This is due in part that there is no true blood supply to the physis but rather the blood supply advances from the blood vessels of the epiphysis and metaphysis and from the perichondrial ring and vessels of the periosteum [ 36 ]. A potential problem with physical activity and exercise on the epiphyseal plates is over-activity. Intuitively, it is the extent that over-physical activity may have on the growth plate resulting in injury.
A better appreciation of how epiphyseal plate physiology works is seen in the response to trauma. The most prevalence of epiphyseal growth plate injuries is to children ages 10 to 16 years [ 38 , 39 ].
If injury occurs to the epiphyseal growth plate the possibility that there may be a premature locking of the epiphyseal growth plate essentially halting bone lengthening [ 40 ]. Most injuries in children's sports and activities are minor and self-limiting thus suggestive that children and youth sports are safe [ 32 ]. Unlike adults, many of the injuries may be treated closed due to the growth and remodeling potential of children [ 41 ].
Skeletally immature children who participate in extreme levels of sports participation can sustain repetitive trauma [ 42 ]. This repetitive trauma can cause the epiphyseal plate to widen.
Laor et al [ 42 ] hypothesized that the metaphyseal vascular supply is disrupted causing the normal process of endochondral bone formation due to long columns of hypertrophic cartilage cells from the physis extending into the metaphysis As the risk of injuries sustained by young athletes can be significant, it is essential that training programs take into account physical and psychological immaturity, so that the growing athlete can adjust to their own body changes [ 31 ].
The period of early puberty is associated with an increased risk of fracture which may be related to the high rate of bone turnover [ 22 ]. A late menarche is a consistent risk factor for fracture in young females due to hormonal instability that may affect bone density [ 22 ]. Growth disturbance depends on extent of the injury and the amount of remaining growth potential [ 36 ]. However, it can be hypothesized that a partially closed physis are weak links in children and that asymmetrically or partially closed physis may be vulnerable to trauma [ 43 ].
It has been suggested that overuse during puberty for females may result in long term development of low bone density and ongoing problems with bone health. The genetic potential for bone accumulation can be frustrated by insufficient calcium intake, disruption of the calendar of puberty and inadequate physical activity [ 15 ].
While many of the molecular mechanisms that control cellular differentiation and growth during embryogenesis recur during fracture healing taking place in a post-natal environment that is unique and distinct from those which exist during embryogenesis [ 44 ].
Disruption of either the longitudinal intraosseous vasculature vertical extraosseous blood supply or the vascular arch in more than two places may lead to selective avascular necrosis extraosseous of the epiphyseal cartilage [ 35 ].
The clinical pathophysiology of excessive activity on the epiphyseal growth plates resulting in injury is one of the more prominent methods of understanding the effects of exercise on growth plate physiology.
The immature skeleton is different from the adult skeleton with unique vulnerability to acute and chronic injuries at the growth plate [ 7 ]. Epiphyseal injuries are usually due to shearing and avulsion forces as well as compressive forces usually due to either severe twisting or direct blows that can result in a disruption of the epiphyseal growth plate [ 31 ]. In young athletes, as the bone stiffness increases and resistance to impact diminishes, sudden overload may subject bone to either bow or buckle [ 31 ].
Swelling, hyperemia, and deformity in the physeal area are the classical signs of physeal injury with pain being potentially less intense [ 36 ]. Gerstenfeld et al [ 44 ] summarized five key points of damaged epiphyseal plate healing that needs to be considered clinically. First, the anatomic structure of callus formation as it progresses during the healing phases should be considered [ 44 ]. Second, morphogenetic signals that facilitate the repair process should be known [ 44 ].
Third, and of importance for clinicians, is the role of the biomechanical aspect in controlling differentiation during cellular repair [ 44 ]. Fourth, the role of key groups of soluble factors i. Finally, knowledge and appreciation for the relationship between the genetic components that control bone mass and remodeling is warranted [ 44 ].
These five key points should be acknowledged clinically in an effort to monitor for proper healing post-injury to the epiphyseal plate. From these key points, one can gain an appreciation for not reducing sport activity but in the intensity of the sport activity during the high intense growth phases.
As well, prohibitions of negative training and in some cases, the prohibition of sports all together, are sometimes necessary to minimize the potential for injury [ 27 ]. While sports are important for children, safety and prevention of needless injury should be considered.
The second and arguably the least discussed aspect concerning the epiphyseal growth plate is the role inactivity may play on the growth plate.
Given the current interest in and rising rates of child obesity such interest in the growth plate should be considered. One of the implicated culprits in the child obesity epidemic is the lack of physical activity. It is known that epiphyseal growth plate activity controls longitudinal bone growth and leads ultimately to adult height yet numerous disorders are characterized by retarded growth and reduced final height either have their origin in altered chondrocyte physiology or display pathological growth plate changes secondary to other causes [ 45 ].
Physical activity may have a protective effect on the epiphyseal growth plate, however, very little research has been conducted on the role of inactivity on the epiphyseal growth plates.
This is possibly due to the lack of clinically-related biomechanical problems that emanate from a lack of physical activity on the epiphyseal plates. In other words, there is a paucity of research in the form of case studies that has implicated a lack of physical activity as an etiology for epiphyseal growth plate injury.
Despite this, one could hypothesize that physical inactivity would not serve as an effect mechanism of protection. Frost [ 5 ] observed this very phenomenon but noted that for an obese person the stronger muscles would put larger loads on bones to which bone physiology should respond by increasing bone strength even if non-mechanical factors are involved. Until further research is undertaken on the effects of inactivity on the growth plate, one can extrapolate such effects from the current literature on normal and excessive functioning that sedentarism may result in inadequate stimulation of the growth plate with a possible result of changed growth potential.
Nonetheless, the recent concern over the increasing incidence and prevalence of obesity as seen in children gives rise to concern for the normal growth process. As previously indicated, functioning growth hormone GH and insulin-like growth factor IGF -I are essential for normal growth [ 46 ]. However, obese children will typically grow at a normal rate despite the presence of low serum GH levels with leptin, insulin, and sex hormones working to locally activate the IGF system at the epiphyseal plate [ 46 ].
Serum leptin may play a biological role in regulating bone metabolism by increasing the proliferation and differentiation of osteoblasts in adults [ 47 ]. Phillip et al [ 46 ] found that an elevated level of leptin in obese children can affect the bone growth center and it may be that leptin also participates in growth without GH observed in obesity.
It may appear that, in some cases, genetic expression, through favorable conditions, can be maximally achieved throughout the entire period of growth [ 48 ]. In this instance, it is hypothesized that for harm to be placed on the growth plate or show delayed growth maturation at the epiphyseal growth plate for those children who are physically inactive, the combination of genetic expression through unfavorable environmental and socioeconomic conditions may be the culprit in abnormal epiphyseal growth plate physiology.
In other words, only through unfavorable conditions such as extreme poverty, lack of nutrition, and other entities will the genetic expression manifest itself for those children who are physically inactive. While it is known that load-bearing tissue, such as articular cartilage, will atrophy in the absence of mechanical forces [ 6 ], future investigation into the effects of a lack of load bearing through a lack of physical activity on the epiphyseal plate is warranted.
The epiphyseal growth plate is a dynamic entity. Growth is dependent not only on intrinsic factors such as hormones and other regulatory factors but on extrinsic factors. These extrinsic factors are based entirely on the biomechanical model. Exercise, a positive aspect for the epiphyseal growth plate needs to be moderated through carefully crafted activities especially during pubertal growth spurts.
Obesity, a major problem among today's youth, can be attributed in part to a lack of exercise. Once activity is undertaken the potential for epiphyseal growth plate disturbances from too much activity may be a predisposing factor to growth plate dynamics. The effects of exercise on the epiphyseal growth plate needs further research to comprehend the entirety of this dynamic anatomical and physiological entity. Research in the area of the epiphyseal growth plate in some children who are sedentary needs to be addressed.
All authors contributed equally to the conceptualization, writing, and approval of the paper. National Center for Biotechnology Information , U. J Clin Med Res. Published online Feb Timothy A. Mirtz , a, c Judy P. Chandler , b and Christina M. Eyers b. Judy P. Christina M. Author information Article notes Copyright and License information Disclaimer.
Email: ude. Accepted Nov This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC. Abstract Background Children need physical activity and generally do this through the aspect of play. Methods A National Library of Medicine Pubmed search was initiated using the keywords and combinations of keywords "growth plate", "epiphyseal plate", "child", "exercise", and "physical activity.
Discussion Bone is a dynamic tissue with a balance of osteoblast and osteoclast formation. Conclusions Mechanical loading of the bone is important for epiphyseal plate physiology. Introduction Bone has been described as a dynamic and highly interactive complex of many cell and tissue types [ 1 ].
A Review of the Normal Physiology of the Epiphyseal Growth Plate As noted previously, skeletal growth at the epiphyseal plate is an active and dynamic process [ 8 ]. Mechanical Influence on the Physiology of the Epiphyseal Growth Plate Comprehension of the biomechanical aspects of bone allows one to conceptualize the physiological processes associated with exercise and physical activity on the epiphyseal growth plate. The Role of Exercise and Physical Activity on the Epiphyseal Growth Plate Over the past decade, there has been a surge in the number of sports opportunities available to young athletes [ 26 ].
Influence of Over-activity on the Epiphyseal Growth Plate A potential problem with physical activity and exercise on the epiphyseal plates is over-activity.
Influence of Inactivity on the Epiphyseal Growth Plate The second and arguably the least discussed aspect concerning the epiphyseal growth plate is the role inactivity may play on the growth plate.
Conclusion The epiphyseal growth plate is a dynamic entity. Author's Contributions All authors contributed equally to the conceptualization, writing, and approval of the paper. Competing Interests The authors declare no competing interests.
References 1. Osteoclastogenesis and growth plate chondrocyte differentiation: emergence of convergence. Crit Rev Eukaryot Gene Expr. Iannotti JP. Growth plate physiology and pathology. Orthop Clin North Am. Systemic and local regulation of the growth plate. Growth plate fractures also can happen from repetitive activities, like training for gymnastics or pitching a baseball. A child with a growth plate fracture can have pain, swelling, and trouble moving and using the injured body part.
Sometimes there is a deformity — this means that the body part looks crooked or different than it did before the injury. Health care providers will order X-rays if they think a bone is broken. Some mild growth plate fractures don't show up on an X-ray, though. Often, a growth plate fracture may be mild and need only rest and a cast or splint.
But if bones are out of place or displaced , they have to be put back into the right position with a procedure called a reduction. A reduction is also called "setting the bone. After an open or closed reduction, the child will usually wear a cast, splint, or brace to make sure the bones don't move during healing.
Most growth plate fractures heal and do not affect future bone growth. However, sometimes changes in the growth plate from the fracture can cause problems later. For example, the bone could end up a little crooked or slightly longer or shorter than expected. Test your knowledge. A year-old boy is brought to the emergency department via ambulance after he was involved in a motor vehicle collision.
The patient is unconscious on arrival. MRI shows small microhemorrhages in the brain stem. The patient remains unconscious for the next 7 hours. Based on these findings, which of the following is the most likely diagnosis? More Content. Click here for Patient Education. Salter-Harris classification of physeal disk growth plate fractures Types I through IV are physeal separations; the growth plate is separated from the metaphysis.
Epiphyseal disks growth plates The first numbers are the age at which ossification first appears on x-ray; the numbers in parentheses are the age at which union occurs. Plain x-rays. Was This Page Helpful? Yes No. Clavicle Fractures. Overview of Shoulder Dislocation Reduction Techniques.
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