Growing Pains / Apophysitis

Children can suffer from growth related pain throughout development.
Two common growing pain syndromes are Severs disease and Osgood Schlatter syndrome. These syndromes are medically referred to as apophysitis – meaning inflammation of the apophysis, which is the cartilaginous prominence next to the physis (growth plate) of the bone. This site is where the tendon of a muscle attaches prior to reaching skeletal maturity.
During maturity, the long bones of the body grow faster than the overlying muscles. This results in short and tight muscles that cause traction on the growth plate when they contract. The shin bones are the first to grow (usually between the ages of 9 and 12) and this results in inflammation of the heel bone where the calf muscles attach. This is referred to as Severs disease. The thigh bone grows next (usually between the ages of 10 and 14) and results in inflammation of the shin bone just below the knee. This is referred to as Osgood Schlatter syndrome.

 

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Apophysitis typically develops from repetitive loading at the growth plate, particularly during or just after a period of growth, hence a child may have several episodes of ‘growing pain’ during development. Heel pain is aggravated by running and jumping which require the contraction of the calf muscles. Knee pain is aggravated by activity involving contraction of the quadriceps muscles such as jumping, squatting and sometimes running. The pain usually gets gradually worse over a few weeks, normally without a specific history of injury. Limping, swelling of the heel or shin bone, and muscle stiffness are also common. These syndromes can be diagnosed clinically, however xrays are sometimes necessary to rule out other conditions.
Growing pains are usually self-limiting, meaning that the child can continue activity and sport if they can tolerate the pain.
Treatment begins by aiming to decrease inflammation of the growth plate and tendon using ice, taping, pain relief and rest. Following this, restoring flexibility in the calf or quadriceps muscle is important to reduce the traction on the growth plate. Massage, stretching, heat packs and taping may be used to assist with this. Other factors such as strength, balance and coordination may need to be addressed.