We often hear about children complaining of growing pains, but what are they really?
Growing pains are quite common for children and teenagers, especially those who are quite active.
During growth spurts, bone and cartilage increase in size significantly faster than muscles. Double this with a high amount of exercise, and it can create large degrees of load and tension where the tendon of a muscle inserts into the bone.
This causes inflammation, pain and although very rare can sometimes cause small avulsions (torn parts of bone) where the tendon attaches.
What is the growth plate?
Growth plates or physis are the areas of active, new bone growth near the ends of the bone. They’re made up of cartilage, a rubbery, flexible material (the nose, for instance, is made of cartilage).When children are done growing, the growth plates harden into solid bone.
In the majority of cases this happens in girls around ages 13–15 and in boys around ages 15–17.
Due to this uncompleted growth, the tendon can pull on the growth plate rather than bone. Now a growth plate is a part of bone that hasn’t fully developed, and is more vulnerable than regular bone. It is a cartilaginous material which is less sturdy than regular bone, but will solidify as you grow.
We generally have 1-2 growth plates in most long bones, which allow for your bones to increase in length and width.
The most common types of growth plate/growing injuries are Osgood Schlatter’s, Sinding-Larsen’s and Sever’s disease (as you can see below).
Where can growth plate issues occur?
Most commonly we see growth plate issues with children around their ankles and knees. The following are the more typical presentations we see:
– Osgood Schlatters :
Pain below the kneecap on the tibia related to exercise
Movements loading the patella tendon can be painful, including squatting, jumping, running and sports
May have a bony growth/lump which can be tender to press on at the front of the knee
May be sore during and ache after activity
Pain will often relate to intensity or duration of activity
– Sinding Larsen’s:
Pain at the base of the patella
Same as Osgood Schlatters above
Sever’s ‘ disease:
Pain at the base of the heel where the Achilles attaches
Possible bony lump at the heel, and tenderness to touch
Pain relating to loading of the ankle with activity, such as hopping, jumping and running.
Why do children get growing pains at these sites ?
There are a few reasons along with growing that this can occur.
Bio-mechanics or movement patterns can also play a role in the beginning and resolution of these conditions.
For example, having a flat foot when running can overload the ankle and knee, placing more tension and load through both tendons. If the athlete continues to exercise on this, one of these conditions can form.
Other contributing factors to these conditions include general lower limb strength and control, the amount of exercise being performed, plus general tightness. All of these will alter the loading and force through the knee and foot during exercise, and can create tension where the tendons insert.
The picture shows an example of bad knee control when jumping, which shows why improving lower limb control will assist with patella loading especially.
What is the best treatment for growing pains ?
Treatment for these conditions are very similar, but will be depend on irritability. These are a list of the ways we decrease pain in these conditions:
1. Decrease the amount and difficulty level of exercise: only work at low levels with minimal pain, rest when it becomes too sore. This will be slightly different for every person.
2. Correcting any bio-mechanical deficits:
– Strength based exercise program targeting lower limb control.
– Possible use of orthotics/correct shoes for foot positioning
– Taping/bracing over the patella/Achilles tendon for improved loading capacity.
– Massage to reduce general tension in muscles and therefore tendons.
3. Ice and anti-inflammatories can be beneficial for pain relief.
Sometimes if these measures don’t work then it needs rest to settle down.
It takes time for conditions likes these to settle and become pain free. A slow progression of exercises, and slow return to full activity is used to ensure the pain doesn’t re-aggravate.
If you or someone you know are having growing pains and need some assistance, feel free to call the clinic on 3351 5639 to book in with any of our physiotherapists.
Thanks for reading everyone, get in touch if you need help or advice with growing pains in your children.