• Amy Wolkin PT, DPT, MBA

When Is It More Than “Growing Pains?”

Have you noticed that your kid is clumsier? Has your child reported growing pains?

Many children can experience aches and pains as they grow. Often, they are told they will “grow out of it.” While growing pains are certainly real, musculoskeletal injuries can, and do, occur during times of growth spurts.

Children’s bodies are still growing, and likewise, they respond differently to loads and stress than adults. Growth occurs first at the bones, and the muscles need time to catch up. During this lag time, it may appear as though your growing child’s flexibility has decreased. This occurs due to the muscle being pulled by the faster growing bone. Continual pulling of muscle on bone can lead to irritation and sometimes pain.

The area where bone growth happens is known as the growth plate, or ossification center. Within the growth plate is a region where the muscle attaches to the bone. This is called the apophysis. It can be irritated by extra tension from the growing bone and/or an increase in activity. If your child is constantly repeating certain dynamic movements in a specialized sport, they might not pull a muscle, but rather develop apophysitis. Apophysitis is a traction injury due to muscle pulling on bone. A growth plate injury, such as apophysitis, needs to be carefully managed to avoid long-term problems and ensure a healthy return to sport.

Below are a few examples of apophysitis injuries listed by body part. Some of these names may be familiar to you.

So, I can label my child’s injury, but what do I do next?

As hard as it is to tell a 10-year-old boy to rest (often has Sever’s disease) or an adolescent female soccer player to take a break from her team sport (iliac apophysitis), it may be necessary to scale back from activity, identify factors contributing to injury, and develop a program for return to sport. The RICE program of rest, ice, compression, and elevation may help to temporarily decrease pain but will not address the underlying problem.

Understanding length-tension relationships of muscles is essential. For example, Sever’s disease is often due to tightness in the calves while iliac apophysitis is from tightness in the hip flexors and quads. Recall that bones often develop faster than muscle, causing muscles to be tighter and limiting flexibility, while they “catch up” to the length of the bone. Reducing tightness in the tissue and stretching the muscle are imperative to lessen the pull on the bone. It is imperative to analyze the whole body and pinpoint imbalances in muscle groups. Which muscles are overworking and which are being underutilized? A child may need to learn how to correctly “turn on” and use particular muscles. For example, at the level of the pelvis, many children lack good control of their glutes and core. While your child can dash around, can he or she hold a side plank or perform a single leg bridge? By conditioning and strengthening deficient muscle groups, the muscles become stronger, movement patterns become more efficient and further injury may be prevented.

How does this explain my child’s clumsiness and sudden lack of coordination?

The boss of movement is the brain. It tells the body when and how to move, and even remembers patterns of movement that are repeated over and over – have you ever heard of muscle memory? Just as the muscles have to catch up to rapidly growing bones during adolescence, the brain also has to adapt to these changes. During this time, coordination, balance and proprioception, awareness of where one’s body is in space, decreases. Challenging balance and body awareness are key components of rehabilitation. For example, have your child try to balance on one leg for a minute. Not yet wobbly? Next, have him or her close eyes for 30 seconds for a greater challenge. Still easy? Have them stand on a pillow or another uneven surface.

Once pain improves, it is important to gradually load the bones as your child returns to sport. Before returning to sprinting at soccer practice, your child needs to be pain free walking, then progressing to pain-free jogging, and then running. Agility and plyometric drills should also be included in a child’s return to sport program, as they further load the bone and challenge the muscles in different ways.

Unsure as to whether your child’s growing pains are normal? Start with an evaluation! A physical therapist can assess whole-body movement and help determine whether x-rays or other medical testing or intervention would be helpful. We will be able to help develop a return to sport protocol and help your child decrease the growing pains.

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