Saturday, July 13, 2024

Squash Matters: Distinguishing ‘growing pains’ in your active child

Most of us who are involved in sport will have come across boys or girls dealing with ‘growing pains’ in their knees or shins.

This can be particularly tough as a parent when it is your child who is experiencing the pain – and the pain can be so much, it can prevent them from performing anywhere near their full potential and can often lead to tears of pain and discomfort (as well as tears of frustration!)

This is a very real, and quite common pain to experience for boys and girls aged between 10 and 17, because that is the time when they are growing a lot. Their bones are growing longer, sometimes at a faster rate than their muscles and bones are growing in strength. The pain is usually a constant, dull ache which intensifies when doing sport, and intensifies further when doing particularly intense exercise.

The bone can also become extremely tender to touch. When I say it is quite common, it is quite common when heavily involved in the world of sport, whether as a coach or a parent – it’s not common at all in less active children

 When a child first experiences this pain, it is usually dismissed as ‘growing pains’… or if you speak to a ‘well informed’ dad at a tournament or go to A&E and see one of their ‘expert doctors’, they’ll tell you that you’ve got something called ‘Osgood-Schlatter Disease’. When you are given this ‘expert’ diagnosis, you’re first reaction as a parent and child is relief. It’s nice to know that what you have is normal and has a label. You think “Phew, at least I’m not a freak or just being a wimp!”. 

You will then be given two choices: (1) Play less sport, or (2) to ‘grin-and-bear-it’ (ie. put up with the pain).  If you’re a keen sportsperson then obviously number 2 is not an option, especially if you have desires to one day be a professional.

And let’s face it, most children who develop these ‘growing pains’ or Osgood-Schlatter are likely not just to been keen sportspersons, but actually very good at what they do. This is because these pains are usually linked to ‘over-training’ and ‘over-playing’, which one has to do to become great at any age.

Yes, I’m using ‘over-training’ and ‘over-playing’ facetiously because when you’re 12 it is not too much to play squash or football 5 or 6 times a week, yet an NHS doctor would say it is too much. Imagine how much poorer professional sport would be if players waited until they were 18+ years of age before they started to play more than twice a week, waiting until they are fully grown. Of course, training changes when you’re 18 and an adult, but younger bodies can handle many hours a week of carefully monitored exercise. Anyway, back to the point, playing less sport is not a reasonable request to ask of a child playing any sport to a high level.

Lichfield Juniors are fully engaged on World Squash Day

So, number 2 it is then. Deal with the pain – but this is not exactly an appealing option either. Taking regular ibuprofen tablets to help with the pain is certainly not sensible for a child. Regular massage of the knee and shin is expensive, and most people would assume pointless because they’ve been told it’s a growing issue with the bone just below the knee-cap, and as we know massage is for soft-tissue not bone.

But alas, you’ve been told it’s growing pains, so there’s nothing that can be done anyway until you stop growing, or at least stop growing so fast. Most of us with knowledge and experience of this problem, relate it to a ‘growth spurt’ – so we need growing to slow down slightly so therefore the body can get used to the longer limbs, and the pain will naturally subside – which it will. Nobody keeps growing at such a fast rate forever (unless you’re Robert Wadlow!). It’s assumed ‘growth spurts’ can only last six months to a year, or in unfortunate cases, two years – but essentially it will pass. 

I used to have pains in my shins when I was younger, and I would push through the pain. I’ve coached several top juniors who have had growing pains which has had an impact on their performance and sustainability in coaching sessions and in matches. All of them have impressed me with how they have continued through discomfort. So, it is possible to cope with Osgood-Schlatter and still maintain a very high level – accepting that performance levels will be below par sometimes, accepting that there will often be pain, all in the faith that it will go away one day.

Lichfield Juniors are fully engaged on World Squash Day[/caption]

I have now been through this as a parent. My oldest daughter started to get painful knees over two years ago. From my experiences as a coach, I was not too surprised as she plays a lot of sport. I thought she needed to ‘ride it out’ and she’d be OK in a year. After one year my wife and I took her to A&E where she was told she had Osgood-Schlatter Disease. Like I said earlier, initially it was a slight relief to be officially diagnosed.

After two years she was not getting any better, in fact she was getting worse. She was still playing a lot of football, but she was having to sit out many school PE lessons (her favourite lesson) because the pain was too much, especially when playing on hard surfaces (as her school has an ‘old-school’ astroturf surface, not the newer, softer 3G and 4G pitches).

She was also seriously struggling in her football matches, having to selectively choose 20 minute periods when to push and when to ease off. She absolutely hated doing this, and also it was detrimental to her team who relied on her as their best player and their leader. For quite a long time, she had been doing daily, full-body work-outs in her room (in a sensible manner!), so her muscles were stronger than any other girl her age, certainly strong enough to support her long legs, but the pain was still intense. She is a very tough girl aswell, certainly not a girl who is affected by anything other than debilitating pain.

I thought “enough was enough” – two years was a more than just a ‘very prolonged growth-spurt’! This got me thinking that Osgood-Schlatter could possibly be a mild myth. As a parent or child, you go from feeling relieved by being given a reason for your pain, but then move on to despair as the fix is completely out of your hands.

The worst feeling for a sportsperson is to have anything out of your control, especially injuries. Most injuries are down to muscular issues, so stretching, massage and certain strength exercises will always help. Some injuries involve time needed for healing, but there is always a time-frame put on it. A tweaked muscle can be a week or two; a pulled muscle can be 4 to 6 weeks; a standard broken bone, maybe a few months; torn ligaments, possibly 4 to 6 months, or an operation and 6 months.

But there is always a pretty set timeframe which has been learned over decades of sport injury studies – and rehab exercises always speed up the recovery. With normal injuries, even though you have to let your body heal and repair, you still feel in control, because there is a path and plan to recovery. With Osgood-Schlatter Disease, there is no plan, not set path to recovery apart from indefinite rest! It varies from person to person, so as I said, it’s indefinite. I started to think to myself, I cannot believe this is the case, an indefinite recovery time is not good enough – there must be another way….

I started to question if it is even a real affliction. I know the pain is real, but is the diagnosis? Every child grows. Every child has a period where they grow quicker (a ‘growth spurt’) as they are about to embark on the joys of puberty. No child grows the same consistent amount each year in their childhood.

 So, why do some experience this knee pain, and often extreme pain, but most do not? Yes, we know it is exacerbated by regular exercise. But still, why do most children who do regular exercise still not develop Osgood’s Disease? I say again, every athlete between the ages of 10 and 16 will experience a growth spurt at some stage, yet most do not suffer with crippling knee pain. As a logical man, I could only come to the thought that Osgood Schlatter is usually a term given out when people either do not have the knowledge or do not have the time to look further into the causes of the pain in that individual.

Awards night for Open Squash’s junior programme

Because I have been experiencing a major injury this season, I have been very lucky to get to know a physio unlike any I’ve had before. Welsh pro Emily Whitlock told me to contact a guy called Doug at Altius Healthcare (and pestered me most days until I went to see him!). I must have seen a dozen different physios over the last 30 years, but Doug was instantly better than I’d experienced before. His knowledge and treatment was second-to-none.

Anyway, my wife and I decided to take my daughter Lucy to go and get checked out by Doug. It was obvious he was of the same opinion as me – there are reasons behind knee pain other than just ‘growing pains’. Doug has seen many, many sporting teenagers who had been told they had Osgood Schlatter. He found a reason to suggest otherwise in every one of them – and he helped everyone of them recover quickly.

After assessing Lucy for an hour – which involved some ‘question and answer’ time, some massage, some mobility exercises, some strength tests, and some biomechanical assessments on the treadmill – he found, and could easily show, that Lucy has a slightly incorrect running style. This ‘wonky’ gait loads pressure from her upper body, through her hips and onto her knees. When seen on a biomechanical running app, her misalignment, particularly on one side, was obvious. The impact on her knees was also obvious.

So, the brilliant outcome from this assessment was that Lucy isn’t having issues because of ‘growth spurts’, but instead from her running style. Now all of a sudden, there’s a complete shift in mindset – a positive one. No more feeling down and disillusioned with a long-lasting pain she cannot do anything about, she can now take control and solve her own discomforts. By doing certain exercises which Doug showed her to do, she can fix herself. (Doug asked her to do these specific exercises three times a week. This was a realistic expectation of a teenage girl. Lucy does them every day!). She has exercises to strengthen her glutes and exercises to stretch out her quads and hamstrings. These will straighten her ‘wonky’ running gait and stop the pressure onto her knees. She was also provided with some orthotic insoles to wear in her school shoes to help correct her ‘slightly flattish’ feet.

I cannot explain the immediate difference in her. It had an incredibly positive effect on her mindset as now she is back in control of her own destiny. Three months down the line her knee pain is massively reduced, her running technique is much nicer and she no longer has to ‘manage’ her matchday performances. It was the best money we could have spent, and I only wish we’d done it earlier. 

It’s possible to think this is a ‘one-off’ case, and I cannot completely rule that out. However, just before Christmas a girl wanted to join my football team and started to come to our training sessions. She told me that she used to play football a few years ago but had to stop because she had Osgood Schlatter. “Here we go” I thought..

What was obvious from the start, and now she has started to play matches for us on the right wing it is even more evident, is that her running style is way off ideal / ‘uniquely quirky’! She leans too far forward, and also over-strides. This is actually very hard to do because when you lean too far forward it actually shortens your stride length. Her centre of gravity is way off centre. She leans so far forward she actually topples over at least a couple of times in a match, making a few girls question “Why’s Emma always on the floor!?”. And do you know what… she’s still getting her ‘Osgood Schlatter’ knee pain!

So, Emma followed ‘expert’ advice and had a long time away from playing football to allow her knees to heal and for her growing pains to subside. Eighteen months of very little sport and not ‘over-doing it’ in any way was more than enough time to allow her ‘growth spurt’ to slow down and for her body to catch up and recover – but here we are two years later – she is still experiencing the same ‘Schlatter-like’ knee pain. Maybe she’s just unlucky? Or maybe she is biomechanically flawed which is giving her intense knee pain? I think we all know what the answer is. And the great thing is – she can address and fix her running style, whereas she cannot tell her body to stop growing!

Children and teenagers grow. Fact. To become good at sport you have to put in many hours of practice. Fact. Combining the two does not mean knee pain is your ‘cross to bear’. Knee pain is not an inevitable sentence of being a sporty teenager. I do not blame people for diagnosing ‘Osgood Schlatter’ because it appears to be logical and scientifically proven. The NHS has always been stretched (certainly now more than ever), and they simply do not know that after they have ruled out any bone breakages or cruciate ligament damage, that maybe there are other explanations to knee pain in children. They have been told it’s Osgood Schlatter. They understandably do not have time to perform biomechanic tests on every child who turn up to A&E.

So, if you are a parent of an especially active child and they develop knee pain, I suggest you consider other options other than accepting it as ‘growing pains’. You could save your child many months or years of unnecessary pain. You will also enhance their performance along the way by improving any muscular or biomechanical issues that could actually be holding them back.

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