Growing pains, what a pain!
During periods of significant growth, some children experience an aching or throbbing pain the legs. Often, there is no obvious cause for this pain and it is attributed to muscle tightness or weakness, or overuse activities. This occurs most commonly between the ages of 3-5 and 8-11 years, but can occur outside of these age brackets depending on when your child has a growth spurt.
When should you seek help:
While most “growing pain” conditions are self-limiting and self-resolving, some conditions can need some further management. You should consult with your child’s physiotherapist or general practitioner if you are concerned about your child’s pain, want some further information about management strategies, or if your child’s pain is:
- Persistent
- Disturbing their sleep
- Impacting their activities
- Impacting their movement
- Associated with symptoms such as fever, fatigue, redness, tenderness, rash, or loss of appetite.
Conditions that are more than just growing pains:
Some conditions early stages appear very similar to growing pains, and treatment can often be delayed as a result.
Medial tibial stress syndrome:
Pain occurring at the front of the shin, where the muscles of the foot and ankle attach to the shin bone (tibia). MTSS is often lumped into the group of conditions known as “shin splints” which encompasses any pain at the front of the shin. MTSS is more common in runners, and jumping athletes, due to the loading that goes through the shins during these activities. It is also more common in females. In severe cases, this bony stress can progress to stress fractures.
Sever’s disease:
Pain occurring at the back of the heel, where the Achilles tendon attaches to the calcaneus (heel bone). Sever’s occurs when the developing bone and growth plates are exposed to high load repetitive forces, such as running or jumping. Over time, the irritation to the bony attachment point results in a bony callus formation, or bony lump where the tendon attaches. In rare, severe cases, high force can cause the Achilles tendon to fracture the bony attachment site (avulsion).
Osgood Schlatter’s:
Pain occurring just below the kneecap, where the patella tendon attaches to the top of the shin bone (tibia). The quadricep muscles are an extremely powerful group of muscles that attach to bone via the patella tendon. Like Severs, when the bony attachment site is irritated over a long period of time, a bony callus begins to form at the base of the patella tendon causing pain. This condition is more common in males, runners, impact sports, and sports that involve significant use of the quadricep muscles. In rare, severe cases, high force can cause the patella tendon to fracture the bony attachment site (avulsion).
How does physiotherapy fit into management?
Physiotherapists perform thorough examinations to determine the specific diagnosis, and root cause of pain. Sometimes, this involves getting scans such as ultrasound, x-ray, or MRI’s. Management initially targets pain modification, which can consist of activity modifications or rest, heat/ice modalities, soft tissue release (e.g. stretching, massage, dry needling in older children or adults), and/or taping or bracing/orthotics. Once the pain has started to settle, management shifts to gradually reloading the tissues to return to normal function, through specific strengthening programs and return to sport programs.
In some cases, physiotherapy alone isn’t sufficient in managing the condition so other interventions such as medical/pharmacology management (through general practitioners or sports physicians) or orthotics (podiatry) are explored.
Can my child still do sports with these conditions?
Participation in physical activity is important for a growing mind and body, and there are great psychological and social benefits to participating in sports. Sometimes, a period of rest is required, but where possible cross training should occur so children can stay active. It is important that your child’s coach/trainer/PE teacher is aware of their condition, and their capabilities and limitations while in the healing stages. Physiotherapist can assist by giving detailed sport specific instructions of suitable participation during the recovery process.
It is important to recognise that most children participate in sports and activities without any pain, and that some children who develop pain don’t participate in sports at all. Finding the root cause is important as often pain in sports is just a symptom!
References:
Mayo clinic: growing pains. https://www.mayoclinic.org/diseases-conditions/growing-pains/symptoms-causes/syc-20354349
McClure CJ, Oh R. Medial Tibial Stress Syndrome. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538479/
Fares, M.; Salhab H.; Khachfe, H.; Fares, J.; Haidar, R.; Musharrafieh, U. Sever’s disease of the paediatric population: clinical, pathologic, and therapeutic considerations. Clinical Medicine and Research. 2021, 19(3): 132-137. https://www.clinmedres.org/content/19/3/132.full
Lucenti, L.; Sapienza, M.; Caldaci, A.; Cristo, C.d.; Testa, G.; Pavone, V. The Etiology and Risk Factors of Osgood–Schlatter Disease: A Systematic Review. Children 2022, 9, 826. https://doi.org/10.3390/children9060826