KIM’S KORNER The Young and the Restless

Pain is not just something experienced only by adults. Young children and adolescents often complain of pain, which initially can be dismissed as growing pains.  But children can also suffer from many of the conditions that affect adults. Although they may have slightly different names the symptoms are often the same: juvenile idiopathic arthritis, juvenile fibromyalgia, complex regional pain syndromes and overuse injuries. So how do you know if it is just typical growing pains or something else?  

Growing pains, aches in the thighs or calves, tend to occur after a very active day or during a growth spurt whereas other, more serious conditions may last more than a few days and be accompanied by swelling, pain in the joints and/or fever.  Once you have determined it is not growing pains and have ruled out serious pathology, arthritis or fibromyalgia, what else could it be? The following are common problems, rather than chronic conditions, that afflict adolescents and can affect everyday activities and limit participation in sports.

Hypermobility—Sometimes referred to as being double-jointed, this is increased range and flexibility at the joints, usually as a result of slack ligaments. When you’re young, being hypermobile can be something of a blessing and sometimes even a party trick (for adults too). Hypermobility can make things like doing the splits easy—making you the envy of your friends; or enable you to pull your fingers back almost to the knuckles—making them squirm. It is said that Houdini was hypermobile, making it possible for him to get into small spaces and even escape from a tank full of water while confined in a straitjacket. But hypermobility has its downside, especially when taking part in sports. Being so flexible can also mean less stability; and less stability can lead to injury. At the first sign of hypermobility, seek advice on how to protect your joints and minimise the risk of injury.

Slipped capital Femoral epiphysis—A condition that affects the hip of adolescents and is more common in boys than girls. The head of the femur slips backwards causing pain, stiffness and instability.  It can occur during episodes of rapid growth or after a fall but it can happen for no apparent reason. The aim of treatment is to correct the deformity and this is done by surgery, after which physiotherapy can help to increase the range of movement at the hip and strength of the muscles.

Osgood-Schlatter (patella tendinopathy) disease—This is inflammation of the patella tendon. It is common during growth spurts and among youngsters who participate in sports that involve running and jumping. In most cases, rest and exercises that include stretching and strengthening are all that’s needed to resolve the problem. Surgery is very rarely recommended.

Patellafemoral Stress Syndrome—This describes pain in and around the kneecap.  It tends to affect females more than males, possibly because females have wider hips, resulting in a greater angle where the bones meet at the knee joint. It can be caused by overuse—excessive running and jumping can put strain on the joint; falling directly onto the kneecap or muscle imbalances. The key to recovery is to ensure that the muscles of the lower legs are strong, and biomechanics are good, not only when participating in sports but also when performing everyday tasks.

Chondromalacia patellae (runner’s knee) This also affects the front of the knee but is caused by damage to the cartilage on the underside of the knee cap. The damage may be a result of excessive running and jumping, hence the name. Sometimes a few days’ rest can resolve the pain but if the problem is due to poor alignment of the patella, special exercises may be required to address muscle imbalances.

Sever’s Disease—This is pain at the back of the heel, at the insertion of the Achilles tendon. It differs from achilles tendonitis in that it describes inflammation at the growth plate of the heel. It is normally seen in children who perform repetitive movements or who are very active, but it is not uncommon for it to appear during a growth spurt. The key to recovery is rest and ice to reduce irritation and inflammation. To prevent recurrence it is important to decrease the stress on the tendon when walking and running, by strengthening the muscles around the ankle, and to improve ankle flexibility. 

So next time your child complains of pain, stop and think what’s causing it. It may be more than just growing pains. If in doubt, contact your healthcare provider or physiotherapist who can perform a full assessment and suggest what steps are needed for a pain-free and active child.