Growing bone pains

Growing pains are a common complaint of children and adolescents. Usually found in young men and women as a result of the rapid growth.

Several conditions such as Osgood-Schlatter Disease, and Sever's Disease, are types of growing pains. These conditions are caused by inflammation around sites where large tendons insert. These tendons pull on the growing bone (at the growth plate) and cause inflammation.

Growing pains are almost always seen in active youths, often while participating in sports.

Growing pains are best treated

with rest

stretching

ice packs.

If activities are causing significant growing pains, they should be avoided until the symptoms resolve.

Children are usually instructed to.......

get rest

ice their sore bones

take anti-inflammatory medications

The shins usually start feeling better after several weeks of rest, and an individual can gradually increase his or her activity level to rebuild strength.

One or more of the following treatments may be used:

Rest. It is important to rest to allow the condition to settle. Sometimes a splint, firm bandage or brace is put on a wrist if this is the area affected. This enforces your hand and wrist to stay in the same position for a time to allow rest of the affected tendon.

Ice packs over the affected area may ease swelling and pain. A simple ice pack can be made by wrapping a pack of frozen peas in a tea towel. Apply it to the affected area for 10 minutes twice a day.

Anti-inflammatory painkillers are often prescribed (for example, ibuprofen). These ease pain and reduce inflammation. However, as discussed above, inflammation may not be the main problem in tendonitis and tenosynovitis. However, they will provide pain relief.

Some anti-inflammatory painkillers also come as creams or gels which you can rub over the painful area. These tend to produce fewer side-effects than those taken by mouth. There are various brands which you can buy, or get on prescription. Ask your doctor or pharmacist for advice.

Other painkillers such as paracetamol, with or without codeine added, may be helpful.

Physiotherapy advised, especially if the condition is not settling with the above measures.

A target antiinflammatory injection into the affected area may be given if the above measures do not work. Steroid injections may be helpful in easing pain in the short-term but pain tends to come back in many people.

Surgical release of a tendon is rarely needed.

What are growing pains?

Occasional aches and sharp, throbbing pains are very common in children between the ages of 3 and 5 and then again between 8 and 12.

Kids most often feel growing pains in the legs, especially in the front of the thighs, behind the knees, and in the calves. They tend to strike in the late afternoon and evening and during the first hours of sleep at night. By morning, the pains are gone.

They can be mild or strong enough to wake your child up. Some kids also have abdominal pain or headaches when they're having a bout.

The term "growing pains" is misleading: There's no evidence that the pain is caused by growing bones. Experts don't know for sure what causes the pain, but it does seem to occur more often after a child has had an especially active day.

Growing pains are not a sign that your child is doing anything wrong or needs to slow down, however. Perfectly healthy children experience them. In fact, 25 to 40 percent of children have growing pains at some point, and they're slightly more common in girls than in boys.

How can I tell if it's growing pains or something else?

It can be tricky to tell. Children are sometimes thought to have growing pains when something more serious is going on, so be sure to talk with the doctor if your child has unexplained pain.

Growing pains generally last only about ten to 15 minutes, and they usually affect both sides of the body similarly (although not necessarily at the same time). The pain is usually felt deep in the muscles, not in the joints. Growing pains do notcause fever, chills, redness, swelling, limping, or joint pain.

Doctors make a diagnosis largely by making sure that nothing else is causing the pain. The following symptoms may indicate that something more serious is going on, such as an infection, a fracture, a tumor, leukemia, juvenile rheumatoid arthritis, or other joint problems:

Pain is coming from one particular spot. (The doctor may want to do a bone scan to rule out a bone infection or tumor.)

Your child has a fever along with leg pain, and there's no obvious source for his fever, such as flu symptoms. (A blood test can determine whether there's an infection.)

He has a lot of pain in one hip, thigh, or knee—or has trouble putting weight on one leg or seems to be limping. (The doctor may order an X-ray to make sure there's nothing amiss with his bones.)

His pain persists during the day.

He doesn't want you to touch or massage the area that hurts. (If the pain is muscular, it'll feel good to be massaged. If something else is going on, though, it may hurt more if you touch it.)

What's the treatment for growing pains?

You can't prevent growing pains, but you can help relieve your child's discomfort with a heating pad or hot water bottle, massage, and the correct dose of acetaminophen oribuprofen. (Don't give aspirin to your child. It can lead to Reye's syndrome, a rare but potentially fatal illness.)

It may help to do some gentle stretching exercises with your child each day. It may also help to encourage her to stretch while she's complaining of pain.

And if the pain is severe, it's a good idea to see her doctor to make sure there's nothing serious going on.Growing Pains: When Should Parents Worry?

What Are Growing Pains?

Growing pains aren't a disease. You probably won't have to go to the doctor for them. But they can hurt. Usually they happen when kids are between the ages of 3 and 5 or 8 and 12. Doctors don't believe that growing actually causes pain, but growing pains stop when kids stop growing. By the teen years, most kids don't get growing pains anymore.

Kids get growing pains in their legs. Most of the time they hurt in the front of the thighs (the upper part of your legs), in the calves (the back part of your legs below your knees), or behind the knees. Usually, both legs hurt.

Growing pains often start to ache right before bedtime. Sometimes you go to bed without any pain, but you might wake up in the middle of the night with your legs hurting. The best news about growing pains is that they go away by morning.

What Causes Growing Pains?

Growing pains don't hurt around the bones or joints (the flexible parts that connect bones and let them move) — only in the muscles. For this reason, some doctors believe that kids might get growing pains because they've tired out their muscles. When you run, climb, or jump a lot during the day, you might have aches and pains in your legs at night.

What Can I Do to Feel Better?

Your parent can help your growing pains feel better by giving you an over-the-counter pain medicine like acetaminophen or ibuprofen. Kids should not take aspirin because it can cause a rare but serious illness called Reye syndrome.

Here are three other things that might help you feel better:

1. placing a heating pad on the spot where your legs hurt
2. stretching your legs like you do in gym class
3. having your parent massage your legs

General measures

Exercise

If possible, exercise regularly. This helps to strengthen the muscles around affected joints, to keep you fit, and to maintain a good range joint movement. Swimming is ideal for most joints, but any exercise is better than none. Many people can manage a regular walk.

Weight control

If you are overweight, try to lose some weight as the extra burden placed on back, hips, and knees can make symptoms worse. Even a modest weight loss can make quite a difference.

- Wearing a Lubar belt or knee brace.

These measures slightly alter the distribution of weight and pressure on the knee joint, which is why they are thought to ease symptoms in some cases. A podiatrist or physiotherapist can advise exactly how to use them.

Braces or supports may also be helpful for other joints affected. For example, a support around the thumb for painful thumb.

Daily walking for 30 to 45 minutes with or without Walking aids

Diet. Getting too little calcium over your lifetime can increase your risk.

Fruits, Salads, green vegetables/leaves, Curd/Yoghurt -250 grammes, Lemon juice with little salt/sugar, daily upto 250-500 grammes is mandatory

Water -5-6 lit per day or more, daily slow sustained yoga type physiotherapy exercises as given in website is essential for good health of bones and body.

Daily brisk/speed walking for 1 hour, getting enough vitamin D from your diet, sunlight will decrease your risk.

Physical activity. Not exercising and being inactive or staying in bed for long periods can increase your risk.

Smoking. Smokers harm their blood circulation, damage all tissues in body by free radicals of smoke and absorb less calcium from their diets.

Medications. Some commonly used medicines can cause loss of bone mass. These include steroids used to control arthritis and asthma; some drugs used to treat seizures; some cancer drugs; and, too much thyroid hormone.

Low body weight, thin – and small-boned – are at greater risk for osteoporosis.

Physiotherapy help if unable to follow correct exercises

Sometimes advice or treatment from a physiotherapist is helpful. For example:

- For advice on which exercises to do to strengthen the muscles above the knee (quadriceps). Strengthening the 'quads' has been shown to improve symptoms.
- For advice on how to keep active and fit.
- For advice on shoes insoles, knee braces, taping to the knee, and how to use walking aids properly (to make sure you have one of the correct height).

Manipulation and stretching around affected joints may be helpful. This is something that physiotherapists may also be able to help with.

Occupational therapy

An occupational therapist may be able to help if you need aids or modifications to your home to cope with any disability caused by OA. Special devices, such as tap turners to help with turning on a tap, may mean that you can carry out tasks around the house more easily.

Other therapies

- Some people have found that TENS (Transcutaneous Electrical Nerve Stimulator) machines help to ease pain from OA. A TENS machine delivers small electrical pulses to the body via electrodes placed on the skin.
- Acupuncture may also help to ease symptoms in some cases.
- Some people find that they can also get some pain relief from using hot or cold packs on the affected joint(s). This is also called thermotherapy. You can use a hot water bottle filled with either hot or cold water and apply it to the affected area. Or, special hot and cold packs that can either be cooled in the freezer, or heated in a microwave, are also available.

Medicines used

Paracetamol

Paracetamol is the common medicine used to treat OA. It often works well to ease pain. It is best to take it regularly to keep pain away, rather than 'now and again' when pain flares up. A normal adult dose is two 500 mg tablets, four times a day. It usually has little in the way of side-effects, and you can take paracetamol long-term without it losing its effect.

Anti-inflammatory painkillers

You may find that a topical preparation of an anti-inflammatory painkiller that you rub onto the skin over affected joints is helpful instead of, or in addition to, paracetamol tablets. This may be particularly helpful if you have knee or hand OA. Compared to anti-inflammatory tablets, the amount of the drug that gets into the bloodstream is much less with topical preparations, and there is less risk of side-effects (see below).

Anti-inflammatory painkillers that are taken by mouth are not used as often as paracetamol. This is because there is a risk of serious side-effects, particularly in older people who take them regularly. However, one of these medicines is an option if paracetamol or topical anti-inflammatories do not help. Some people take an anti-inflammatory painkiller for short spells, perhaps for a week or two when symptoms flare up. They then return to paracetamol or topical anti-inflammatories when symptoms are not too bad. There are many different brands of anti-inflammatory painkillers. If one does not suit, another may be fine.

Side-effects may occur in some people who take anti-inflammatory painkillers:

- Bleeding from the stomach is the most serious possible side-effect. This is more of a risk if you are over 65, or have had a duodenal or stomach ulcer, or if you are also taking low-dose aspirin. Stop the medicine and see a doctor urgently if you develop indigestion, upper abdominal pain, or if you vomit or pass blood. Read the leaflet that comes with the medicine for a list of other possible side-effects. You doctor can prescribe another medicine that can help to protect your stomach if you are taking anti-inflammatory painkillers in the long-term. You should discuss this with them.
- Some people with asthma, high blood pressure, kidney failure, and heart failure may not be able to take anti-inflammatory painkillers.

Codeine

Codeine is sometimes combined with paracetamol for added pain relief. Constipation is a common side-effect from codeine. To help prevent constipation, have lots to drink and eat a high fibre diet.

Capsaicin cream

This cream is made from chilli peppers and it works by blocking the nerve signals that send pain messages to the brain. It may be helpful if you have knee or hand OA. It takes a while for the effects of this cream to build up and may take around one month to get the maximum benefit. You should rub in a pea-sized amount of cream around the affected joint four times a day, and not more often than every four hours.

Don't use this cream on broken or inflamed skin. You may notice some burning after you apply the cream but this tends to improve the longer you have used it. Avoid having a hot bath or shower, before, or after, applying the cream because it may make the burning sensation worse. Also, be careful to wash your hands after applying the cream. Because it is made from chilli peppers, it can cause burning if it gets into your eyes, mouth or around your genital area.

An injection of antiinflammatory medicine

An injection directly into a joint is useful if a joint becomes badly painful / inflamed.

When to Go to the Doctor

If you have a fever, are limping when you walk, or your leg looks red or is swollen (puffed up), your parent should take you to the doctor. Growing pains should not keep you from running, playing, and doing what you normally do. If the pain is bothering you during the day, talk to your parent about it.

You might never feel any growing pains, but if you do, remember that before you know it, you will outgrow them!

Osteochondrosis: common causes of pain in growing bones.

Osteochondrosis is a term used to describe a group of disorders that affect the growing skeleton. These disorders result from abnormal growth, injury, or overuse of the developing growth plate and surrounding ossification centers. The exact etiology of these disorders is unknown, but genetic causes, repetitive trauma, vascular abnormalities, mechanical factors, and hormonal imbalances may all play a role.

Legg-Calvé-Perthes disease is a hip disorder that causes hip pain, an atraumatic limp, and knee pain. Osgood-Schlatter and Sinding-Larsen-Johannson diseases are common causes of anterior knee pain that is aggravated by jumping activities and kneeling. Sever disease causes heel pain that is exacerbated by activity and wearing cleats. It often mimics Achilles tendinitis and is treated with activity and shoe modifications, heel cups, and calf stretches.

Freiberg disease and Köhler bone disease often cause foot pain and are disorders of the metatarsal head and navicular bone, respectively. Radiographs show sclerosis, flattening, and fragmentation of bone in both diseases. Elbow pain can be caused by medial epicondyle apophysitis or Panner disease.

Medial epicondyle apophysitis is exacerbated by frequent throwing and is treated with throwing cessation and acetaminophen or nonsteroidal anti-inflammatory drugs.

Panner disease is the most common cause of lateral-sided elbow pain in children younger than 10 years. It may or may not be associated with frequent throwing, and it resolves spontaneously. Scheuermann disease causes back pain and a humpback deformity from vertebral bone anterior wedging.

Morning pain may mean something more serious is wrong with your child.

Like mumps and measles, growing pains are a rite of passage, a sign of growing up. Most parents take it in stride. "It's just growing pains," they tell their crying child.

But what exactly are these pains? Why do some kids get severe pain, while others get none? Could the pain mean something is really wrong? How can parents know?

Growing pains typically occur between ages 3 and 7. Doctors say the pain is triggered when bones grow, stretching the bone's thick covering, explains Larry Vogler, MD, a pediatric rheumatologist at Emory University School of Medicine in Atlanta.

According to the American Academy of Pediatrics, these pains have been linked to particularly active days and not growth. Growing pains are real discomforts for many children; often growing pains can awaken children fromsleep.

Some kids are predisposed to getting growing pains. If dad had them, his child will, too. The pains seem most intense after a day of vigorous jumping and running. Kids typically feel the pains at night, then they disappear in the morning. "Be reassuring, give a massage, and give Tylenol with a little food if you think you need to," Vogler tells WebMD.

If your child develops certain symptoms, it's wise to notify your child's doctor. Worrisome symptoms that might indicate that something other than growing pains and something more serious may be going on include:

- Persistent pain, pain in the morning or swelling, tenderness, and redness in a joint
- Joint pain associated with an injury
- Limping, weakness, or unusual tiredness

If a child wakes up in the morning with leg pains -- then feels relief after moving around -- it may be juvenile rheumatoid arthritis (JRA),

"Those pains need to be investigated by a doctor," "They should not be simply dismissed. It may not be anything serious, but it needs to be evaluated."

Arthritis Often Missed

Lehman regularly sees young patients with all types of arthritis, but especially juvenile rheumatoid arthritis. It's an unpredictable disease with symptoms that can worsen or disappear without clear reason, he explains. In general, children with JRA have one or several symptoms including joint pain, joint swelling, and joint stiffness early in the disease. Most children have good and bad days.

He's seen it too many times: "Virtually every child with arthritis has been dismissed as 'just having growing pains,'" Lehman tells WebMD. "And because proper diagnosis is delayed -- sometimes for months -- there are irretrievable circumstances."

Most children with juvenile rheumatoid arthritis (70% to 90% of them) will recover without any serious disabilities. But some symptoms can continue into adulthood, such as stiffness, pain, limits on physical activity, and chronic arthritis.

In the worst cases, the length of the child's leg can be affected. That happens when inflammation in an untreated joint increases blood flow in that joint, he explains. "With that increased blood flow, the bone will grow bigger. One leg will actually be longer than the other. It can affect walking, [and] cause hip and back problems."

"The whole key is to understand what growing pains are, and what they aren't," says Lehman. "A child with growing pains will have no daytime pain, no limp, no other abnormality. But when the child gets pain during the day -- and the pains are persistent or abnormally severe -- the child needs to see a doctor."

Often, children with JRA are mistakenly sent to an orthopaedic surgeon, and "If the pain is misinterpreted as a hairline fracture, the child gets a cast. With JRA, immobilizing the joint is counterproductive. The treatment should involve anti-inflammatory medications and working on regaining lost range of motion."

For most kids, getting spoiled by late-night attention is the biggest problem with true growing pains, "The growing pains take on a life of their own. Children find out that crying at night gets mom's attention, and it becomes positive reinforcement. Parents need to be aware that most kids with growing pains don't have them every single night. It's fine to reassure, but don't overindulge."

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