As parents, it’s hard to see our kids in pain. And it can feel even worse to be told that there’s little that can be done for our children’s growing pains aside from waiting for them to get better on their own - especially when that means watching our children sit out their favourite sports, as well as events with their friends. Research shows that sports involvement does much more than benefit a child’s physical health and physical skills like coordination, it also helps with developing their self-esteem, confidence, emotional skills, social skills (including a sense of belonging and forming friendships), a healthy mindset around winning and losing, discipline, teamwork and more. So can growing pains really be treated? Absolutely - let us explain.
What Are Growing Pains?
Until we reach maturity and stop growing, the process by which our bones lengthen and grow is via areas called growth plates (medically known as apophyses) located at the ends of the bones. Think of these areas as construction sites to which the body adds new bone. Unfortunately, the apophyses are cartilaginous (made of cartilage) and so are not as strong as the strong bone surrounding them, meaning they are vulnerable to pain and injury when the bone is under excess stress.
Growing pains typically occur in the evenings, nights or during physical activity. They manifest as aching, throbbing, pain and tenderness at the area of the growth plate. We often see growing pain in kids between the ages of 6-16 years. The pain can be intermittent, with periods of pain followed by pain-free intervals.
What Causes Growing Pains?
Growing pains is the most common cause of musculoskeletal pain in early childhood. While the exact mechanism of growing pains is much debated and not completely clear in the research, it is thought to be linked to the rate of bone growth versus muscle growth. Specifically, when muscles fail to adequately lengthen with bones, this places pressure on the bones where they attach, which irritates the vulnerable growth plates and leads to pain. This could explain why growing pains may be associated with growth spurts that leave the attaching muscles in a very tight and tense position so they constantly pull on the bone as kids run, walk and play.
Other causal associations have included a lower pain threshold in early childhood, anatomical abnormalities such as a flat foot posture, overuse syndromes and other genetic factors. Even wearing low-set football boots could contribute to growing pains if they put further strain on the Achilles tendon, for example, irritating the growth plate at the back of the heel.
Types Of Growing Pains
In podiatry and physiotherapy, the back of the heels, the knees and the outside of the middle of the foot are the three most common areas for growing pains that we see and treat.
Sever’s disease
‘Sever’s’ describes growing pains at the back of the heels. Looking at your heel bone (calcaneus), kids have a growth plate right at the back of their heel close to where the Achilles tendon attaches. Being the strongest tendon in the body that connects the calf muscles to the back of the heels, a tight and tense Achilles tendon will transmit a large amount of force onto the back of the heel bone anytime your child moves, especially when they run, which irritates the nearby growth plate and causes mild to severe pain with potential swelling at the back of the heel. The symptoms will tend to start during or after sports, and may cause them to limp off the field.
Osgood Schlatter’s
Osgood Schlatters describes growing pains at the knees. This means that the growth plate at the top of the shin bone (tibia) is likely being irritated by the pull of the patellar tendon, which comes down from the muscles at the front of your thighs, crosses the knee and kneecap, and attaches at the top of the shins. This produces pain and swelling below and around the kneecap, especially when bending the knee.
Iselin’s disease
Run your fingers along the outside edge of the foot - feel that bony bump around the outer middle of your foot? That’s where your child will feel their pain and potential swelling with Iselins. Here, it is the peroneus brevis tendon that travels down from the outer leg, across the outer ankle, and attaches to that bony bump (your ‘styloid process’) which causes the growth plate irritation on this bone.
Treating And Preventing Growing Pains
When you know and understand the likely cause of any problem, like the musculoskeletal imbalance and tightness like we have in growing pains, then the solution is fairly straightforward: reducing or eliminating this tightness (and therefore the tension) on the bone and growth plate means that the painful symptoms will stop - or may not start in the first place. It’s also important to address any contributing factors to the tension and growth plate irritation, including correcting any poor foot biomechanics, switching out unsupportive footwear that is making the problem worse, looking at a child’s unique muscle strength, the range of motion in their joints, their gait pattern, and much more. Once we have the full picture, our team at PhysioCentral can create a treatment plan to address the problems, which will then enable your child to get back on the field and doing the things they love, while reducing the risk of their growing pains recurring in the future.
Stretches For Growing Pains At The Back Of The Heels
If you have a child experiencing growing pains at the back of their heels, try these stretches and exercises.
Gastroc stretch
- Stand facing a wall with your hands placed against it at shoulder height for support.
- Take a step back with your affected leg, keeping it straight with the heel flat on the ground.
- While keeping the back leg straight and the foot firmly planted, lean forward by bending the front knee.
- You should feel a gentle stretch in the calf of the back leg.
- Hold the stretch for 20-30 seconds while breathing deeply.
- Repeat the stretch 2-3 times for each leg.
Soleus stretch
- Sit on the floor with your legs stretched out in front of you.
- Bend one knee and place the foot flat on the floor, close to your buttocks.
- Position the opposite ankle on top of the bent knee.
- Gently press down on the knee of the bent leg while keeping your back straight and chest lifted.
- You should feel a stretch in the lower calf of the bent leg.
- Hold the stretch for 20-30 seconds while breathing deeply.
- Repeat the stretch 2-3 times for each leg.
Heel dips
Stand with your feet shoulder-width apart and place your hands on a sturdy support, such as a countertop or chair back, for balance.
Lift both heels off the ground, rising onto the balls of your feet.
Slowly lower your heels back down to the ground.
Repeat this movement for 10-15 repetitions.
Perform 2-3 sets of heel dips, taking a short break between each set.
Towel stretch
- Sit on the floor with both legs stretched out straight in front of you.
- Loop a towel or resistance band around the ball of one foot.
- Gently pull the towel towards you while keeping your knee straight, aiming to bring your toes closer to your body.
- Hold the stretch for 20-30 seconds while breathing deeply.
- Release the tension slowly and switch to the other foot.
- Repeat the stretch 2-3 times for each foot.