Feature Article

Ouch! Growing Pains!
By Sallie Rediske, MPT

  Many people who come in to Homer Physical Therapy want to know why they have pain in a joint or an area of their body that "has never been injured".

  One answer to this question may be found by looking back into a young person's physical development history. Often, the key to non-traumatic joint pains can have their beginning some time around the onset of puberty. During the period leading up to physical maturity, we all experience "growth spurts" to some degree or another. We all know and remember some kid that experienced terrific growth during their late childhood/early teen years. Sometimes these children can shoot up 7-8 inches in height in one calendar year resulting in months of suffering the aches and pains associated with rapid growth.

  When this rapid growth occurs, it is important for parents to understand that often, life-long movement patterns are being established that can effect a child's future physical health. According to L. I. Karlin in "The Lower Extremity and Spine in Sport Medicine" change in bone length does not necessarily coincide with muscle length change - bone length change typically occurs at a faster rate than does muscle length change. The results are postural shifts that compromise good movement mechanics. Knees that once were straight become bowed, "knock-kneed", or "locked backwards", spinal alignment that once was upright and straight become slouched and stooped, feet that once had substantial arches become flat. These postural shifts prevent the lengthened bones frompulling so aggressively on the slow to lengthen muscles - making the growing child temporarily more comfortable.

  The challenge with this imbalance in bone and muscle growth is further accentuated when children are involved in activities that create additional shortening in some muscles and not in others. Some of the activities that do this include sports, dance, playing musical instruments, and even studying. All of these activities can contribute to muscle tightness that further reinforces the postural shifts that a child may be utilizing due to a sudden height change.

  Additionally, children who are going through these sudden changes often appear to have lost their sense of coordination which can further compromise the quality of movement throughout the body. One might compare the changes in a growing child with the changes in movement and proprioceptive ability (the ability to "know where your parts are in space") with a big Labrador puppy. Suddenly, the puppy goes from a bouncy, tumbling, well proportioned pup to a gangly, large footed, clumsy clown of sorts. The puppy has
grown so fast and so much that the feet that once felt 12 inches from the trunk are  suddenly 20 inches from the trunk leaving the brain unable to adjust to the new sensations perceived by the legs, trunk, and head. The leg moves, but it goes much further than it went with the same amount of effort, leaving the gangly pup tripping over some object as if it were not even seen.

  The child does the same things to some degree. The bones grow and the brain is quickly trying to sense the new relationships with respect to movement of the body. This is further compromised by the relatively slow process of muscle lengthening which leaves the body further unable to optimally control the movement at a joint. The active child often ends up with aches and pains that are no longer just internal "growing pains", but have become joint pains from the alteration in forces around the joints due to the postural shifts and the change in the way the child uses the joint due to the brain's perception of "where the joint is" in relation to the other joints and the environment.

  Depending on the level of activity, the genetic predisposition, etc. a child may be more or less likely to experience long-lasting effects of these postural and coordination shifts that often accompany the onset of puberty.

  Many of these changes can be moderated or eliminated through appropriate and effective stretching routines, instruction in safe and efficient movement patterns and soft tissue work when needed. Contacting a licensed physical therapist for help in developing a wellness program for young teens prior to onset of symptoms is an excellent approach to insuring a healthy young adult. 

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