Childhood & Adolescent musculoskeletal growth pain

Childhood musculoskeletal pain usually occurs after a growth spurt or period of rapid growth. This type of pain is often aggravated by sporting activities or poor posture. Commonly, biomechanical factors are present. Childhood musculoskeletal pain is generally occurs from the age of eleven until the growth phase has finished.  Patients will often complain of sore feet, heels, achilles tendons, knees, shins, shoulders, hips, neck or back pain symptoms. Pain can be aggravated by specific events such as running, standing or prolonged sitting.

There are a range of conditions to consider with adolescent patients. Some of the most commonly seen complaints are:
• Osgood-Schlatter’s disease
• Sever’s disease
• Schuermann’s disease.
• Plantar fasciitis
• Patellofemoral issues
• Groin strains
• Scoliosis
• Swimmers shoulder

There are a number of biomechanical anomalies that may be present. These include:
• Pronated feet
• Tibial rotation
• Squinting patellae
• Valgus knees
• Hyperextension of the knees
• Variation of normal spinal curves.

It is important that appropriate explanation is given to the patient as to what the problem is and why it has occurred. Typically, treatment consists of advice and specific exercises to reduce the biomechanical factors causing the pain. Other actions and interventions may be indicated which can include orthotic prescription, taping, bracing, joint mobilising, soft tissue work or physiotherapeutic modalities.


Children generally tend to have less injury worries than adults, as their structural tissues are more elastic. However, there are injuries specific to children that we need to be alert for - growing pains, heel and knee pain, headaches, and uneven shoe wear.


What is scoliosis?

Scoliosis is a disorder that causes an abnormal curve of the spine.
The spine has normal curves when looking from the side, but it should appear straight when looking from the front. People with scoliosis develop additional curves to either side, and the bones of the spine twist on each other, forming a "C" or an "S" shape in the spine.
Scoliosis is about two times more common in girls than boys. It can be seen at any age, but it is most common in those over 10 years of age. Scoliosis can be hereditary in that people with scoliosis are more likely to have children with scoliosis.

What are the symptoms and signs of scoliosis?

The most common symptom of scoliosis is an abnormal curve of the spine. Often this is a mild change and may be first noticed by a friend or family member (i.e. curve in spine, waist line/height differences and head position).The change in the curve of the spine typically occurs very slowly so it is easy to miss until it becomes more severe. It can also be found on a routine school screening examination for scoliosis. Those affected may notice that their clothes do not fit as they did previously or that pant legs are longer on one side that the other.
If the scoliosis is more severe, it can make it more difficult for the lungs to work properly. This can cause shortness of breath and chest pain. In most cases, scoliosis is not painful, but there are certain types of scoliosis than can cause back pain. Additionally, there are other causes of back pain, for which further assessment can be necessary.

What is the treatment for scoliosis?
Treatment of scoliosis is based on the severity of the curve and the chances of the curve getting worse. Certain types of scoliosis have a greater chance of getting worse, so the type of scoliosis also helps to determine the proper treatment. There are three main categories of treatment: observation, bracing, and surgery.
As explained above, scoliosis is not typically associated with back pain. In cases with back pain, the symptoms can be lessened with physical therapy, massage, and exercises. These can help to strengthen and balance the muscles of the back and may help to improve or prevent the curve to get worsen.

What is the prognosis for scoliosis?
Screening programs have helped to identify many cases of scoliosis early. This allows people to be treated with either observation or bracing and avoid the need for surgery in many cases. Most people with scoliosis live full, productive, and normal lives.

Is there a cure for scoliosis?
At this time, there is no cure for scoliosis. There are good treatment options as discussed above. Researchers are trying to find the causes of the different types of scoliosis. This will hopefully lead to better treatments or a cure.


What is the joint hypermobility syndrome?
The joint hypermobility syndrome is a condition that features joints that easily move beyond the normal range expected for a particular joint. The joint hypermobility syndrome is considered a benign condition. It is estimated that 10%-15% of normal children have hypermobile joints or joints that can move beyond the normal range of motion. Hypermobile joints are sometimes referred to as "loose joints," and those affected are referred to as being "double jointed."

What causes joint hypermobility syndrome?
Hypermobile joints tend to be inherited in specific genes passed on by parents to their children. It is felt that these certain genes predispose to the development of hypermobile joints. As a result, there is a tendency of the condition to run in families (familial).

What are the symptoms and signs of joint hypermobility?
Because the joints are capable of excessive motion in people with the joint hypermobility syndrome, they are susceptible to injury. Symptoms of the joint hypermobility syndrome include pain in the knees, fingers, hips, and elbows. There is a higher incidence of dislocation and sprains of involved joints. Scoliosis (curvature of the spine) occurs more frequently in people with hypermobile joints.
Signs of the syndrome are the ability to place the palms of the hands on the floor with the knees fully extended, hyperextension of the knee or elbow beyond 10 degrees, and the ability to touch the thumb to the forearm.

How is hypermobility syndrome treated?
Often joint hypermobility causes no symptoms and requires no treatment. Treatments are customized for each individual based on their particular manifestations. Joint pains can be relieved by medications for pain or inflammation. Proper physical fitness exercise can strengthen muscles and stability, but the nature of the exercise should be designed to avoid injury to joints.  Understanding the condition and getting proper advice and exercise can potentially prevent child from getting serious injuries.

Can joint hypermobility syndrome be prevented?
Because joint hypermobility syndrome is inherited, it is not preventable. Nevertheless, when joint hypermobility syndrome causes symptoms, preventing injury and pain is possible by avoiding trauma and with appropriate treatments.

What is the outlook (prognosis) for those affected by joint hypermobility syndrome?
Frequently, there are no long-term consequences of joint hypermobility syndrome. However, hypermobile joints can lead to joint pain. Over time, joint hypermobility can lead to degenerative cartilage and arthritis. Certain hypermobile joints can be at risk for injury, such sprained ligaments.
If your child has issues with his/her joints (i.e. keep rolling ankle, loosing balance, knee buckling), it is important for him/her to get reviewed by qualified providers.  Recurrent injuries inhibit proper muscle activation and lose appropriate sensation (proprioception).  This can happen without any existence of serious injuries –such as broken bones and damaged ligaments.
Our highly skilled and experienced Physiotherapists can assess and address those issues and potentially prevent further injuries.