When growing pains need more attention


DEBILITATING More serious and localised pains can occur as children reach peak growth periods.

Andrew O’Brien

Does anyone remember ‘Growing Pains’? The American family-based sitcom of the 1980s that ran for way too long and used some very heavily recycled jokes every week. No? Seems like my college housemate and I might be the only ones left.
What about the other type of growing pains? The variety that keeps kids sidelined from sport and used to leave my little sister crying in the bath in the evening? Most adults who had them have long since forgotten about them, but our son just turned nine and is entering into prime growth-related pain territory, so it’s time for me to remember them again.
There are two types of growing pains, ordinary generalised aches, and more specific pains at points where tendons attach to bones.
Ordinary growing pains are most common in pre- and primary-school-aged children, and tend to be more common in girls than boys. They cause an aching or throbbing pain in both legs: most likely the front of the thighs, calf muscles or at the back of the knees that starts in the evening or night time and settles by the following morning. Very little is known about the pain mechanism, as growth in itself isn’t painful, and short of using hot water bottles or a warm bath there is little in the way of treatment.
There are, however, more serious and localised pains that occur as children reach peak growth periods that can be quite debilitating.

Localised pain
The three main growth-related conditions chartered physiotherapists see are: Osgood-Schlatter’s disease, Sever’s disease and Sinding-Larsen-Johansson syndrome. As always, the names of these conditions make them sound like some form of contagious and potentially terminal illness, when in reality they tend to be relatively benign and self-limiting.
All three of these conditions occur in periods of rapid growth. As a result they tend to be more prevalent in boys whose growth comes in spurts. Each is related to the fact that the long bones of the body grow quickly and muscles take time to stretch or catch up to the extra length in the bone. As a result, there is a tensioning effect and the tendon insertion can become inflamed, which is described as an apophysitis.
Sever’s disease usually affects boys between nine and eleven years of age, around the time of the first major growth spurt. It causes pain at the heel, where the Achilles attaches to the calcaneus or heel bone. The pain tends to worsen with activity and as the day goes on – I remember being in tears at the end of a school sports day with unrelenting heel pain.
The best treatment is to stretch the calf muscles as much as possible, trying to encourage them to lengthen with the bones, and use ice and rest when in pain. Symptoms will usually settle within eight weeks.
Osgood-Schlatter’s disease can affect girls and boys aged 12-15, but is at least three times more prevalent in boys, causing pain just below the front of the knee where the patella tendon attaches to the tibia. Often, a painful lump develops at the site due to the tendon pulling and reshaping the bone. Again, treatment involves stretching, ice and rest as required.
Like Osgood-Schlatter’s disease, Sinding-Larsen Johansson syndrome affects the patella tendon, this time at the top where it attaches to the knee cap, causing pain and tenderness to touch at the lowest point of the patella. It is most common in very active children aged 10-15 years, and is treated in much the same way as Osgood-Schlatter’s with stretches, ice and rest. Unfortunately, recovery from Osgood-Schlatter’s can be slow, taking 12-24 months.
If your child complains of any of these symptoms, especially if they are growing rapidly, the first thing to do is have them take it relatively easy for a week or two, using ice on the painful site as needed. If that isn’t enough to settle the pain, seek an assessment and advice from your chartered physiotherapist.
It’s important to note though, that the rest period should not involve watching 1980s sitcoms. Those of us who were there know that would be more painful than the condition being treated.

Andrew O’Brien is a chartered physiotherapist and the owner of Wannarun Physiotherapy and Running Clinic at Westport Leisure Park. He can be contacted on 083 1593200 or at www.wannarun.ie.