This is another one of those pet peeves of mine, and yes I know, enough of the eye-rolling.
The “Growing Pains” diagnosis is delivered daily to concerned parents and affected child with the advice that “this too shall pass”. Just like acne, temper tantrums, nose bleeds and all the other myriad of interesting afflictions associated with childhood.
So after a quick consultation with Dr Google I was delighted to see the primary sources presented had at least dropped the suggested narrative of rapid bone growth, and had instead identified the link with increased levels of activity and possible trauma. The constant theme is as follows
Causes
“Doctors don’t know what causes growing pains”. They do know that children who have growing pains may feel more pain after physical activity than other children feel.
Well, guess what, your Podiatrist or Chiropodist should be able to figure that one out pretty good.
By its very nature, pain is not normal, it is a very specific neural signal telling the individual that something is not right.
According to Woolf, there are three classes of pain: nociceptive pain, inflammatory pain which is associated with tissue damage and the infiltration of immune cells, and pathological pain which is a disease state caused by damage to the nervous system (neuropathic pain) or by its abnormal function (dysfunctional pain, like in fibromyalgia, irritable bowel syndrome, tension type headache, etc.) [1]
Nociceptive pain is what we typically deal with in our clinical setting. Pain is never normal, its our body saying “hey stupid I’m hurting here, can you stop doing whatever it is your doing to me”. It always requires investigation and never more so than in younger patients who may not have fully developed communication skills.
Dr kevin Kirby DPM a world respected podiatrist said of this condition:
“Over the past decade, I have often stated that the podiatry and medical communities should be able to clearly see that children’s “growing pains” are nothing more than a form of sports or athletic injury that we see commonly in adults. Children run and play most of the day
The normal running, jumping and playing activities that children perform on a daily basis, when combined with sub-optimal structure and function of the foot and lower extremity, will lead to increased abnormal tissue stresses which will cause pain and injury.
So in layman’s terms if there is an instability or disfunction in the way the child is walking and running, that is what is causing the mechanical injury resulting in pain. Treatment must always begins with identifying the source of the mechanical instability. That means history taking, physical exam, weight/non-weight baring evaluation, gait analysis. Then with education and understanding, the parents, patient and practitioner can agree upon a plan to address the condition.
This can be as simple as modifying activity, changing footwear/habits, strengthening, exercising, physical therapy, custom/non custom orthotics.
References:
1. Woolf CJ. What is this thing called pain?. Journal of Clinical Investigation. 2010;120(11):3742–4.
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