Growing Pain: Things your parents didn't tell you.

The Knee

Everyone has them unless we stopped growing at the age of 5. When we complain, our parents tell us we are just having "growing pains". Through the years sports became better organized and the "season" became year around. "Select teams" were formed and the pressure to perform raised the level of play both psychologically and physically. Paid coaches push their players as if their jobs depended on it and it did. Competition for college scholarships was the measuring stick used by the teams to lure the best players. Add the physical stress of a player who wants to play another sport with soccer and the breakdown begins. It is not unusual for a player to have track before school, school soccer after school and club soccer practice that evening. They come to me complaining of sore feet, ankles, shins, knees, hips and backs.

The secret to treating "growing pains" is simple. Identify the problem, determine the cause (biomechanical or overuse), and treat to alleviate the causes and symptoms. Most of the "pains" I see are mechanical in nature aggravated by overuse or a growth spurt. The knee is the most common joint affected by growth spurts. It does not discriminate between boys and girls.

The most common ailment around the knee is "Osgood Shlatters". This is when the bones elongate and the muscles haven't caught up with them. The patella tendon will try to pull away from the bone below the kneecap. It is common to develop a boney lump at this site. Total avulsion (pull loose) from the bone is rare but this tendon-bone injury can be quite painful. Treatment can include a decreased or total cessation of sports activities, icing, stationary bike, light stretching, and leg exercises to pain tolerance. Time and patience are needed most during this inflammatory phase. Kids can play to their pain tolerance but with the pressure to play some will go beyond this pain to please a coach or parent. Padded knee braces can also help when there is contact with another player or the ground. Recovery time is different with each player depending on how much they grew and how fast. The physical stresses during this growth phase will also have a bearing on how long they will be out. The time can range from a few minutes during a few games to a whole year without playing. Finding a good orthopedic to monitor progression will minimize the effects of this malady. Return to play should be dictated by the pain and should be a gradual process. Staying in shape can be accomplished using alternative, pain free exercise programs. Tight quadricepses are associated with "Osgood Shlatters" but we must not forget the hamstrings group. Tight hamstrings can inhibit the forward motion of the lower leg as well as cause stress on the hips, SI, and lower back. Stretching with a belt or strap is the best way to isolate the hamstring muscle group. (Picture 1&2)

The tracking of the kneecap can also be affected by a growth spurt, especially in females. As the bones lengthen, the support structures around the kneecap become compromised. This is especially true when a female reaches puberty and her hips widen out causing a stance change increasing the angle of the knee to the ankle.(picture3) At this time it is not uncommon for girls to sublux or dislocate their kneecaps. Care should be taken not to compromise the support structures of the kneecap causing permanent damage. I have felt crepitus and degeneration in the female knees as young as 10 years old. My 53 year old soccer knees (still playing) are in better shape than many teenage female knees. Fortunately, kicking a soccer ball is the purist form of exercise to promote a healthy female knee. Add a patella-femoral tape job(picture4)or a patella stabilizing brace and many players can continue playing. Understanding the biomechanics and knowing when not to play can give these kids a long and happy soccer playing career. I will go over the hip, shin, ankle and foot problems associated with growing pains in my next article.