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In a muscle and tendon unit there are certain areas at high risk of injury: these are the attachments of muscle and tendon to bone, the muscle and tendon tissue itself, and also the point at which muscle and tendon merge (the muscle-tendon junction). In adults, the muscle or tendon tissue itself is often injured by trauma,while the corresponding trauma in adolescents causes injuries to the attachments of the muscle or tendon to bone. Studies have shown that physical training increases the strength of tendons and ligaments faster than that of their attachments.

Apophysitis (inflammation of an apophysis) resulting from overuse occurs mainly in specific sports, such as soccer, football, long jump, and high jump, that involve a great deal of jumping and bending of the knees, thus exposing the apophyses to great tensile stress and overloading.The site at which apophysitis most often occurs is that of the attachment of the patellar ligament to the tibia (Osgood-Schlatter disease). Overloading of the apophysis causes inflammation in the attachment of the tendon which manifests itself as pain, tenderness, and swelling. An X-ray shows fragmentation of the bone under the attachment of the tendon.

Apophysitis also often occurs in the attachment of the Achilles tendon to the calcaneus (apophysitis calcanei). In cases of apophysitis it is essential that the affected athlete rests at an early stage, avoiding the movements that trigger pain, until no more pain and discomfort are felt. The condition can otherwise be of long duration.The most common cause of apophysitis is one-sided training. Here it is appropriate to warn against excessive strength training by young, growing people. When strength training is carried out with a heavy load, the strength of the muscles develops faster than the strength of the skeleton and can result in apophysitis and also in avulsion fractures. Growing youngsters should therefore practice strength training using only their own body as a load.

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