Growing, is it painful?
Research also reports that this pain is almost always reported in the evening before bed, and often children wake with pain during the night. Of concern, many of the referrals we receive for “growing pains” are not in the muscles, but more in the joints. Affected adolescence regularly report pain worse in the mornings when they first wake up and pain with running, jumping or playing sport. This is not “growing pains” as regularly reported. On assessment our experienced physiotherapists will always exclude what we call “red flag conditions” if this may be suspected. This may include x-rays or blood tests ordered from GP’s to exclude more concerning causes for pain. However, most often, pain appears to be linked to dysfunction during the “peak growth velocity” period, or what is more commonly called the “adolescent growth spurt.”
Peak Growth Velocities
Peak growth velocity (PHV) is when your child experiences their greatest upward growth in stature or the times that they grow the fastest. Specifically, within this document we will focus on the PHV that occurs in adolescence. This is the approximately over a 1-year period where an adolescence will reach to an average of 91% of their final height. In girls the timing of the PHV is between 10.8-12.2 years and they grow approximately 8-10cm in one year and in boys between 13.3-14.4 years old, increasing their height on average by 10.3cm in one year.
Although this growing phase is very normal, it does pose additional stressors on the body. To be clear, these stressors are not growing pains. However, pain and general body dysfunction can occur due to multiple increased pressures on joints, bones and tendon networks. They are growing so fast! The length of long bones increases before the length of muscle and tendon networks. This means that your adolescent has longer levers to control, less muscle control and higher centre of mass- or what we like to nickname “baby giraffe syndrome.” This will cause even the most physically gifted adolescent to appear clumsy and therefore be more prone to injury during this time. To make factors more “awkward” growth is not uniform across the body. Growth phases begin at the feet, then the lower leg, thigh bones then torso and upper limbs over that PHV year. This doesn’t all occur at the same time. We can even see transient leg length discrepancies when one leg appears to grow faster than the other (this normally rights itself within a couple of weeks!).
Growth cartilage is less resistant to injury, especially rotational or pivoting forces of dynamic sports and dancing. Furthermore, bone density is at its lowest prior to onset of PHV. There are rapid increases in height and weight in adolescence before bone density “catches up”. This leaves the resulting bone and growth cartilage more exposed to injury and pain, if movement is not biomechanically correct or if loading through these immature joints is too much.
So, should you wrap your teen or pre-teen up in cotton wool as soon as their feet start growing in front of your eyes and the pantry gets emptied at an increasingly rapid pace? NO! This is an essential time within a person’s development to encourage habits of lifelong exercise and improve their long-term health outcomes. Furthermore, increases in muscle mass, strength and cardiopulmonary endurance that occur during puberty are greater than at any other age. This is often referred to as the “window of opportunity” amongst coaches and trainers. This is where correct technique, appropriate loading and overall management of a youth athlete has been shown to “lift the ceiling” of future physical development.
Overall, I would always recommend appropriate training loads for an adolescences age including regular rest periods. I would analyse an adolescent’s height development and ensure that movement patterns are optimal. Most of this stems from appropriate education on loads and how their body is designed to move through the fundamental movement patterns specific to their chosen sport(s) or dance. Finally, pain is not expected during this period. Pain can be an indication of injury, increased bone or growth plate stress from loading or poor movements causing torsional stress through these areas.
If you have any questions or concerns about your adolescent, their training loads, their movement patters or their pain, please do not hesitate to contact us about an assessment. We would prefer to help you with a small problem than be having to rehabilitate a significant injury that can keep your child away from the activities that they love.
Important things for parents to note:
You should seek attention from your GP if your child has the below symptoms accompanying their pain:
- Redness or swelling around the joint
- Unusual rashes
- Loss of appetite
- Unusual behaviour
Written by Amanda Meys, April 2020
Amanda (Mandy) has two areas of special interest, Paediatrics and Pain Rehabilitation. Amanda has completed postgraduate paediatric physiotherapy study through Monash University in Melbourne and her post-graduate diploma in Child Health through AUT. Amanda is passionate about delivering thorough patient-and family-centred care. Mandy runs a weekly hydrotherapy clinic for Avenues Physio-Fitness, providing specialised pool therapy to enhance rehabilitation outcomes for our clients. She also runs our Pain Management Service Programs and has an interest in chronic pain. She is a member of the NZ Pain Society. BPhty (Otago), PGDip Child Health (AUT)