safe return to sport.
• Patient and Family Education: Detailed information about the nature of the problem, the treatment process, what to pay attention to at home, and how to perform exercises correctly. The family’s support and involvement is very important for the success of rehabilitation.
• Use of and Training in Assistive Devices, If Needed: Support with the correct use of assistive devices such as braces (for scoliosis, kyphosis) and orthotic insoles.

Prof. Dr. Murat Bozkurt’s Role in Rehabilitation and the Multidisciplinary Approach in Ankara

Prof. Dr. Murat Bozkurt plays a central role in managing growth problems during adolescence:

• Early and Accurate Diagnosis: Ensures the problem is accurately identified through detailed physical examination, necessary imaging methods (X-ray, MRI, etc.), and analyses.
• Developing the Treatment Plan: Based on the diagnosis, evaluates conservative treatment (rehabilitation, bracing, etc.) or surgical treatment options and decides on the most appropriate treatment plan together with the patient/family.
• Management of the Rehabilitation Program: Plans or approves the personalized rehabilitation program and monitors the progress of the process with regular check-ups.
• Surgical Intervention (If Necessary): Successfully performs the necessary surgical interventions in cases where conservative treatment is insufficient or the structural problem requires surgery (for example, progressive scoliosis, SCFE).
• Post-Surgical Rehabilitation: Meticulously plans and manages the rehabilitation program, which is the most important part of the post-surgical recovery process.
• Multidisciplinary Collaboration: Works in close collaboration with experienced physiotherapists and orthotic-prosthetic technicians in Ankara, as well as physicians from other specialties (such as endocrinology and pediatrics) when needed, to provide the patient with holistic care.

Recommendations for Families During Growth Problems and the Rehabilitation Process in Adolescence

• Early Awareness: Take seriously any abnormalities you notice in your child’s posture or gait, or any pain complaints during physical activity, and consult a specialist.
• Choosing a Specialist: Consult an orthopedics and traumatology specialist experienced in adolescent musculoskeletal problems.
• Patience and Consistency: Rehabilitation is a process that requires time and patience. Encourage your child to attend the exercise program regularly and to do the exercises given for home.
• Positive Support: Motivate your child and provide emotional support during the treatment process.
• Open Communication: Stay in constant communication with your doctor and physiotherapist, and don’t hesitate to ask any questions you have.
• Healthy Lifestyle: A balanced diet and regular physical activity are important for overall musculoskeletal health.