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Growing beyond pain

By Physio Thomas

Picture this: your son comes home from playing basketball, he’s putting in a lot of effort to make the under-14’s, he’s somehow even taller than last week and eating three servings for dinner. He starts mentioning knee pain after training, and maybe hobbles a bit around the house. He says it’s fine, but you’re concerned and go to Dr Google for some trustworthy advice. After typing “knee pain teenage boy,” the first thing that pops up is Osgood-Schlatter’s Disease. Disease? All the symptoms match, so he must have some sort of bone disease, right?

This is a typical situation we encounter at Vital Core Physiotherapy, with parents coming in, concerned about their children’s growth pains and ‘disease.’ However, in this blog, we’ll discuss just what these diagnoses are, and how physiotherapy can help everyone involved.

Research has shown that the term ‘disease,’ induces unnecessary dread and anxiety in both parents and children. Therefore, at Vital Core Physiotherapy, we agree with and advocate for the recent changes and more technical descriptions of these common childhood conditions, and hope that you join us in using them.

What are growth pains?

Growth pains are incredibly common in child and adolescent development. Boys and girls are equally affected, and the pain typically presents in the knees, heels or feet. Pain is caused by a recent increase or constance of physical activity that children undergo, resulting in an inflammation and irritation at the growth plate of a bone, known as apophysitis. Importantly, growth pains can limit your child’s willingness to participate in sport and activity, affecting his physical and psychological development.

Common types of growth pains

Tibial tuberosity apophysitis (formerly Osgood-Schlatter’s Disease)

Tibial tuberosity apophysitis is a common diagnosis for knee pain, especially boys aged 12-15 and girls 8-13. It is most typically present in active children playing basketball, volleyball, football and sprinting. It is caused by repetitive strain from running and jumping activities which causes irritation at the tibial tuberosity/tubercle, a bony prominence of the shin. Signs and symptoms include:

Painful to the touch just below the knee, either on one side or both

  • Worsened pain after physical activity or sport
  • More pronounced boniness/apparent swelling over the tibial tuberosity

Typical imbalances of children with tibial tuberosity apophysitis include overactive quadriceps muscles (located on the front of the thighs/ the driver) and underactive gluteal muscles (the buttocks). This is because many of the associated sports have a jumping or explosive component from the ground, which require strong contractions of the quadriceps. However, without strong gluteal and postural muscles, it is common for the knees and feet to cave in when jumping and landing, causing excess strain on the knee and an increased chance of inflammation or irritation. Physiotherapists will therefore prescribe exercises to lengthen the quadriceps and strengthen the glutes, such as glute bridges or crab walks

Calcaneal apophysitis (formerly Sever’s Disease)

                                                                                     image: www.orthoinfo.com

Calcaneal apophysitis is the most common cause of heel pain among children aged 10-12. It is caused by an inflammation and irritation of the growth plate on the heel. Things to look out for include:

  • Pain on heels on either one or both feet
  • Increased pain with running or jumping
  • Limping at the end of physical activity
  • A limitation to bending the affected ankle

Due to the heel pain, children will typically present with other movement changes in their foot, often placing more weight on the outside of the foot than the inside. Interestingly young athletes with this condition will often be tight in other areas of the leg – the calf or the hamstrings. Physiotherapists will provide treatment by mobilising the bones of the foot to help restore proper biomechanics, release tight muscles, prescribe exercises to improve ankle and leg range and control. We often use support taping to help offload the sore heel which often gives good pain relief. From this we may potentially prescribe orthoses/other support devices as well as give footwear advice. We will often work with one of our podiatry colleagues to ensure the best possible outcome for the child.

Apophysitis of the fifth metatarsal (formerly Iselin’s Disease/Syndrome)

Apophysitis of the fifth metatarsal is a typical diagnosis for foot pain amongst growing children. It is caused by an overuse injury of the fifth metatarsal (the long outer bone of the foot). It is common in children aged 9-14, especially those who do a lot of running and jumping. Symptoms include:

  • Pain along the outer edge of the foot
  • Swelling on the outer bump of the foot
  • Difficulty wearing shoes
  • Walking on the inside of the foot
  • Limping after physical activity

Similar to calcaneal apophysitis, physiotherapists will provide treatment by mobilising the bones of the foot to recover biomechanical changes, relax overworked muscles, and provide taping if need-be as a short-term solution.

The role of Physiotherapy in managing growth plate pain

Although growing pains are common, the pain can last for months (or even years!), and can be so debilitating that the child stops their sport or play commitments. This stunts not only their athletic potential, but also their personal and social development, pivotal for well-rounded adolescents. For this reason, it’s important to work alongside a physiotherapist, who will:

Diagnose and prescribe

A thorough assessment from our physiotherapists will diagnose the specific condition. Importantly, physiotherapists can rule out more sinister conditions with similar presentations, such as juvenile osteoarthritis, fractures, and even bone tumours.

Provide an individualised recovery program

Our physiotherapists will collaborate with you and your child to hasten their recovery. This includes the exercises and treatments mentioned above, tailored specifically to your child and their current ability, to help them return to function.

Furthermore, one of the most effective ways to manage apophysitis is by load modification. Historically health professionals recommended the immediate and complete cessation of sporting activities during the highly inflammatory periods, however the research now shows that a balance of activity and rest is optimal for recovery and healthy physical and psychological development. To achieve this, your physiotherapist will thoroughly plan and collaborate with you and your child to find the amount of sport and activity that will keep them physically healthy and social, while reducing further progression of injury.

Address compensations

While the pain of apophysitis may be local, postural compensations can occur, especially as children are growing. Our physiotherapists will perform thorough, full-body testing to identify biomechanical discrepancies, including weakened abdominal muscles, glutes, or compensatory movement patterns with longer-term implications.

While every child is unique, with different pains and sporting requirements, typically we want to improve the strength and control around the affected joint(s) during more functional activities. For this reason, we highly recommend our Kidfit and Teenfit classes. These are progressive weekly exercise circuits specifically designed to help children and teenagers improve their athleticism. These classes are held through the school term and are run by qVital Core physiotherapists, who will have a thorough understanding of your child’s history, and can help finalise your child’s functional capacity and strengthening in a cost-effective and engaging manner.

Conclusion

Overall, growing pains are common, and can hinder a child’s development, social interaction, play, or sporting ability. Therefore, it’s important to collaborate with a health professional to identify the individualised pathway to get your children back on track to healthier and more enjoyable play. The scientific evidence strongly suggests that collaboration with physiotherapy and a balanced load management program are most important for recovery and return to optimal function.

So, book an appointment today at Vital Core Physiotherapy, to help your children grow beyond their pain.