Growing Pains

growing pains

We’ve all heard of growing pains, that seemingly mandatory right of passage that affects all kids at one stage or another. But what are growing pains, how can they affect your child and what do you need to do to help them out?

Growing pains, as the name suggests, are a painful response to a sudden increase in the rate of growth of bones. The rapid growth causes a strong muscle pull on softer growth plates located at the end of most bones. The two most common locations of growing pains are in the heel known as Sever’s disease and at the top of the shin known as Osgood Schlatter’s disease.

The exact timing of these growth spurts is difficult to predict but typically occurs between the ages of 11 to 14 years and is often preceded by a sudden jump in shoe size. The onset of pain is often timed with sporting involvement, so your initial suspicion is that your child has overstressed a joint or strained a tendon on one side. They’ll comment about a mild ache that is present during and immediately after playing sport. “It’s not that bad” they’ll tell you, and they often don’t notice it when they’re distracted by the game.

As the condition worsens, it begins to appear on both sides and worsens to the point that they are hesitant to run at full speed or begin to noticeably limp when they exert themselves. The ache now lasts into the next day after sport and the soreness is there more often than not. It’s all very concerning as it’s often the first time you’ve seen your little one in this much pain. As a parent, you just want to do something!

But here’s the truth of it all. Growing pains are completely harmless. They will only last as long as the growth spurt is in progress, usually around 6 months. You can’t cause any lasting damage by pushing through the pain. There are some things you can do to help alleviate the soreness but you don’t need to be concerned that you’re missing something if some level of pain persists.

In heel pain, Sever’s disease, the calf muscle is exerting the force on a growth plate in the calcaneus, the heel bone. For Osgood Schlatters disease, the quadricep muscle is exerting force just below the knee, at the top of the tibia. So the first thing we can do is decrease the reaction in the growth plates by using a simple ice pack. Used immediately after sports, the ice can help the reaction settle faster, leaving less soreness the next day. You can also help to distract from the soreness by using a heat cream such as Dencorub or Tiger Balm (note that Voltaren Gel has additional pharmaceutical ingredients which need to be taken into consideration in this age group).

Helping the muscle adapt and lengthen quickly is also beneficial. Importantly, vigorously stretching the muscles doesn’t help the condition or lengthen the muscle and can often make things worse. To help a muscle adapt, gentle strength exercises with the muscle in the lengthened position can often help. Something as simple as a walking lunge will cover both heel and knee soreness. More specific programs can be designed based on your child’s chosen sport and current level of flexibility.

For knee pain, there are also inexpensive braces that can be used to offload the pull of the tendon. Often referred to as Patellar Tendon Straps, these braces only cost $20 to $30 and can effectively reduce the soreness during high load activities.

The key point to all this is that physiotherapy intervention is very rarely required. If your child can tolerate the soreness, they can continue playing the same volume of sport. If the soreness is getting too much, they can reduce the number of sports they play, the number of weekly sessions or intensity of their play to manage the soreness.

Physiotherapists can get involved if the soreness is unmanageable or if you have concerns about the diagnosis. This may apply in cases of sharp pains, constant night pain, one-sided soreness or pain lasting longer than six months. Otherwise, you can manage these conditions with some simple interventions and reassurance that all pain typically resolves in six months and there are no long term negative consequences of playing through it.