Active children usually between the ages of 7-15 years can be vulnerable to developing what is often called “Growing Pains”. This title is a very broad term for a myriad of symptoms that can develop around the growing body. During this age, children have growth plates (physis) present in their bones and softer boney protrusions where tendons attach. These are called apophyseal sites.
Pain can develop around these apophyseal locations and is caused by a variety of factors:
- Rapid periods of growth – there is often a difference between the rate of bone growth and the ability of the muscle-tendon complex (or soft tissues) to keep up. This results in the inability of the muscle-tendon complex to stretch sufficiently to the load that is being placed on it, causing an overload tension at the apophyseal site where the tendon attaches.
- The amount and quality of sporting and activity load; too much training and competition load can place increased stress, resulting in microtrauma of the apophyseal sites which causes pain.
- Underlying biomechanical factors and general strength and flexibility of the whole body kinetic chain
- Inadequate warm-up prior to high intensity or impact activity can also be unhelpful
Severs Disease
One of the most common apophyseal injuries in children is Severs disease. Severs disease affects the Achilles tendon insertion into the calcaneal (heel bone) apophyseal growth plate, which through repetitive microtrauma can lead to pain.
Pain is often felt at the heel and into the Achilles itself at times which is made worse by running and jumping activities. It can often occur at the beginning of a season of sport.
There can be an associated tightness or loss of flexibility through the calf area resulting in decreased ankle muscle strength and limitation of joint movement. Tension of the nerve structures can also be apparent.
Boys are 2-3 times more likely to get Severs disease than girls.
Severs disease is a self-limiting condition and the severity of symptoms determines the best course of management.
Treatment
Physiotherapy is very helpful in the management of this condition. Physiotherapists are able to discuss training and activity modification which might range from complete rest to being able to play and train at less frequency and intensity.
Trained physiotherapists are also able to help identify biomechanical factors, areas of tightness and weakness. The analysis of sporting technique can also be helpful in the management of this condition. For example, looking at how an individual jumps and lands can provide many clues as to the management and prevention of further injuries.
Soft tissue mobilisation, nerve and muscle stretches and strengthening exercises all make up the rehabilitation plan.
Podiatry is also helpful in determining appropriate foot wear and the possible addition of formthotics should they be needed. Sometimes it is a case of unloading the areas that are being overloaded.
Self-management includes activity modification, ice, massage, stretching and strengthening where appropriate.
There are multiple apophyseal sites in the growing child and these are the most common cause of pain in active children. If your child is complaining about growing pains or they are very active and have recently had a growth spurt then it’s definitely worth an assessment to identify potentially troublesome areas. It‘s also good to rule out any other possible conditions that could occur.
