My 13 year old active (baseball, basketball) nephew is having pain in his legs and his father is attributing it to “growing pains” and rapid femur growth that is causing pain in his leg muscles. My understanding was that bone growth could not cause pain and the pain was likely due to other factors, like fatigue or delayed onset muscle soreness, or lack of calories/nutrition. The latter I have been corrected on by Dr Baraki. What does the evidence say on the topic and what would you recommend to do for dealing with this unique pain?
There is a lot to unpack here. Attributing pain to one tissue can be problematic as Austin has likely alluded to, and fatigue and DOMS can certainly play a role. Depending on what sports your nephews play, and how much, that can certainly contribute as well. There are some natural aches and pains I would put in the “growing pains” camp but there are some things worth evaluating further. There is a good amount of evidence that tendon, bone, and muscle adapt at different rates, and if someone is playing something with an overemphasis on one particular movement, these can not all adapt together at an ideal rate. There is also some evidence that having those adaptations can predispose an athlete to symptoms. I want to be explicitly clear there that there is a huge difference between predisposition and causing symptoms. As this is barbell medicine and we have a piece coming out on this soon, I would be remiss to not say how we typically treat this is with resistance training. There is a strong case to be made against early sports specialization and while baseball and basketball are two different sports, the skill set they require is predicated upon a lot of top end speed and power. While pain is multifactorial in all instances, sometimes the adaptation seen between bone, tendon, and muscle does create some discongruence in terms of adaptation. This is where diagnosis like Osgood Schlatter, Sinding Larsen Johansen, and Severs come from. I would still prefer the vernacular of “growing pains” though as it tends to imply something that will get better and nothing to worry about where Severs Disease has people running to google to figure out what is this disease.
Thanks Dr. @Derek_Miles , I’ve read your response several times over the past couple days and I’m doing my best to decipher what you have unpacked. The topic seems to be nuanced with regards to pinpointing an exact cause, yes? Although, you didn’t seem to allude to the natural growth process as the culprit of pain. More so, a much more plausible explanation would be overemphasis of one particular movement to which the pain may be caused by tendon/bone/muscle not adapting(recovering?) at the same rate. Throwing a curve ball, what about children in early adolescence who are experiencing similar pain in the leg musculature but are not athletes and are not highly active. Is this simply a phenomenon that we don’t understand as of yet?
This gets at pain being VERY multifactorial, especially in adolescents. There are instances where leg pain occurs as a result of not doing much and can be amplified by expectations and beliefs. This isn’t specific to leg pain either. There is a diagnosis called amplified pain syndrome where normal activities are perceived as painful even if nothing in particular is “wrong.” Natural growth can contribute to symptoms but it is the sum of those contributions that eventually crosses the precipice of experiencing pain. Also to your example of the inactive child, it often comes down to what you are trying to do. If you are not active and remain not active the overall demand on the system doesn’t deviate much. Until you try and do something that exceeds capacity the likelihood of experiencing pain is probably less. That being said, you also do not have much input to the system to really determine what a threat is. If someone is used to walking 500ft/day and goes to Disney and walks 10 miles, they have likely exceeded capacity. In the same token, if a kid is active 10 hours/week in different sports and goes and plays in a tournament consisting of 15 hours of competition over two days, that kid is likely pushing the capacity for what they are trained for. It is all contingent upon what you are prepared to do and what you are trying to do. The other variables move the scales to a lesser degree.