Growing Pain Explained

What are growing pains?

Essentially they are muscular pains, primarily affecting the calf, front of the thigh (quads), or back of the knee (hamstrings insertion). There is no clear evidence to explain what causes growing pains, but we think it has something to do with the muscles being over stretched as the long bones grow, and/or struggling to work properly to keep up with activity levels, and support postural changes during growth periods.

Who is affected?

Girls and boys are affected equally. Active, and less active children are affected equally, though the pain may make it difficult for children who are active in sports to participate fully. Most of the time activity does not change the level of pain as it can be equally as sore at rest. Commonly, growing pains will affect children between the ages of 3-6, and 8-11, and sometimes into the early teenage years. Generally there is no external trigger for the pain, such as in injury, and the onset of pain will be gradual.

Assessment and Treatment?

While the pains can be very intense and cause a child some distress, they are harmless, meaning that no lasting damage is caused to the muscles or bones. The treatment is often very simple and effective, but it is important to have a health professional, such as a Physiotherapist, assess your child to rule out any more serious causes of pain.

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Gentle massage to the affected areas can be relieving, and the use of children’s paracetamol can aid in reducing the pain to help with your child being more comfortable during the day, or sleeping better at night. Your Physiotherapist can show you some techniques to use if you are unsure where to start, and also guide your child through some stretches for the affected areas.

If the pain does not seem to be settling with massage and paracetamol, or if the affected areas become red, swollen, inflamed, extremely sensitive to touch, or your child is reluctant to weight bear on their limb, review by your Physio, or GP is strongly recommended, as there are a number of conditions that may initially present as simple growing pains.

Other Conditions to Consider

Osgood Schlatter’s Disease is an apophysitis of the tibal tuberosity, which is a fancy was of describing inflammation of the region at the top of the tibia (shin) bone where the patella (kneecap) tendon inserts. It is a relatively uncommon, but quite debilitating, over use injury which can affect both girls, and boys between the ages of usually 8-13, and 11-15.

The mechanism of injury it thought to be repeated, strong contractions of the quadriceps (thigh) muscles during activity, which causes traction of the tendon where it joins onto the growing and developing bone. There is a higher incidence in children who are active and participate in sports requiring repeated running and jumping such as netball, AFL, soccer, basketball, athletics, and dance.

Signs and Symptoms include;

  • Local pain, swelling, and tenderness at the insertion of the quadriceps, at the top of the tibia
  • Tightness and weakness of the quadriceps muscle
  • Pain with running, jumping, squatting, kneeling, stairs, and direct contact to the affected region
  • The pain may be bilateral
  • The tibial tuberosity may become an enlarged bony lump in chronic cases.

Physiotherapy management is extremely effective in resolving the majority of cases. Treatment includes immediate short term cessation or restriction of painful activities, and the provision of specific strengthening and stretching exercises, muscle release work, and advise about using ice and heat correctly. In some cases taping techniques, or patella braces may be useful in reducing symptoms while your child resumes sport.

The majority of cases will resolve within 3 months, but some children experience recurring symptoms over 12-24 months which require ongoing self management, and follow up visits with the Physio. Severe cases may require onward referral to a Sports Physician for medical management such as anti-inflammatory medication, or blood testing to rule out more sinister causes of pain, such as juvenile arthritis.

Untreated, or poorly managed cases may lead to damage occurring at the growth plate of the tibia, and potential avulsion fracture where the patella tendon is pulled away from the bone. Children will experience resolution of symptoms when the growth plate of the tibia reaches maturity, however, if the tibial tuberosity is enlarged, it may cause ongoing discomfort in kneeling.

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Sever’s Disease, or ‘Calcaneal Apophysitis’ is inflammation of the growth plate in the heel of adolescents. Similar to Osgood Schlatter’s Disease, it is caused by repetitive trauma to the affected area, such as in running or jumping, typically in boys between the ages of 10-15, and girls 8-13 years of age, who are physically active during growth spurts. Those with poor foot and ankle biomechanics may have a pre-disposition to developing Sever’s Disease, as the volume of load bearing activity does not always seem to correlate with severity of the disease.

Signs and Symptoms Include;

  • Pain, swelling, and tenderness at the back of one or both heels, which is exacerbated by physical activity
  • Awkward running or walking pattern, usually a tendency to rise up onto the toes to avoid placing weight through the heel.

Initial treatment involves rest, or modification of aggravating activities, icing the affected area, and the use of pain killers/anti inflammatory medications if required. From here, the child needs to be assessed to determine what changeable factors are contributing to the pain. For example tight calf muscles, muscle weakness, or poor foot position can all be managed through stretches, exercises, and footwear modification or orthotics. Most importantly, advice from your Physio regarding load modification and gradual return to exercise will ensure that any exacerbations of pain are kept to a minimum. This will also help to minimise the risk of permanent damage or deformity of the back of the heel bone, as this can occur in poorly managed cases.

The majority of muscle and joint pains in adolescents are not serious conditions, but they can be very painful, and distressing for both you, and your child, so they must be taken seriously. Thankfully for all of us, identifying an illness or disease such as Juvenile Arthritis or joint sepsis is rare, which means that most of the time following the first consult, your child feels immediately better, we have a diagnosis, and a plan. If you are concerned that your child may have growing pains, or one of the two apophysitis conditions mentioned here, call up, or jump online to book an appointment with one of our team.

Sue Lin Kalisch

Senior Physiotherapist