Posted on 27th September 2016 by Fiona
Many children experience aches and pains as they grow which are typically written off as ‘growing pains’, told there is nothing that can be done and that they will ‘grow out of it’.
There is some truth to this; during a growth spurt the bones will lengthen first and then the muscles adapt and lengthen to keep up and there can be a period of discomfort around the joints whilst this happens.
However in young sporty children these ‘growing pains’ may well indicate a traction apophysistis (growth plate injury) that needs to be carefully managed to avoid long-term problems and ensure a quick return to sport.
What is a traction apophysitis?
This happens when the muscles are pulling on the growing part of the bone that hasn’t fully fused yet – like a rope pulling on cement that hasn’t hardened. If this area is overloaded by repeated, forceful muscle contractions, inflammation, pain and microtrauma to the growth plate will result.
This usually happens in very active sporty children who typically play 10+ hours of sport a week – especially kicking, sprinting and jumping activities like football, basketball and gymnastics. It always occurs during a growth spurt and is thought to affect around 20% of 9-16 year olds.
The main areas affected are the knee (Osgood-Schlatters disease) giving pain below the knee cap, or the ankle (Severs disease) giving pain above the back of the heel. Both conditions are associated with tightness of the muscles surrounding these joints pulling on their respective growth plates.
What can be done about it?
Rest, ice and anti-inflammatories can be helpful but most kids won’t want to wait months and months for their bones to stop growing before they return to sport, particularly if they are a budding athlete.
Will stretching help?
If the muscles are tight why don’t we just stretch them?
Well this actually pulls on the area where the muscle attaches to bone, potentially making it worse, not better!
So in response to this dilemma the Strickland protocol has been developed by a Physiotherapist to address the cause of the pain (tight muscles pulling on the growth plate) and to help guide return to sport and activity.
What is the Strickland Protocol?
The Strickland Protocol involves:
- Applying a specific type of massage towards the insertion of the muscle to improve a muscle’s length and reduce its tightness, which reduces the pull on the tendon attachment – this needs to be done for a minimum of 2 minutes a day.
- Once underlying tension is taken out of the muscle, helping it to catch up in length with the bone, the attachment site seems to repair in double quick time.
- Once the child feels no pain in stretch position, we replace massage with stretches, safe in the knowledge that it should be able to cope with the loading of stretches.
- Massage is continued in parallel with stretches to speed up process of elongation.
- Rest from aggravating activities is essential – for a minimum of 3 weeks we recommend nothing more strenuous than walking, otherwise this delays healing substantially!
- An important aspect is the involvement of the parent / guardian as the protocol cannot be done without their help & cooperation, as it will be them that performs massage on daily basis.
- This is followed by sport-specific rehab and addressing a biomechanical or technique issues as we guide you back to sport.
Does it work?
YES! It has a 95% success rate in 3 weeks when correctly adhered to!
How can goPhysio help?
If your son or daughter is suffering with knee pain (or pain at their heel), you may have been to see your GP who has advised you that there is nothing that can be done, your child just needs to rest. However, we have found that by using this treatment protocol we can effectively help children get back to what they should be – running round, doing sports and having fun!
What we can do to help you and your child is assess the problem thoroughly to make sure we’re confident with the diagnosis. We will then advise you on the best course of action. The great part is that the treatment is pretty simple, with our guidance you can carry out the programme at home – we’re here to provide extra support and advise on progress as and when you need it.