During any periods of change, the general population commonly use terms such as “growing pains” or “teething problems” as light hearted ways of describing the difficulties or challenges faced during a transition phase before a final result is achieved, but what is going on exactly from an anatomical and physiological perspective during these phases?
Growing pains refer to the transition period that young teenagers and pre-teens experience during puberty, both hormonally and physically in terms of how their body changes and grows during these pubertal years. Puberty can be defined as the transitional period from childhood through the development of secondary sexual characteristics to the achievement of final height of our body in adulthood.
Growth in height is driven by elongation of our long bones (bones that are defined as longer than they are wide, for example – our large lower limb bones such as the femur and tibia that make up most of the skeletal structure of our legs). This happens at the epiphyseal plates of the bone, also commonly known as the growth plates.
The speed of growth is most notable in early and mid-puberty and is referred to as the pubertal growth spurt. This occurs at slightly different ages between boys and girls. The rate of growth then decreases dramatically and eventually stops once our growth plates have closed in late puberty.
It is important to remember that there are many factors related to the stimulation of bone formation and growth in the pubertal growth spurt. This includes nutrition, cellular activity, as well as paracrine and endocrine activity.
The epiphyseal growth plate of our bone structure is made of several key aspects including cartilaginous, bony and fibrous components, which act together to facilitate bone growth. An injury to this region that occurs before these growth plates close, has the potential to limit growth in the affected limb, making these injuries crucial to be managed correctly.
In the normal process of growth, without injury, we would like you to think back to your early teenage years and how the changes to your body and your psychological state occurred. It can be an extremely difficult and challenging time for any child, while some might experience it more severely than others.
Clumsiness is a common issue for some children as their growth spurts start rapidly and earlier on than others. Our long bones grow faster than the soft tissue around them, such as muscles, tendons and fascia. Often muscle insufficiency, pain, injury, balance issues and poor proprioception may all be side effects of a rapidly growing child.
As a result, the growing pains experienced might not only be due to the pain experienced from the body change but also due to the pain experienced when bumping into the doorway, stubbing their foot on the dining room table or even from falling, as these structures may already be more sensitive than usual due to the underlying changes that are occurring.
These challenges are common and can be overcome through physical activity, whether by general play on the school sports field or through specific and graded exercise prescription from a health practitioner. This will depend on the severity of what each child is presenting with in terms of their growing pains and needs to be adjusted accordingly.
While there is a need for children to participate in physical activity, clinical consideration needs to be given to how the epiphyseal growth plate functions as briefly described above. The epiphyseal growth plate is a dynamic entity and thus our bodies should be dynamic as well. Bone growth is not only dependent on intrinsic factors such as hormones and other regulatory body factors, but on extrinsic factors and the biomechanical forces that we put our body under in our daily lives.
Exercise and play are positive aspects for the epiphyseal growth plate and needs to be moderated through specific exercise prescription especially during pubertal growth spurts. While adults can be prone to overloaded or overtraining, so can children in this age group.
We as physiotherapists have a significant role to play in this through the assessment of a child experiencing difficult pubertal transitions as well as subsequent treatment and intervention of what issues may arise through exercise prescription, balance activities, proprioception improvement and sport specific rehabilitation to name a few.
A good take home message for any child experiencing growing pains is that there are forms of activity that can be beneficial when performed in a controlled and structured environment, keeping in line with the relevant health practitioner intervention. Growing pain is a self limiting condition as is tends to resolve once the growth has stopped, this can however, be rather significant for many children, making them feel despondent and reluctant to participate in sport.
