Recent Article in the Journal of Pediatric Orthopaedics.
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Growing Pains: Are They Due to Increased Growth During Recumbency as Documented in a Lamb Model?
Noonan, Kenneth J. MD; Farnum, Cornelia E. DVM, PhD; Leiferman, Ellen M. DVM; Lampl, Michelle MD, PhD; Markel, Mark D. DVM, PhD; Wilsman, Norman J. DVM, PhD
Journal of Pediatric Orthopedics. 24(6):726-731, November/December 2004.
The authors suggest the growth plates are compressed during weightbearing.
" A possible mechanism of pain may result from increased tension in the periosteum as the growth plates sping back from released compression or by some signal transduction mechanism during recumbency."
With the successful use or orthoses and triplanar wedges in the reduction of symptoms associated with "growing pains", or lower leg aches are we seeing a mechanical affect on the bones/growth plates or simply reducing muscle fatigue ???
Thoughts ???
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Could it be that wedges and other biomechanical foot devices reduce periosteal tension/tugging, therefore reducing overall stress/inflammation experienced during periosteal growth phases. :confused:
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A search on "growing pains" will reveal several theories, only one of which is described in this article.
Regards,
David -
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Theres no doubt that orthoses help symptoms of children with lower leg aches as demonstrated by A.Evans. We see this on a daily basis. The greatest effect of such devices is most likely on soft tissues and muscle function as opposed to recumbent leg growth as documented in the original article. It raises the old question "do growing bones hurt" ??? :rolleyes:
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From the Australasian Podiatry Council Conference in Christchurch, NZ:
Angela Evans
Are Foot Posture and Functional Health Differrent in Children with Growing Pains?
180 children; surveyed for growing pains and several health status measures.
Several foot posture measures used (parts of FPI; navicular height and drop; etc).
No clinical differences found in foot posture between those with growing pains and without.Last edited: Aug 31, 2005 -
Growing Pains in Children and Sports Injuries in Adults Share Common Etiologies
Over the past decade, I have often stated that the podiatry and medical communities should be able to clearly see that children's "growing pains" are nothing more than a form of sports or athletic injury that we see commonly in adults. Children run and play most of the day. The normal running, jumping and playing activities that children perform on a daily basis, when combined with suboptimal structure and function of the foot and lower extremity, will lead to increased abnormal tissue stresses which will cause pain and injury.
These athletic injuries, for some reason, have been called "growing pains" in children. However, if an adult goes out and runs, jumps and plays the same number of hours per day that a child does, develops similar aches and pains, we say they are "overdoing it" and have developed a "sports injury".
From my perspective of seeing many children with "growing pains" and adults with "sports injuries" of the lower extremities for over 20 years, these two sets of injuries occur due to the same reasons. Therefore, children's growing pains should be treated just like sports injuries in adults: modified rest, ice, stretching, shoegear changes, over-the-counter orthoses and possibly custom foot orthoses. -
I just went back over the Precision Intricast Newsletters I have done over the past few years and found that my August 2003 Newsletter was titled "Growing Pains in Children" where I discussed the research by many authors including Angela Evans' wonderful JAPMA paper from 2003.
Here a few excerpts from the newsletter:
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Optimistic x 1 - List
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I'm in the process of putting my 4yo into some orthotics in the hope of reducing the number of times he complains of sore feet and legs (and to reduce the crying and sleeplessness that goes with it!)
Just through observation (& not particularly vigilant obs at that!) I can equate the nights he waks up with sore legs to the days when he's been busiest. I've always assuemd it was "overuse" rather than growing pains. -
Dear all experts
Having treated children with "growing pains" for approx 20 years of my career I can say that in a large majority of children that complain consistently about "aching legs", reluctance to walk distances and asking to be carried because "my legs are tired", a functional biomechanical abnormality can be found. Most commonly an overpronated gait pattern. If this is successfully addressed then I become a miracle worker as far as the parent is concerned. The child stops complaining and waking at night and not wanting to walk. This is I accept not backed up by a research project done by me but on my clinical expereince. I think it would be an interesting Masters study if I can ever pluck up the energy to do one. In the meantime I will continue to treat these children in the same way as it gets the results the parent (and I hope the child) wants.
I accept as Mr Kirby states that some of these pains may be as a result of overuse as a child who runs around a lot may be very alike the pains an athelete gets when training but a lot of the chilren that I see arn't running around because of the pans that they get and because the legs are tired as a result of the compenatory nature of the gait patterns they are exhibiting. Once this is controlled then they can run around more withou the pain. I am doing a presentation on this very subject to colleagues so would value any information/ researchthat I could use to support this. I think the pain levels vary from child to child just as pain levels vary from adult to adult depending on their individual pain thesholds so it is difficult to quantify whether the "crying with pain" child is actually in more pain than the child who is just complaining. it is good to know that research is going on in these areas.
Kate Grundy
Podiatrist NHS UK -
“Growing pains” in young children: A study of the profile, experiences and quality of life issues of four to six year old children with recurrent leg pain
The Foot Volume 16, Issue 3 , September 2006, Pages 120-124
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Todays British Medical Journal has this editorial:
Growing Pains (only those with institutional access can get the full article -
For those nay-sayers who doubts mechanical stress is a factor, ask how many kids have growing pains in their arms, hands, etc. If they grow at the same rate as feet and legs, why do not children have growing pains there? I have had similar very good results with children over many years who I have treated as being biomechanically greater at risk or developing overuse stress injuries.
Last note: orthodonic dentristry seems to approach alignment with an early intervention attitude to prevent teeth, jaws from taking on an injurious attitude.
Best regards
Freeman Churchill, Certified Pedorthist (Canada) -
As a mother and pod ,whatever order you please, my 6years old has experience "Growing pains" -unilaterally in his left calf -occasionally for approx 3 years and only after a busy day and going to bed later than usual Panadol helped
Can growing pains be unilateral? yvonnespod -
unnilateral growing pains
As another mother and Pod, please get your 6 year old with unilateral pains checked for Juvenile Arthritis, my Daughter suffered for 3 years before she was correctly diagnosed, she only has it in one knee but we were told for ages she had growing pains/ cartilage problems/ attention seeking etc etc
:) Don't panic though, they do grow out of it, my daughter is now 15 and hasn't had a flare for 6 months. And yes, orthotics help a lot, damage limita tion is imperative to prevent problems later on. -
Re: Unilateral Growing Pains
Dear Mum/Pods,
Have you done a biomechanical assessment rulling out scoliosis,hip drop, leg length discrepancy? Orthotics work well wiith these patients if the biomechanical difference in R and L is not excessive. Have son 9 who developed aches early, and loves to run. Wears soft full length orthotics.
Pod777 -
Guest
Re: Growing Pains
Tuesday, April 24, 2007. 6:45am (AEST)
Sydney researchers begin study into 'growing pains'
Researchers at a Sydney hospital are investigating the cause of growing pains in children, but it appears the cause is unlikely to have anything to do with growing.
Nocturnal limb pain syndrome, or growing pains, is a common childhood complaint.
The syndrome affects many children aged between three and 13, with pain usually felt in the legs during the night.
Associate Professor David Champion of the Sydney Children's Hospital says there have been many theories about the causes, including growth, flat fleet and bone fatigue, but none have been proven.
He says it is likely to be caused by something similar to that of severe headaches.
"Migraine is clearly a disordered function of the nervous system and so it appears likely that growing pains syndrome is disordered function in nervous system," he said.
He says the hospital is looking for child volunteers to be part of the research that involves non-invasive tests and the findings will be released later this year.
He says he hopes the study will shed some light on the problem (more from the ABC...) -
Re: Growing Pains
Migraine's??
Huh?!?
The dear professor seems to have grabbed two utterley different pathologies and brought them together from out of nowhere.
Is my education at fault - or does this seem like a complete load of nonsense - whatever current 'growing pains' theory you subscribe to!
Someone please enlighten me. :eek:
LL -
Re: Growing Pains
Are foot posture and functional health different in children with growing pains?
ANGELA MARGARET EVANS, SHEILA DOREEN SCUTTER
Pediatrics International (OnlineEarly Articles).
doi:10.1111/j.1442-200X.2007.02493.x -
Re: Growing Pains
Growing pains: contemporary knowledge and recommended practice
Angela M Evans
Journal of Foot and Ankle Research 2008, 1:4doi:10.1186/1757-1146-1-4
Published: 28 July 2008
Abstract (provisional)
Background
Leg pain in children, described as growing pains, is a frequent clinical presentation seen by an array of health care professionals. Described since 1823, growing pains continues to puzzle practitioners, yet diagnostic criteria and evidence based treatment is available.
Methods
The medical literature has been searched exhaustively to access all articles (English language) pertaining to leg pains in children which are ascribed to being 'growing pains'.
Results
The literature, whilst plentiful in quantity and spanning two centuries, is generally replete with reiterated opinion and anecdote and lacking in scientific rigour. The author searched 45 articles for relevance, determined according to title, abstract and full text, resulting in a yield of 22 original studies and 23 review articles. From the original studies, one small (non-blinded) randomised controlled trial that focused on GP treatment with leg muscle stretching was found. Nine prevalence studies were found revealing disparate estimates. Ten cohort (some case-controlled) studies, which investigated pain attribute differences in affected versus unaffected groups, were found. One series of single case experiment designs and one animal model study were found.
Conclusions
Growing pains is prevalent in young children, presents frequently in the health care setting where it is poorly managed and is continuing to be researched. A common childhood complaint, growing pains needs to be acknowledged and better managed in the contemporary medical setting. -
Press Release:
Study is the first to link sleep duration to infant growth spurts
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Growing Pains: A Study of 30 Cases and a Review of the Literature
Pavone, Vito, Lionetti, Elena, Gargano, Valerio, Evola, Francesco R., Costarella, Luciano, Sessa, Giuseppe
Journal of Pediatric Orthopaedics: July/August 2011 - Volume 31 - Issue 5 - p 606–609
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Funny thing about growing pains is that they are (in my experience) probably the easiest fix with orthoses. If they are "growing pains" why should that be?
And why are they never in elbows? -
I agree. I can't remember the last case of "growing pains" I didn't cure with custom foot orthoses. Funny, the children continued growing even with the orthoses.:rolleyes: -
Bone strength in children with growing pains: long-term follow-up
Y. Uziel, G. Chapnick, A. Oren-Ziv, L. Jaber, D. Nemet, P. Hashkes
Pediatric Rheumatology (in press)
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Couple of question folks put in the simplest of terms. Is it the growth of bone that causes the pain or the struggle of ligaments, tendons and muscles to 'catch up'. If the latter is the case, surely a stretching regieme may be more beneficial that othoses. If, in most cases, there is overpronation, could that not just be caused by 'tight' tendons. Just a thought.
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One of our students posted this in our internal learning forum. I have their permission to repost it here.
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Was the poorly isolated pain unilateral or bilateral?? -
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Here is another:
Highwood family’s ordeal met with community support
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Is it restless leg syndrome or growing pains. From the Huff Post
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A Growing Pains (gp) Questionnaire : Validation And Reliability Control
M Vasilopoulou, E Kritseli, N Myriokefalitakis, M Tsolia
Arch Dis Child 2014;99:A238
Champion D, Pathirana S, Flynn C, Taylor A, Hopper JL, Berkovic SF, Jaaniste T, Qiu W.
Eur J Pain. 2012 Oct;16(9):1224-31.
Last edited: Feb 20, 2015 -
A New Growing Pains Diagnostic Tool:evaluation In A Mediterranean Clinical Sample
M Vassilopoulou, A Spathis, I Paspati, M Tsolia
Arch Dis Child 2014;99:A567-A568
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The differential diagnosis, and the methods by which, not only the pain presents itself, but by the physician's techniques, is critical. For instance, while myelogenous leukemia, neuroblastomas, rhabdomyosarcoma and osteosarcomas are real concerns, for the most part, they present differently than true GPs.
Rhabdomyosarcoma:
http://www.cancer.org/cancer/rhabdomyosarcoma/detailedguide/rhabdomyosarcoma-signs-symptoms
osteosarcoma:
http://kidshealth.org/parent/medical/cancer/cancer_osteosarcoma.html
myelogenous leukemia:
http://www.cancer.gov/cancertopics/pdq/treatment/childAML/Patient/page1
neuroblasomas:
http://kidshealth.org/parent/medical/cancer/neuroblastoma.html#
The key and common finding, if these cancers do present in the LE, is swelling in the limb with pain upon palpation to the swelling. In GPs, there is no swelling or pinpoint pain elicited with palpation to the lower or upper leg. While blood tests and plain film radiographs can be utilized to R/O these rare cancers, (as well as Still's Ds), there is no positive findings from these tests with GPs.
Dr. Hight and myself have made the hypothesis that the majority of GPs is referred from the STJ.
http://www.podiatrym.com/Current_Issue2.cfm?id=1632
Considering the percentages of children that present with pain in their legs at night, we stand by that hypothesis. The only pain that is elicited by the practitioner, is palpation to the sinus tarsi, or posterior facet of the STJ, usually much worse in the afternoon, which resolves after orthotic therapy after the 2nd night of treatment. Much more research needs to be performed on the tie between GPs and RLS, but the authors feel this was a necessary start to the discussion. -
Perinatal Risk Factors and Genu Valgum Conduce to the Onset of "Growing Pains" in Early Childhood.
Kaspiris, A.; Chronopoulos, E.; Vasiliadis, E.
Preprints 2016, 2016080113 (doi: 10.20944/preprints201608.0113.v1).
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