Growing pains - fact or fiction?

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    Parents frequently hear their young soccer player's knee pain is due to "growing pains." I believe this is a misnomer. Growing, in and of itself, is not painful, nor does it directly result in pain. Physiologic consequences of skeletal growth can lead to a condition such as muscular imbalance that can secondarily become painful, but to lump painful knee conditions into the category of "growing pains" is inaccurate.

    Knee pain among young athletes is commonly a result of trauma, muscular imbalance, growth plate irritation and overuse. Traumatic injuries are easily recognized as they are acute, and the source and mechanism of injury are observed. Muscular imbalance occurs as soccer players' long bones grow faster than the surrounding muscles. This imbalance frequently leads to hamstring tightness. As a result, the patella and anterior knee are overloaded leading to pain. Growth plate irritation often occurs in active young athletes as well. This condition occurs due to overload of the growth plate at the top of the soccer player's leg in the anterior knee. It results in a bump at the front of the knee. Finally, young athletes often experience overuse injuries, such as tendonitis. Patellar tendonitis and plica irritation are common examples.

    Treating non-traumatic injuries usually begins with rest and ice. Muscular imbalance and tendonitis are usually treated with physical therapy and specific exercises and stretching. Growth plate problems are treated with rest and immobilization. Traumatic injuries are treated variably according to their type.

    In conclusion, knee pain in the growing athlete is not due to growth alone. A specific diagnosis should be made and treatment directed accordingly. Lumping all sources of knee pain under the diagnosis of "growing pains" results in failure to provide appropriate treatment, which, in turn, slows down the athlete's recovery time.

    Peter H. Edwards, Jr., M.D. is an orthopedic sports medicine specialist at the Ohio Orthopedic Center of Excellence in Columbus, Ohio. He specializes in lower extremity sports medicine with an emphasis on soccer injuries.


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