It is important to distinguish musculoskeletal pain in children from classic idiopathic ‘growing pains’. Children and adolescents often complain of pain and it can be confusing for parents and health professionals to distinguish between the various types of pain. Idiopathic growth pain is usually seen between the ages of three and twelve. It is often a vague intermittent pain mainly down the muscles of the legs. It is frequently present at night time and not specific to any joint or muscle. Childhood growth pain tends to run in families and affects 30% of children. Generally children will grow out of this. Interestingly, it is commonly seen in children with biomechanical issues such as poor posture and flat feet. This suggests that there is a possible relationship between growth pain and biomechanical faults.
Childhood musculoskeletal pain is quite area specific. This usually occurs after a period of rapid growth. It may be aggravated by sporting activities or poor posture brought on by long periods of study for example. There are usually biomechanical factors involved, which may include muscle tightness. It is generally seen between the ages of eleven and upwards until the growth phase has finished. This can be as late as seventeen for females and twenty one for males.
Subjectively, these clients can complain of sore feet, heels, Achilles tendons, knees, shins, shoulders, hips, neck or back pain. Onset usually occurs without any significant event and is intermittent. Growth spurts may have occurred recently and may be picked up by enquiring about appetite, sleeping /fatigue patterns, changes in height and shoe size. Pain can be aggravated by specific events such as running, standing or sitting. Persistence as a health practitioner is needed to get a good subjective history from the patient. We can put this down to lack of body awareness and coordination during this phase of life. The body is rapidly changing and clients often appear gangly and not quite comfortable in their body.
They can also be quite self-conscious and posture may reflect this. It can further be difficult to assess these clients adequately due to their embarrassment. Asking the client to wear a swimming costume, or crop top and shorts may help the assessment. It is also important to get a thorough history of the activity the child participates in during the subjective assessment. This will give an indication of which muscle groups are getting heavily used and the ones that will need more focused work.
There are a range of conditions to consider with adolescent clients. Some of the most commonly seen complaints are:
- Plantar fasciitis
- Sever’s disease
- Osgood-Schlatter’s disease
- Patella femoral issues
- Groin strains
- Swimmers shoulder
- Postural dysfunctions
Biomechanically there are often significant changes that acute observation and testing will pick up. These might include but are not limited to:
- Pronation of the feet
- Tibial rotation
- Squinting patellae
- Valgus knees
- Hyperextension of the knees
- Tight musculature
- Increased or flattened lumbar curve
- Increased thoracic kyphosis
- Hip and shoulder height differences
- Protracted chin position
- Poor lumbo-pelvic stability
Once diagnosis has been established, it is vital that the patient is educated regarding what is occurring and why. Compliance of exercise prescription can be difficult with this age group, so support and education of the family is important for recovery. Most often treatment consists of advice and specific exercises to reduce the biomechanical factors causing the pain. However other interventions such as soft orthotics, taping, bracing, acupuncture, electrical modalities, and joint mobilisations can also be helpful. Body awareness and coordination exercises may assist in reduction of pain.
If treatment has been specific to what was found on assessment, recovery should be relatively rapid. Sometimes flare ups will occur with future growth spurts. Intermittent reviews are appropriate to monitor this. The risk is, as pain reduces so will compliance with exercise. Old postural habits may return, causing flare ups. If pain does not settle with treatment further investigations/opinions need to be sought to ascertain the reason for this referral to physiotherapists who have experience with these types of conditions is recommended.