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Adolescent Joint Health: Growing pains explained

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Mark Adshead, Managing Director of Physio2go St. Albans looks at the physical stresses placed on adolescent joints. Mark explores some of the common causes of joint pain in the young athlete and briefly explains some issues in assessment and management.
“Growing pains” is a term rarely used by the medical profession; many parents however will recognise the periodic symptoms of various lower limb pains that occur around the time when their teenage children have spurts of growth. Despite the very rapid increase in length, it is usually not the bone that is the source of the pain. It is often the muscle and/or tendons which move and control the bones and joints.
Youngsters are sometimes unable to cope with the altered biomechanics induced by the relatively rapid bone growth coupled with the frequent increased intensity of sporting competitions. Some conditions occur in adolescents with no known cause and as a parent, it can be difficult to know when to seek medical advice for a child complaining of pain. This can often be the case with back pain caused by poor posture, as many youngsters prefer to slouch rather than take on board the good advice of their parents to sit up when using a computer for homework or playing computer games. They are more likely to view it as parental nagging!
In the above mentioned cases a visit to the GP or a Physiotherapist to check for correct development of the spine can work wonders. Often, a series of tips and exercises for better posture is prescribed, thus confirming the parental view but being delivered by someone in a “white coat”.
In recent years the practice of children having to carry heavy school bags has been highlighted and most schools now provide secure lockers in which to store belongings However, a double shoulder strapped backpack is the best way to distribute the load evenly from the books and equipment they do need to carry.
You can carry out a few simple checks at home. Firstly you will need to look at your child without him wearing a shirt so that you can see the natural curves of the spine. Make sure he is standing on a level floor and that both knees are “locked straight.” From the side the spine should look like a long gentle ‘S’ shape. From behind there should be no deviation of the spine to the left or right; the shoulders should be on a level as should the waist. If you notice an alignment problem you should initially consult your GP.

The young athlete

Back pain in the young may be due to over development of the muscles around one shoulder, for example in a tennis player who may develop permanent changes from asymmetrical training. Intensive training in the young athlete can cause the muscles and bones in their racket arm to increase in size, while the ligaments and tendons become lax, causing the shoulder to drop. Bowlers in cricket are also susceptible to this problem.
In recent years there has been an increase in the regular training and competitive sport for children and adolescents coupled with a decrease in the age at which they start. In certain sports such as swimming and gymnastics children start training as young as 5-6 years old, with training for 2-3 hours 5-6 days a week not uncommon. This increased demand on their growing bodies will have an effect on the development of their musculoskeletal system. They may be at risk of injury due to overuse. The skeleton is very vulnerable in adolescents and biomechanical discrepancies can occur as bones and muscles grow at different rates during growth spurts.

What to do

The advice that is most often given in these cases is to reduce the intensity of sport/activity to a level where the pain is abolished or reduced to such a level that it is bearable and not exacerbated by activity. This will often necessitate a reduction in the number of training sessions and matches with them being spread through the week rather than being consecutive days followed by a few days rest.
Pain is best managed by the application of either an ice pack or a heat pack (such as a wheat bag or a hot water bottle in a cover). In cases with more acute pain, analgesic tablets (e.g. Paracetamol) can be given; however, I am not in favour of long term drug therapy or anti inflammatory medication such as ibuprofen (Nurofen) in such a young age group. As the pain settles, any pain medication should be discontinued before a gradual return to full activity. Progress should be monitored in case the pain recurs whereupon further management of the activity level and pain control as before should be reinstated.
If the pain does not resolve with this regime, your GP may refer your child to an Orthopaedic Consultant for assessment and further investigation.
It is likely that you will also be referred to a Physiotherapist and/or a Podiatrist who will assess your child’s gait and biomechanics. This is a process of looking at whether particular muscle groups are ‘too tight’ and need a regime of specific stretching exercises. If a structural imbalance is identified, functional orthoses (fitted in the shoes) may be prescribed. This intervention aims to correct the way the feet transfer the force generated by the impact of running and walking, thus reducing the stress on ankles, knees, and hips. As a general rule, if your child has an acute joint pain with no history of trauma lasting 48 hours, or they complain of a more niggling ache that still persists after 2 weeks, with or without a history of trauma, medical advice should be sought.

For further information please contact:
Physio2go Ltd.
York Lodge,
St. Peters St,
St. Albans,
AL 1 3HD
Telephone: 01727 850925
Email: info@physio2go.co.uk