Growing Pains

Living on the sunshine coast there is never a real ‘off season’ for kids sport. If it’s summer we see cricket fields and our surf life-saving beaches inundated with children every weekend. In winter netball, football and soccer keep not only the kids busy but the parents too! Then there are the all year-round activities such as dancing and swimming. With our active young population it is all too common for your child to start complaining of growing pains.

What are growing pains?

The underlying cause is muscular. During periods of growth, children can complain of non-specific leg pain as their bones grow faster than their muscles lengthen. This will put their muscles under tension as well as pull on the bone on which they attach. Although most children will recover from these pains once they cease growing, Physiotherapy is very effective at decreasing pain and speeding up the recovery process with hands on treatment & prescription of a home exercise program.

Early Physiotherapy intervention will also prevent your child from developing any secondary postural changes, muscle weakness or imbalances and altering sporting technique if they are compensating for pain. Loss of sleep due to pain is also an indication to see your physiotherapist. Growing pains we commonly see are:

• Osgood-schlatters disease: is pain located at the prominence at the top of the shin bone below the knee cap (tibia tuberosity). This becomes painful due to the quadriceps (thigh) muscle pulling on this attachment.
  

• Sever’s disease: is pain at the heel where the Achilles tendon attaches onto the bone. Calf muscles join together to form the Achilles tendon, so tension in these muscles can lead to sever’s disease.
  

• Shin splints: shin pain can be either on the inside &/or outside shin boarders, depending on which muscles are tight (eg. Tibialis anterior or posterior).
  
• Behind the knee: is a less common area of growing pains but will occur due to hamstring &/or calf muscle tension.

Contributing Factors

There are some underlying factors that may predispose some kids to growing pains more than others. These can include:

• The type of sport: impact sports are more likely to aggravate growing pains (eg. Running or jumping) rather than non-weight bearing activities (eg. Swimming or cycling)
• Biomechanics and technique:
  • How a child runs can effect muscle length & tension in the legs
  • Foot position- over or excessive pronation (rolling in)
  • Underlying joint stiffness or muscle tension
  • Footwear
  • Poor posture &
  • History of a previous injury that was poorly managed eg. Ankle sprain or muscle strain

Symptoms & Presentation

Growing pains can vary in presentation. They usually present in children aged 3-8 years or in adolescents. The child or parent can usually indicate that there has been a rapid period of growth in conjunction with development of their pain. Symptoms of growing pains can be:

• Described as aching or burning
• Located in muscles or tendon attachment points at the knees, shins & heels
• In both legs, however one is usually worse than the other
• Mild to severe in intensity
• From minutes to hours to constant in duration
• Local swelling &/or pain at boney attachment points that fluctuates in relation to activity  (especially Osgood-schlatters and sever’s)
• Specific in a pattern of pain:
  • Can have a warm up effect- sore on initiation of activity then it eases
  •  Worse during or after activity- especially with impact sports like dancing, running & football
  • Worse at night- some kids wake every night from the pain, others might relate night pain after a day of lots of activity, although sometimes it will be unpredictable and unrelated to activity

Physiotherapy Assessment

Your physiotherapist will question both you and your child in relation to their growing rates, their pain and its pattern as well gather information about the amount of activity in which they participate. It is important that your physiotherapist rules out any other underlying conditions that may be causing your child’s pain.

The physical assessment will include many things but will be guided by the information they have gathered from you. This assessment may include: palpation (muscles, tendons & bones), assessment of joint range of motion, muscle length, muscle strength and physical tests of surrounding structures (eg. Ligaments).

They will have a look at your child’s posture, biomechanics (how they move), gait (walking) patterns & how they perform activities that aggravate their pain (eg. running or jumping). Rarely is medical imagining indicated as your physiotherapist should be able to diagnose growing pains with an in clinic assessment.

Physiotherapy Treatment

Once a diagnosis of growing pains is established there are many modalities your physiotherapist may utilise to treat your child. It is very important that advice for management and a home exercise program is prescribed as soon as possible as daily stretches are vital to correct the muscle length issue.

Your physiotherapist can use massage, stretching, acupuncture and heat to help lengthen tight muscles. They may also mobilise underling stiff joints that are contributing to the pain. The use of strapping tape can be effective in unloading painful regions to help settle inflammation or unload the area during activity. Sometimes your physiotherapist may refer your child to a podiatrist to address any biomechanical issues with custom made orthotics.

A home exercise program of gentle stretching and strengthening will be prescribed. For example: in cases of Osgood-schlatter’s it is important to stretch the quadriceps & in Sever’s, the calf muscles. The application of heat to these muscles prior to stretching can also be helpful in lengthening the tight muscles.

Strengthening of stability, core and global muscles is also important. Your physiotherapist will design a strengthening program specific to your child’s requirements. Proprioception (balance) exercises will also be incorporated into their home program during the later stages of rehabilitation, as will sports specific drills.

Children can usually continue to participate in their chosen activity. The goal is to find a level of activity that doesn’t aggravate or worsen the pain as they continue to rehabilitate with physiotherapy. If your child continues to participate in activities that aggravate their pain, then the use of ice afterwards can help decrease pain and swelling.

In severe cases, a period of complete rest from sport & aggravating activities will be required. In these cases, cross training can be recommended. This means participating in alternative activities that don’t aggravate your child’s pain eg. Swimming or cycling. Growing pains can disappear in days to weeks once the appropriate treatment is commenced and your child can return to sport pain free.