When is it More than Just Growing Pains?
As a physical therapist specializing in sports medicine for 20 years, I have discovered a plethora of misinformation pertaining to the pain our youth are experiencing as a result of their athletic endeavors. In my practice, I have witnessed an increase in the numbers of kids, ages 5-18, who play one sport 4-6 days per week, year-round. Many of these kids have struggled with the same injury on and off for years before they come in for treatment. I frequently encounter upset parents because they were instructed to have their child “rest, it will just go away.” Rest can help to diminish the injury temporarily, but if it isn’t healed properly, that same injury will return to haunt and hinder every sports season.
Another myth I often hear is, “it’s just growing pains; they’re kids, they will just heal.” The problem is it doesn’t always just heal. Remember, pain is a signal to our bodies that something is wrong. Also, when someone has pain, compensatory patterns can develop. Think of a limp, it becomes a habit and even when the pain is gone, the limp may still be there. We have the opportunity to correct these problems BEFORE they become an issue. The beauty of the youth athlete is they are still growing and changing. This is the prime window of opportunity to guide their movement and strength progressions while they are developing, before it becomes a chronic injury.
Next, I want to highlight overuse injuries in the youth athlete. Over 70% of youth injuries are from overuse. Kids have common patterns of overuse that are very different from the adult athlete. Children are not small adults. There are variations we must consider in their athletic training.
1. Growth spurts, the pattern in which they grow, will change how they move. During a growth spurt, the brain does not know yet where the body is in space, therefore the child may be clumsy (think of the puppy with big paws that falls every time it runs). That in and of itself, will predispose the young athlete to injury.
2. Energy expenditure associated with growth may cause fatigue, and thereby increase risk of injury.
3. Year-round training in one sport has been shown to increase overuse injuries significantly in our youth athletes.
The common overuse injuries we’ll address today are fractures, growth plate injuries, soft tissue strains and chronic sprains.
A stress fracture is an overuse injury in a young athlete due to the increased porosity of the immature bone. When the muscles are tired, there is inevitably more impact and stress on the bones. With the increased volume of training sessions, the cells of the bones are unable to repair fast enough to keep up with demand. This often occurs more frequently in the lower legs. Stress on the shins (shin splints) is very common for runners and sports that involve high levels of running like: track, soccer, basketball, volleyball. Vertebral (low back) injuries are high among gymnasts, divers and skiers. It is very common to see the onset of pain early to mid-season, in concert with the increased volume of training because the body is not yet trained to keep up.
Growth Plate injuries are very common in children. The growth plates are the space on the ends of the long bones that have not hardened yet. Because the plate is sandwiched between the hard bone, it is more vulnerable to shear and compressive forces.
“Approximately 15% to 30% of all childhood fractures are growth plate fractures. Because the growth plate helps determine the future length and shape of the mature bone, this type of fracture requires prompt attention. If not treated properly, it could result in a limb that is crooked or unequal in length when compared to its opposite limb. Fortunately, serious problems are rare. With proper treatment, most growth plate fractures heal without complications.”
Common injuries that happen with trauma and overuse are Severs (heel pain), Osgood Schlatter disease (tibia: large painful bump just below the knee cap), little league elbow and gymnast wrist. These injuries can be overlooked and regarded as “just a sprain.” When these injuries are not identified, significant problems can arise that may affect the child well into their adult years.
Soft tissue injuries are something I see very frequently in my athletes. https://www. ncbi.nlm.nih.gov/pmc/articles/PMC2213798/ These are commonly known as Tendonitis and chronic muscle strains. Shoulder pain is frequent throughout the season in our pitchers and swimmers. The ache just below the knee cap for our soccer players and volleyball players. The chronic hip flexor strain for all my track athletes, and don’t forget the “pulled hammy” that just won’t stop hurting with all my sprinting and cutting sports.
The soft-tissue injuries occur when the muscles around a joint are not balanced. The muscles are pulley systems. Image a huge round stone with a bunch of guidewires, we have 10 people pulling these wires to roll the stone in a straight path. If everyone pulls evenly in the right sequence the stone will roll straight. If one side pulls harder or at the wrong time, the stone moves in that direction. If the hamstrings pulls before the gluteus muscle, that muscle gets the brunt of the force. The outcome is an overtaxed and painful hamstring. The same goes for the quadriceps and hip-flexors. These are prime examples of the common compensation patterns I referred to at the beginning of the article.
Rest and ice are imperative to stop the symptoms of the injury. The way to address the root cause is to evaluate the movement patterns. A skilled physical therapist will evaluate the poor patterns and re-train for appropriate balanced muscle. This is needed to abolish the poor pattern that caused the stress. A good physical therapy program will include a strong focus on the neuromuscular education, teaching the nerves and muscles to move in a pain free efficient manner. The gains in strength and speed will be exponential!
The common ages that children experience growing pains are 3-5 and 8-12. To help ease that pain, I recommend a massage or gentle rubbing, Epsom salt baths, and gentle movement.
What can we do to help our kids?
1. Listen to them. If they hurt let them rest. They may still desire to play in the pool or goof-off in the backyard. This can be active recovery from a tough week of drills at practice.
2. There is a growing body of evidence that shows sports specialization before high school can lead to greater risks of overuse injury and burnout. They may do better with an entire season off. Let them play a recreational sport, one that is different from what they are doing competitively. The majority of professional athletes played more than one sport allowing the body to actively recover between seasons.
3. Find a physical therapist or trainer who will work with your child to teach effective patterned movements. Regardless of the injury or the cause, there will be imbalances in the injured region, in addition to, the joint above and below. The time of healing is the perfect time for a professional movement specialist to retrain the muscles and joints to move with the best efficient pattern. You will see huge gains when your child can move effectively without pain!
The list of potential injuries and treatments could fill a text book. Should you desire more information on specific injuries, I provided links to a few helpful articles. Remember, pain is a message to our bodies that something is wrong. Finding a trained practitioner to help your athlete move through their childhood with less pain will reap the rewards twenty fold.
Julie Granger Young Female Athlete, Prism Wellness 2016.