A fairly common complaint I see in my office is the ambiguous “growing pains”. It occurs mostly in children from 3-9 years of age and then also in the pre-adolescent population. It is known to occur in up to 20% of all children. Although the incidence is high, the medical approach to treating the condition has not changed in decades. It is pretty much a standard answer, “they’ll grow out of it”. In this month’s column I intend to discuss the condition, it’s presentation, possible causes and the approach I use in the office to ease both the patient’s and the parent’s distress.
It makes sense that when children are in very active growth states and they complain of pain at the same time that parents and doctors alike correlate the two. One must be connected to the other if they are both occurring at the same time, right? Well not exactly. If that were the case then why don’t all kids have the same complaints? And what about tall kids, shouldn’t they have more trouble with growing pains than their counterparts?
The condition is usually described as a diffuse pain that is located in the legs both above and below the knee, mostly in the front of the leg, but sometimes behind the knee. There is no sharp pain component rather it is described as a dull throbbing toothache kind of a pain. It seems to strike children most commonly in the evening or in the middle of the night when they are at rest. Rarely is the same pain noted during active phases associated with play. The condition is often intermittent. It may appear for several nights in a row, then be absent for a time before making a reappearance.
The term “growing pains” implies that growing bones can be the source of the pain that children experience. There is no evidence that the actual cellular activity which causes bones to grow causes any pain. So what causes the pain? Read on as we discuss this further.
The nonspecific, generalized nature of growing pains may be a feature of many other childhood diseases. In fact, "growing pains" is what many pediatricians consider to be a "diagnosis of exclusion". In other words, different conditions should be ruled out as a diagnostic possibility before this one can be made. Most often, a thorough history and physical examination by a child’s doctor is sufficient to accomplish this; in other instances, blood tests and x-ray studies may be required. Once the other possible disease processes have been ruled out, pediatricians are left with nothing to report but “they’ll grow out of it”.
The commonly accepted cause of growing pains is now described as muscle injury. Many physicians are of the opinion that when the rate of the bone growth outpaces the ability of the soft tissue muscles and tendons to keep up, muscle injury, spasm and even tearing can occur. Though this explanation may be a part of the story, I believe there’s more to it.
I believe that subluxations are at the core of this condition. Subluxation is defined as the loss of proper position or motion of a joint. Abnormal joint mechanics result and can cause localized pain and inflammation as well as abnormal soft tissue tension and pain. Misaligned joints don’t work the way they were intended and alter gait and other motion patterns.
In my clinical experience I find that children suffering with “growing pains” have subluxations affecting the function of the knees, hips, pelvis and sometimes the feet and ankles. The focus of treatment is adjustments that restore the normal alignment and the mechanics of joint motion. Soft tissue work in the form of stretching and massage is also helpful, but doesn’t seem to achieve lasting effects when practiced in the absence of adjustments.
I have seen dozens of kids (and parents) lives changed as a result of proper identification and treatment of “growing pains”. If you have a child or know of one that deals with this complaint get them the attention of a chiropractor who specializes in the special needs of children. Perhaps they won’t have to wait until they grow out of it.