GROWING PAINS

 OR

 ‘TRACTION APOPHYSITIS’

Have you ever wondered why adolescents experience growth related pains?

Where does it come from and how should it be treated?

Growing pains are common, particularly in active children and adolescents. As the name suggests, growing pains mainly occur during periods of rapid growth and/or just after a growth spurt. Traction Apophysitis is a term used to describe a group of overuse traction injuries which commonly cause pain in adolescents. In a growing skeleton there are growth centres, and activity here causes lengthening of the bones, sometimes rapidly. This quick change in length causes tightness in muscles that attach to these bones. The site of attachment of these muscles to the bone is called an apophysis, these areas are softer and more susceptible to injury than in a mature skeleton.

For your ‘’sporty’’ child it would be fair to say that between the ages of 11-17 activity levels ramp up. Training 4-5 x per week for both club and school sport, and games both days of the weekend can be typical at this age. The amount of accumulative load put through the musculoskeletal system at this time is immense, and often there is not enough rest if you add ‘’nipping’’ out to shoot a few hoops with mates, or to give the trampoline a quick go is often the go. For our young athletes, this prolonged spike in activity along with rapid skeletal development puts them at the coalface of potential overuse and load related injuries at the muscle attachment points. This repetitive traction at the attachment site, and the immature nature of the area causes micro-trauma, inflammation and pain can follow. As growth stops at these centres of growth (this happens at different centres at different ages!) Symptoms settle.

The two most common places where this condition can occur are: the heel bone just below the achilles tendon insertion (Sever’s Disease). Commonly around the age of 11-12 and :-The bony prominence just below the knee (Osgood-Schlatters Disease), Commonly around the age of 13-14. Other common areas are around the kneecap and hip, and there are a few less common problems that affect the elbow and foot.

The term disease is often confronting! It is worth reminding you it is not a disease but rather a very understandable load related problem which will get better!!

Physiotherapists can accurately diagnose and differentiate from other causes of MSK pain. Management of these ‘’growth related’’ issues reflect the level of pain and recovery times. Symptoms will respond negatively to activity and positively to rest, therefore management must involve a degree of exercise modification. The trick is working out how much modification is needed for ‘’acceptable’’ symptoms. In many cases the patient can be ‘’sore but safe’’ to continue to be active, but higher levels of pain will mean more activity modification. Additionally, home exercises aimed at improving muscle strength, post activity management and in rooms physiotherapy will all aid better management. Occasionally for more severe symptoms radiological assessment can assess for more significant injuries to the apophasis (these are rare). Your physio will guide your child through the ups and downs of management during this sometimes-troublesome period with assessment, monitoring, and tailored management advice.

By Gary Stevens

Physiotherapist