Growing Pains & Children's Sports Injuries

By Anthony Dileo Osteopath I Kallista Osteopathy

Around one in three young children may experience “growing pains”, while research suggests that approximately 60% of children and adolescents experience significant headaches at some stage. At the same time, increasing training loads, year-round sport and early specialisation are exposing growing bodies to injuries that adults simply do not experience in the same way.

Children are not just smaller adults.

Their bones, muscles, tendons and nervous systems are developing. Their coordination is changing, their limbs may be growing quickly and the growth plates at the ends of their bones remain vulnerable to repetitive stress.

However, this does not mean that every pain needs treatment.

After 17 years in clinical practice, one of the most important lessons I have learned is that, with children, less intervention is generally better than more.

The role of the osteopath is not to repeatedly “correct” a growing child. It is to determine whether their symptoms fit a normal and reassuring pattern, identify the small number of presentations requiring further investigation, provide practical advice and help the child remain confident and active.

What are growing pains?

“Growing pains” generally describe recurring aches in the legs of otherwise healthy children, commonly between approximately three and twelve years of age.

The discomfort is usually felt in areas such as:

• the calves

• the thighs

• behind the knees

• the shins

It often occurs in both legs, develops later in the day or during the night, and has usually disappeared by the following morning.

Despite the name, we still do not know whether growing pains are directly caused by bones growing. Researchers have found considerable inconsistency in how the condition is defined, with reported prevalence estimates ranging from approximately 3.5% to 37%.

A more useful way to think about growing pains is as a pattern of recurring childhood limb pain, rather than proof that a particular structure is being damaged.

Typical growing pains should not usually cause:

• persistent morning pain

• visible swelling

• redness or heat

• a consistent limp

• pain isolated to one precise point

• progressive worsening

• fever, fatigue or unexplained weight loss

• difficulty participating in normal activity

The Royal Children’s Hospital describes growing pains as generalised leg aches occurring in approximately 15–30% of children. Simple reassurance, massage, warmth and occasional pain relief are usually sufficient.

How can an osteopath help with growing pains?

The most valuable part of the consultation is often the assessment, rather than the hands-on treatment.

I will usually ask about:

• when the pain occurs

• whether it affects one or both legs

• whether the child wakes with pain

• recent changes in sport or activity

• recent growth spurts

• limping or altered movement

• sleep, nutrition and general health

• whether there has been a fall, collision or other injury

I will then assess the painful area, nearby joints and the child’s general movement. This may include walking, hopping, squatting, balancing or performing movements related to their sport.

When the presentation fits a typical growing-pain pattern, the most important treatment is often reassurance.

Parents frequently arrive worried that their child has damaged something, has poor alignment or needs ongoing correction. In many cases, they do not.

Simple measures may include:

• a warm bath or heat pack

• gentle massage

• temporarily reducing unusually high activity loads

• maintaining normal movement where comfortable

• improving sleep and recovery routines

• a small number of easy stretches or exercises when appropriate

Hands-on treatment may sometimes help reduce discomfort or muscle sensitivity, but it should be gentle, age-appropriate and used as only one small part of management.

There is limited high-quality evidence supporting manual therapy for paediatric conditions generally. Systematic reviews have found that many of the available studies are small or methodologically weak. While I have seen very good results in practice, those experiences are anecdotal and should not be presented as stronger evidence than they are. That is one reason I avoid suggesting that every child needs repeated manual treatment.

Not every sore leg is a growing pain

One of the risks of the term “growing pains” is that it can be applied too casually.

Pain that repeatedly occurs in the same location, worsens during sport or changes the way a child runs may represent a more specific load-related condition.

Common examples include:

• Osgood-Schlatter disease at the knee

• Sever’s disease at the heel

• bone stress injuries

• tendon or muscle injuries

• joint sprains

• irritation around a growth plate

These conditions are usually manageable, but they should not automatically be dismissed as growing pains.

Growth-related knee and heel pain

Osgood-Schlatter disease commonly causes pain and tenderness around the bony prominence just below the kneecap. Sever’s disease generally causes pain around the back or underside of the heel.

Both are often associated with running and jumping sports and may become more noticeable during a growth spurt.

The name “disease” can sound frightening, but these are usually temporary, load-related conditions rather than evidence that the child’s body is breaking down.

Management generally involves adjusting activity to a tolerable level rather than completely stopping all sport.

That might mean:

• reducing running or jumping volume temporarily

• modifying training drills

• avoiding playing through escalating pain

• improving calf, thigh and hip capacity

• gradually rebuilding sporting load

• communicating with coaches

Pain during activity does not always mean damage is occurring. However, repeatedly pushing through worsening pain, limping or significant loss of function is rarely sensible.

Growth plates need particular care

Growth plates are areas of developing tissue near the ends of children’s bones. They are generally weaker than the surrounding mature bone and can be affected by either an acute injury or repeated loading.

Research into youth sport has identified accelerated growth, high training volumes, body size and previous injury as potential risk factors for growth-plate problems. Continued repetitive stress may occasionally cause lasting disturbance to the growth plate, which is why persistent focal pain should not simply be ignored.

Signs that raise my suspicion of a growth-plate injury include:

• very localised tenderness over a bone

• pain following a fall, twist or collision

• swelling

• inability to bear weight

• pain that consistently worsens during sport

• pain that does not improve with an appropriate reduction in load

Where necessary, I will refer the child to their GP, a specialist or an emergency department for imaging or specialist assessment.

The aim is not to scan every sore child. It is to recognise when the clinical pattern warrants investigation.

Sprains and strains in children

Children regularly experience ankle sprains, muscle strains, bruises and minor joint injuries. Most recover very well.

In the early stages, treatment may involve:

• protecting the injured area

• relative rest

• compression or support where appropriate

• restoring comfortable movement

• gradually reintroducing weight-bearing

• rebuilding strength, balance and confidence

Complete rest is not always necessary and can sometimes delay recovery. For uncomplicated ankle sprains, modern rehabilitation generally encourages early movement, functional support and progressive exercise rather than prolonged immobilisation.

The important question is not simply, “Does it still hurt?”

A better return-to-sport assessment considers whether the child can:

• walk and run without significant pain

• hop and land confidently

• change direction

• balance on the injured side

• perform sport-specific movements

• complete training without a major flare-up afterward

Return to sport should be treated as a gradual process rather than a single clearance date.

A common sporting case

A typical case I see is a child who has recently increased from one or two sporting sessions each week to four or five.

They may be playing club sport, school sport and an additional development program, often while going through a growth spurt.

The child develops knee or heel pain, and the family assumes something is structurally wrong.

On examination, there may be local sensitivity and a temporary reduction in strength or control, but no evidence of a serious injury.

In these cases, the solution is rarely an intensive course of treatment.

It is more often:

1. explaining the problem in reassuring language

2. temporarily modifying the highest-load activities

3. providing two or three targeted exercises

4. keeping the child involved in sport where possible

5. gradually increasing their capacity again

Sometimes the most helpful thing I can do is give the child, parent and coach a clear plan.

Headaches in children

Headaches are surprisingly common in children and teenagers. A large review estimated the pooled prevalence of primary headache disorders in children and adolescents at approximately 62%, although prevalence varies considerably between studies and populations. Migraine affects approximately 8–9%.

Children’s headaches may be influenced by:

• migraine biology

• stress or anxiety

• inadequate sleep

• dehydration

• missed meals

• prolonged screen use

• visual strain

• illness

• jaw clenching

• neck and shoulder discomfort

An osteopathic consultation may help identify musculoskeletal or lifestyle factors contributing to the overall headache pattern.

However, a child with headaches should not simply have their neck treated without an appropriate history and neurological screening.

The Royal Children’s Hospital advises that children with headaches require assessment for red flags, although most children with primary headaches do not require medical imaging.

Referral for medical assessment is particularly important when headaches are:

• sudden and unusually severe

• progressively worsening

• repeatedly waking the child

• associated with persistent vomiting

• associated with fever or neck stiffness

• triggered by coughing or straining

• accompanied by weakness, altered coordination, confusion or seizures

• occurring after a significant head injury

For uncomplicated headaches, management often begins with the basics: regular sleep, hydration, meals, movement, stress management and an appropriate medical plan where migraine is suspected.

Hands-on care may form one part of treatment when neck or jaw discomfort is present, but it is rarely the entire answer.

What about posture and screen-related pain?

I regularly see children whose parents have been told that their posture is poor or that their spine is “out.”

I try to be careful with this language.

There is no single perfect posture that children must maintain all day. Bodies are designed to move and children naturally adopt many different positions.

The issue is more often too little movement, rather than one supposedly incorrect posture.

A child may become uncomfortable after sitting at a laptop, gaming or using a phone for several hours, but that does not mean their spine has become damaged or permanently misaligned.

My advice is usually practical:

• change position regularly

• break up long periods of sitting

• keep screens at a comfortable height

• remain physically active

• build general strength

• avoid making the child fearful of normal spinal positions

The best posture is often the next posture.

Less treatment, more confidence

Children can become worried very quickly when adults use alarming language.

Statements such as:

• “Your hips are out”

• “Your spine is twisted”

• “One leg is shorter”

• “You will always have a weak ankle”

• “Your posture is damaging your back”

can unintentionally create fear and dependence.

Minor differences in posture, flexibility and movement are normal. They do not automatically require correction.

My preference is to give children a positive and accurate explanation:

“This area has become a little more sensitive because it has been doing more than it was ready for. It is safe to move, and we are going to help it settle and become stronger again.”

Children should leave an appointment feeling more confident in their bodies—not more fragile.

How much treatment should a child need?

There is no fixed number.

For many children, one or two consultations may be enough to:

• assess the problem

• exclude concerning features

• explain what is happening

• provide a simple activity plan

• teach a small number of exercises

• establish when follow-up is actually necessary

Some injuries require closer rehabilitation, particularly after fractures, more significant sprains, surgery or extended time away from sport.

However, routine weekly treatment should not be presented as necessary simply because a child is growing.

My general principle is:

Use the smallest amount of intervention that helps the child understand the problem, recover and return confidently to normal life.

When should parents seek an assessment?

It is sensible to seek professional advice when a child has:

• pain lasting more than a few weeks

• repeated pain in the same location

• a persistent limp

• swelling, redness or heat

• difficulty bearing weight

• pain after a significant fall or collision

• pain that is becoming progressively worse

• loss of movement or strength

• pain that regularly wakes them

• headaches with concerning associated symptoms

• symptoms interfering with school, sleep or sport

Most childhood aches and sporting injuries are not serious. The challenge is distinguishing common, self-limiting pain from problems requiring a more specific diagnosis or referral.

Final thoughts

Sport and physical activity are enormously valuable for children.

The goal should not be to prevent every ache or protect children from all physical stress. Developing bodies become stronger by running, jumping, falling, recovering and gradually adapting to load.

When pain occurs, an osteopath may help by assessing the child, identifying the likely source, screening for conditions requiring referral and developing a practical recovery plan.

Hands-on treatment can sometimes be useful, but it should never replace good clinical reasoning, education, appropriate exercise, load management or medical referral when required.

Above all, children should not be made to believe they need regular treatment to keep their growing bodies aligned.

In most cases, the best approach is reassuringly simple:

Listen carefully, rule out the important problems, keep the child moving and do no more than is genuinely needed.

This article provides general information and does not replace individual medical assessment. Children with significant trauma, inability to bear weight, systemic illness, neurological symptoms or other concerning features should be assessed promptly.