Growing Pains in Children – Is It Real?
A Physiotherapist’s Perspective on Osgood-Schlatter and Sever’s Disease
Parents often hear their children complain of “growing pains,” especially during periods of rapid growth. While the term is widely used, physiotherapists know that not all pain in growing children is simply “normal.” Two common conditions—Osgood-Schlatter disease (affecting the knee) and Sever’s disease (affecting the heel)—are prime examples of musculoskeletal issues linked to growth spurts. These conditions are real, diagnosable, and require thoughtful management to prevent long-term complications.
What Are Growing Pains?
“Growing pains” traditionally describe vague aches in the legs, often occurring at night, without structural damage. However, when pain is localized, persistent, and activity-related, it may indicate a condition involving the growth plates. Growth plates (physes) are areas of developing cartilage near the ends of long bones. They are weaker than surrounding tissues, making them vulnerable to stress during rapid growth.
Osgood-Schlatter Disease (OSD)
Definition:
OSD is an overuse injury where the patellar tendon pulls on the tibial tuberosity (the bony prominence just below the knee).
Cause:
During growth spurts, bones lengthen faster than muscles and tendons can adapt. Repetitive stress from running, jumping, or sports leads to inflammation at the growth plate.
Symptoms:
- Pain and swelling just below the kneecap
- Tenderness over the tibial tuberosity
- Pain worsens with activity, especially squatting, jumping, or climbing stairs
Risk Group:
Active adolescents, particularly those in sports like soccer, basketball, and athletics
Sever’s Disease (Calcaneal Apophysitis)
Definition:
Sever’s disease is inflammation of the growth plate in the heel bone (calcaneus), where the Achilles tendon attaches.
Cause:
Similar to OSD, rapid growth combined with repetitive loading (running, jumping) causes traction at the heel’s growth plate.
Symptoms:
- Heel pain, especially after activity
- Limping or walking on toes to avoid heel pressure
- Tenderness at the back of the heel
Risk Group:
Children aged 8–14, often involved in running sports.
Physiotherapist’s Perspective
From a physiotherapy standpoint, both OSD and Sever’s disease are real conditions, not just “normal growing pains.” They reflect biomechanical stress on vulnerable growth plates. Importantly, they are self-limiting—symptoms usually resolve once growth plates close—but management is essential to reduce pain and maintain participation in physical activity
Management Strategies
Physiotherapy focuses on conservative treatment and education:
- Activity Modification - Reduce high-impact activities temporarily.
- Encourage cross-training (e.g., swimming, cycling) to maintain fitness.
- Stretching & Flexibility - Stretch quadriceps and hamstrings for OSD.
- Stretch calf muscles for Sever’s disease.
- Aim to reduce tension on the growth plate.
- Strengthening - Strengthen surrounding muscles to improve load distribution.
- Focus on core and hip stability to reduce knee and heel stress.
- Footwear & Orthotics - Supportive shoes or heel cups can reduce stress in Sever’s disease.
- Shock-absorbing insoles may help with OSD.
- Pain Management - Ice after activity.
- Gentle massage and soft tissue release.
- Education - Reassure parents and children that these conditions are common and not dangerous.
- Emphasize that pain is a protective response, not permanent damage.
Are They Dangerous?
No. Both conditions are benign and self-limiting, but they can significantly affect a child’s quality of life and participation in sport. Without management, pain may persist and lead to avoidance of physical activity, which can impact overall health and confidence.
Conclusion
“Growing pains” is a misleading term when applied to Osgood-Schlatter and Sever’s disease. These are real, biomechanical conditions linked to growth plate stress. Physiotherapists play a vital role in diagnosis, reassurance, and management—helping children stay active while minimizing discomfort. With proper care, most children recover fully and return to sport without long-term issues.
References
• Australian Sports Physiotherapy. The Role of Physiotherapy in Addressing Osgood-Schlatter and Sever’s Disease in Growing Adolescents (2024). Australian S…
• NR Physiotherapy. Osgood Schlatter and Sever Disease – Evidence Based Advice (2024). co.uk
• Dar, M.H., Goel, A.K., Anandabai, J., Panda, B. Physiotherapy Management and Rehabilitation Approaches in Osgood-Schlatter Disease: A Comprehensive Review (JETIR,
2024). JETIR