Growing Pains

What are Growing Pains?

Growing pains. Do they really exist? It’s not nice for anyone when your little one wakes in the night with painful legs and cramps. Or when they complain of tired legs and refuse to keep walking around the supermarket due to growing pains.

Growing pains is an extremely vague description that doesn’t really explain what is causing your little one to endure this soreness, that usually occurs in the legs and feet. Funny how most kiddies rarely complain of “growing pains” in their arms or hands isn’t it?

Well perhaps these “growing pains” are not growing pains after all, and the sore legs and feet are a result of something else. The pain in the muscles and tendons, and the bones that they attach to, could quite possibly be due to the muscles working too hard to compensate for inherently weak ligaments. Joint hypermobility, caused by ligament laxity, is a common finding in youngsters that results in muscle stiffness and cramps. The foot and leg muscles, in simple terms, attempt to provide joint stability where the stretchy ligaments do not.

Imagine a short steel cable. This is how a fully matured, strong ligament should be. However, in many children they are more like elastic bands. It’s more common in girls than boys and certain nationalities demonstrate it more than others, such as Asians and Pacific Islanders.

As Sports Podiatrist’s, we fix up these floppy feet and this gets rid of the soreness in the foot and leg, that is caused by this inherent weakness. Sounds simple, and it really is! And because kids are so fresh and healthy, they respond to treatment in no time at all. Before you know it, little Johnny will have forgotten that his shins and calf muscles were ever sore at all.

Case Study – Growing Pains in a 9 Year Old Girl, by Sports Podiatrist, Karl Lockett

Growing Pains History

A young girl of only 9 years arrives at the clinic and reports pain and soreness in both legs and feet of approximately 6 months. Her concerned mother explains to the Sports Podiatrist that she believes her child to be describing growing pains and this was confirmed by the family GP. The patient, who we will refer to as “Lisa” is an active girl who enjoys netball and gymnastics. The growing pains are causing great discomfort during these physical activities and of late have caused Lisa to stop. She reports that she is able to play netball for around 5 minutes before the growing pains really take a hold of her. She tells the Sports Podiatrist that the pain is in the front of her legs, below the knee caps, in the upper third of the shin bone. She feels a sharp pain which hurts as she runs and continues to cause a dull ache for the following few hours. Lisa’s mum explains that her older sister went through the same painful experience at a similar age, and only found relief by stopping sports.

Lisa’s growing pains were also causing her to wake in the night. Her mum explains to the Podiatrist that at least 3 nights out of the week, Lisa would call out to her mum in pain as her calf muscles cramped. Lisa’s mum would rub her legs and massage her calves for a few minutes, and push her foot back to stretch the muscles. This would relieve the growing pains for Lisa so she could go back to sleep. The next morning she would feel stiff. Lisa’s mum explains that these episodes were more apparent, and that the growing pains were more severe, on the days of netball. Lisa was able to perform gymnastics with less frequent pain.

Physical Assessment of Lisa’s Growing Pains

Growing pains are often felt at the sites of growth plates, in the tibia and calcaneus – the heel bone. The pain felt in the tibial tuberosity and associated growth plate is known as Osgood Schlatter’s disease, while in the heel bone, Sever’s disease. In these conditions, there is irritation between the growth plate and the maturing bone. Lisa did not report pain at these sites, when pressure was applied. However, she felt pain when pressure was applied to the patella tendon. The tendon was also sore when resistance was applied. Did Lisa really have growing pains? Her symptoms seemed to be consistent with Patella tendonitis.

The range of motion in Lisa’s ankles was poor, due to extreme stiffness in her calf muscles. The Gastrocnemius muscles and Soleus were tender to touch and felt hard.

The Sports Podiatrist carried out ligament tests which revealed a Beighton’s score of 9! There was extreme hypermobility at the knee, sub-talar and mid foot joints. This would explain the tight calf muscles, which were compensating for weak foot and ankle ligaments.

Biomechanical Assessment by Sports Podiatrist

In order to determine the cause of Lisa’s growing pains it was important to assess her foot function in a weight bearing position. Bisection lines were drawn on her feet and legs and she was observed standing in a natural, relaxed position. Flat feet were noted bilaterally. Arch measurements were 9mm left, and 8mm right. Foot ligaments were unable to maintain foot architecture.

The Sports Podiatrist observed Lisa walking bare foot on the treadmill and this was recorded using digital software. Extreme pronation was noted bilaterally as the foot collapsed during a slow walk. The medial side of the ankle protruded and the lateral side of the foot “peeled” off the treadmill as the foot flexed across it’s mid line. This foot collapse and over pronation, due to “stretchy” ligaments causes the foot and leg muscles to compensate, and this can lead to stress and strain of the muscles groups involved. In addition to the sensation of growing pains it can lead to tendonitis and cramps, as the muscles fatigue.

During bare foot running on the treadmill, the over pronation became more severe and the angles between foot and leg, extreme.

Diagnosis: Ligament Laxity or Growing Pains?

It was explained to the patient and her mother that Lisa’s condition, although commonly referred to as growing pains was more specifically related to the stress and fatigue of her muscle groups. The quadriceps were dysfunctional due to excessive knee rotation (patella tendonitis) and the calf muscles stiff due to over pronation in the feet. Lisa’s lax ligaments were the major factor in these bio mechanical joint problems.

Treatment for Growing Pains

It was explained to Lisa and her mother that in order for these growing pains, or more specifically, pain from strained muscle groups, to subside we must support and stabilise Lisa’s joints. Foot support, and resultant leg re alignment, can be achieved in 3 ways. Footwear improvements, strapping with rigid sports tape and orthotic therapy.

Lisa was given a list of appropriate school and sports shoes to purchase, that suited her foot type and strapping was applied to both feet. The strapping was to remain in place for 7 days and was to serve partly as a trial for the orthotics. After one week, Lisa reported to the Sports Podiatrist that the support from the strapping felt good and she could feel the stability and control it provided. To this end, it was decided to arrange prescription orthotics to be placed inside Lisa’s school shoes. These could be easily transferred to her netball shoes. Lisa was advised to apply strapping before gymnastics to give support to her bare feet.

Follow Up

Lisa returned to see the Sports Podiatrist after 8 weeks for a follow up of her growing pains. She reported that the pain subsided in approximately 3 weeks, although the night cramps persisted for a further 2. Lisa’s mum arranged weekly calf massages for a month, which, in addition to regular use of the orthotics and new shoes, allowed the night cramps to subside. Lisa was able to play netball and perform gymnastics without foot or leg pain.

PLEASE NOTE: This case study should not be taken as general advice. If your child has growing pains or any type of lower limb problem, you should discuss this with a qualified Sports Podiatrist.