For anyone who’s had kids you probably know that they tend to complain of aches and pains pretty often but they’re usually a one off and you probably don’t think twice about it. But what about when this complaining becomes a bit more frequent and they tell you about the same type of pain a little more often?
I’m sure you’ve heard the term ‘growing pains’ or maybe ‘Osgood Schlatter’s or Severs Disease … so when is it time to get those so-called ‘growing pains’ checked out? Is there really anything we can do to treat them? Or is it just a part of growing up?
Today’s blog is going to give you a bit more detail into these types of conditions and help to guide you on how to best manage them at home. Lastly, we will help you decide when they might need to get in to see the physio!
So what’s actually going on here..?
This type of pain falls into a condition known as Traction Apophysitis and can affect a number of different areas of the body. The most common conditions you may have heard of are on the back of the heel and the front of the knee. These are known as Sever’s Disease and Osgood Schlatter’s Disease respectively. Here is a list of some of the other areas where traction apophysitis’ can occur:
Severs Disease = Heel (Calcaneus) – Achilles Tendon
Osgood Schlatter’s = Knee (Tibial Tuberosity) – Patella Tendon
Sinding Larrsen-Yohansson = Knee (Patella) – Patella Tendon
Little League Elbow = Elbow (Medial Epicondyle)
Hip Joint Anterior = superior iliac spine OR
Ischial Tuberosity OR
Anterior inferior iliac spine
This condition occurs in children and adolescents typically secondary to a growth spurt as the bones tend to grow faster than the muscles causing tension through the attachment site of these muscles. As the bodies’ larger muscles contract repetitively, particularly in very active children, the constant pulling on the immature bone causes local irritation, inflammation and microtrauma.
Who is at risk?
Traction apophysitis’ are more common in boys than girls and usually around the ages of 9-14, typically around the time of a growth spurt. It is more common in active children who are playing high levels of weekly sport, particularly running, jumping and kicking sports. Thus it is an overuse type of injury. It can affect one side of the body but also affects both sides in up to 30% of children.
How do we diagnose a traction apophysitis?
Pain is often a gradual onset but can be aggravated by a single event e.g sudden increase in activity. The pain increases with activity and will usually settle with rest although as the condition progresses it can also be painful during rest! The area of pain is tender to touch, for example the back of the heel or front of the knee, and can result in local swelling and inflammation. This inflammation and repetitive trauma can result in the formation of a lump on the heel or knee.
In some cases the pain may cause the child to limp and in extreme cases an avulsion fracture can occur. This is when the tendon pulls a piece of bone off secondary to a strong muscular contraction. There may be associated tightness of the surrounding muscles and often some biomechanical predisposition to the condition.
So can we treat this condition?
You may have been told that these ‘growing pains’ will eventually go away… and yes that’s true, it is a self-limiting condition which means as they reach skeletal maturity the pain will eventually subside… But that doesn’t mean that treatment isn’t effective!
As Physio’s we can help to manage symptoms and allow the child to continue playing sport (as they usually want to to!) and most children will respond well to this conservative management.
The first step involves reducing local symptoms by the use of rest and ice post activity. Anti-inflammatories may also be effective in the early stages. From here treatment will focus on gradually loading the surrounding muscles to better support the painful area, addressing abnormal biomechanics and movement patterns and some stretching (being mindful not to aggravate the painful area).
Isometric muscle activation can be effective early on and exercises will progress from non-weight bearing positions into weight bearing. The use of taping to help offload the tendon is also very effective particularly in the heel and knee. Heel raises can also be used for the same effect when treating Severs.
Often in the early stages the child can continue playing sport but as it progresses and becomes more painful there may need to be a discussion between parents, coaches and the physio about modifying their activity levels. Although the evidence doesn’t suggest an acceleration of the healing process it will contribute to a reduction in pain and is therefore important to consider for your child.
How long do symptoms normally last?
This will vary between children depending on body type, level of activity as well as a number of other factors. It is important to know that symptoms may be present for up to 2 years!
Do I need to get my child an x-ray?
These conditions are clinically diagnosed and radiographs are usually not required. Imaging may only be indicated if an avulsion injury is suspected. Your physio will be able to tell you if they are concerned about this.
Stay tuned for some examples of how to tape your child to help reduce symptoms!
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Do you think your child could be suffering from one of these conditions? Bring them in and see one of our friendly physios for an assessment.