For anyone who’s had kids you probably know that they tend to complain of aches and pains pretty often but they’re usually a one off and you probably don’t think twice about it. But what about when this complaining becomes a bit more frequent and they tell you about the same type of pain a little more often?

Growing Pains

I’m sure you’ve heard the term ‘growing pains’ or maybe ‘Osgood Schlatter’s or Severs Disease … so when is it time to get those so-called ‘growing pains’ checked out? Is there really anything we can do to treat them? Or is it just a part of growing up?

Today’s blog is going to give you a bit more detail into these types of conditions and help to guide you on how to best manage them at home. Lastly, we will help you decide when they might need to get in to see the physio!

So what’s actually going on here..?
This type of pain falls into a condition known as Traction Apophysitis and can affect a number of different areas of the body. The most common conditions you may have heard of are on the back of the heel and the front of the knee. These are known as Sever’s Disease and Osgood Schlatter’s Disease respectively. Here is a list of some of the other areas where traction apophysitis’ can occur:

• Severs Disease = Heel (Calcaneus) – Achilles Tendon
• Osgood Schlatter’s = Knee (Tibial Tuberosity) – Patella Tendon
• Sinding Larrsen-Yohansson = Knee (Patella) – Patella Tendon
• Little League Elbow = Elbow (Medial Epicondyle)
• Hip Joint Anterior = superior iliac spine OR
• Ischial Tuberosity OR
• Anterior inferior iliac spine

This condition occurs in children and adolescents typically secondary to a growth spurt as the bones tend to grow faster than the muscles causing tension through the attachment site of these muscles. As the bodies’ larger muscles contract repetitively, particularly in very active children, the constant pulling on the immature bone causes local irritation, inflammation and microtrauma.

See also: Patellofemoral Pain Syndrome

Who is at risk?
Traction apophysitis’ are more common in boys than girls and usually around the ages of 9-14, typically around the time of a growth spurt. It is more common in active children who are playing high levels of weekly sport, particularly running, jumping and kicking sports. Thus it is an overuse type of injury. It can affect one side of the body but also affects both sides in up to 30% of children.

How do we diagnose a traction apophysitis?
Pain is often a gradual onset but can be aggravated by a single event e.g sudden increase in activity. The pain increases with activity and will usually settle with rest although as the condition progresses it can also be painful during rest! The area of pain is tender to touch, for example the back of the heel or front of the knee, and can result in local swelling and inflammation. This inflammation and repetitive trauma can result in the formation of a lump on the heel or knee.

In some cases the pain may cause the child to limp and in extreme cases an avulsion fracture can occur. This is when the tendon pulls a piece of bone off secondary to a strong muscular contraction. There may be associated tightness of the surrounding muscles and often some biomechanical predisposition to the condition.

So can we treat this condition?
You may have been told that these ‘growing pains’ will eventually go away… and yes that’s true, it is a self-limiting condition which means as they reach skeletal maturity the pain will eventually subside… But that doesn’t mean that treatment isn’t effective!

As Physio’s we can help to manage symptoms and allow the child to continue playing sport (as they usually want to to!) and most children will respond well to this conservative management.

The first step involves reducing local symptoms by the use of rest and ice post activity. Anti-inflammatories may also be effective in the early stages. From here treatment will focus on gradually loading the surrounding muscles to better support the painful area, addressing abnormal biomechanics and movement patterns and some stretching (being mindful not to aggravate the painful area).
Isometric muscle activation can be effective early on and exercises will progress from non-weight bearing positions into weight bearing. The use of taping to help offload the tendon is also very effective particularly in the heel and knee. Heel raises can also be used for the same effect when treating Severs.

Often in the early stages the child can continue playing sport but as it progresses and becomes more painful there may need to be a discussion between parents, coaches and the physio about modifying their activity levels. Although the evidence doesn’t suggest an acceleration of the healing process it will contribute to a reduction in pain and is therefore important to consider for your child.

How long do symptoms normally last?
This will vary between children depending on body type, level of activity as well as a number of other factors. It is important to know that symptoms may be present for up to 2 years!

Do I need to get my child an x-ray?
These conditions are clinically diagnosed and radiographs are usually not required. Imaging may only be indicated if an avulsion injury is suspected. Your physio will be able to tell you if they are concerned about this. 

Stay tuned for some examples of how to tape your child to help reduce symptoms!

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Do you think your child could be suffering from one of these conditions? Bring them in and see one of our friendly physios in Kellyville and Carlingford for an assessment.

Chances are you’ve heard the term shin splints before… Over the past few weeks I have noticed a spike in the number of patients coming in to the clinic with what is most commonly known as ‘shin splints’. This could be due to the fact that we are coming to the end of the winter sport season or maybe because we are sitting in the middle of the running season!

In the physio world ‘shin splints’ is actually a broad term used for a number of conditions which fall under medial tibial stress syndrome (MTSS) and is any pain experienced in the front of the lower leg.

In this post I am going to give you a guide on how to identify this condition and give you 3 simple exercises to help reduce your symptoms and get you back on the track!

So what are they…?
Medial tibial stress syndrome could be caused by a number of tibial injuries including tendinopathy, inflammation of the periosteum (connective tissue surrounding bone), stress reaction of the bone and remodelling of the periosteum.
The most common complaint we hear in the clinic from someone suffering this condition is a general, dull ache in the mid-lower part of the shin bone and is most commonly associated with increasing activity. The diagram to the right displays the usual area of pain for this condition.

See also: Injury Treatment – Biceps Tendinopathy

The condition commonly presents in both legs at the same time but the pain may be greater on one side. At first it may only present at the beginning of exercise and once the body is ‘warm’ the symptoms disappear but then return as the body ‘cools’ down. As the condition progresses, the pain tends to stay throughout the whole event, including afterwards. Like the name suggests, shin splints are a stress reaction to chronic, repetitive loads going through the tibial bone.

What increases my risk of getting shin splints?

• Females 2-3x more likely than males
• Sudden increases in training (frequency, duration, intensity)
• Running or playing sport on hard surfaces
• Recent change in footwear
• Fat fleet (Pes planus)
• Weak or inactive core muscles
• Biomechanical abnormalities and training errors

I think I’ve got shin splints… What can I do??
Most people will probably tell you to stretch or foam roll your calves if you’re suffering from shin splints… but this is only part of the answer.

Here we’ll look at 3 simple exercises which can help manage pain coming from the shin bone region. Remember this is a complex condition and ideally requires a physiotherapy assessment which is directly tailored to you and the causes of your tibial stress! If your symptoms aren’t improving or are getting worse, make an appointment with your trusted physio!

1. Attack the source

Calf raises with eccentric focus
Studies show that weak calf muscles are more prone to muscle fatigue, leading to altered running mechanics and in turn extra strain on the tibia. This exercise is to start as soon as the acute painful stage has subsided and the exercise is tolerable.

2. Attack contributing factors

Glute med
Crab Walks
The glutes are extremely important muscles which sit on the side/back of the hip and contribute to lower limb stability and alignment. Although this muscle is higher up the chain, weakness of the glute medius will result in torsion of the tibia and in turn greater stress on the bone!

It also allows you to start the rehab process early as these exercises do not cause excessive stress on the painful area of the shins.

3. Attack poor foot biomechanics

Toe Swapping
When it comes to the lower limb, the inner foot muscles are extremely important in keeping the foot, in particular the arch, placed in an optimal position. These muscles often become weak or underactive leading to collapse or poor stability through the arch.

This exercise can be made easier and harder by performing in standing or on unstable surfaces.

What else could my pain be coming from…?
Stress Fracture: thought to be caused by similar processes to MTSS this is a more progressed condition in which small fractures start to appear in the tibial bone.

Chronic Exertional Compartment Syndrome: also occurs from repetitive loading or exertional activities. Can present with symptoms that indicate nerve involvement such as weakness or numbness in the lower leg. More commonly affects the outer region of the lower leg.
    

Galbraith, R. et al. (2009) Medial tibial stress syndrome: conservative treatment options. Current reviews in musculoskeletal medicine. Sep; 2(3) 127-133.