Salving those growing pains

For those of you from my generation, the mention of Growing Pains brings memories flooding back of a cringeworthy American sitcom tasked with grappling with the "modern day" struggle of parents with teenaged precocious children. The title obviously hints at struggles encountered in the formative years of transitional immature humans, humorously yet sensitively portrayed by some "American" stars.

The Real Growing Pains is more of a reality series played out in your home and on local sports fields. It is a bewildering phenomenon for the victim, often curtailing months and sometimes years of enjoyment, and potential exposure to All Blacks and Silver Fern talent scouts. So what are some of the facts of growing pains, and if you are a parent reading this for hope above hope, hopefully you see some encouragement in these words.

GROWTH SPURTS
Growing pains are most common in or around the time of the growth spurt. True growing pains exhibit characteristics that fit this season. There is no set formula for the prediction of when a child will transition into adolescence, but when it happens, you notice almost overnight someone is now looking over your shoulder, or commenting on your early hair loss. As the bony elongation is rapid, the muscles could almost be forgiven for being caught unawares, and having to catch up. A combination of weakness and tightness is the temporary result of this rapid growth. Increased tension on muscle insertions can result in some of the more well known growing pains, or apophysitis in the medical lingo: where repetitive muscle contraction causes inflammation, micro-tearing or even tearing away from its immature tendon insertion into bone.

Robert Osgood had to share his shot at medical glory with Carl Schlatter in the early 20th century as they offer their names to the adolescent sore knee problem that a good percentage of teenagers will now have heard of. James Sever latched on to his own condition, as the same type of condition affects the Achilles tendon insertion, and Sinding, Larssen and Johanssen share the glory for the less common knee cap type.

The answer to these problems is not always the popular one. Look at the volume of activities the child is doing and reduce to the essentials, and if this doesn't help, rest may be the best bitter pill to swallow. The physiotherapist can help here with advice and guidance. With the apophysitis family of dysfunctions, regular gentle stretching can help as the thigh and calf muscles naturally become tight due to the longer bones.

ALIGNMENT AND POSTURE
With the rapid growth of adolescence often comes the innate ability to warp the teenage body around furniture intended to promote good postures. Sloth-like postures ensue, and as a student diligently can put hours into learning, so too can the same individual dedicate hours of time draped over a chaise longue, or recliner chair. Just as there are rewards for good positions, like beautiful posture, symmetry and attractiveness, the rewards for working at slouch ability are there also. Ugly terms like Dowagers Hump, and Cervico-Thoracic Kyphosis are hard earned, and unfortunately have no transferrable credit in the real world. Waffle aside, the habitual postures our adolescents adopt will contribute to their musculoskeletal enjoyment, and complaints of pain may be as much due to sloth factor as they are to growing pains. The difficult thing for parents, who want their children to look mostly human, and want them to feel good about themselves is that their best line of communication - well intentioned nag (WIN) - is filtered out by the teenage brain with such inherent skill that it is breathtaking. Less obvious strategic encouragement (LOSE) is a more likely weapon. Once again, a charismatic physiotherapist with a textbook full of malformed and posturally frightening images may inspire the teen to dedicate their remaining adolescent years to becoming an upright citizen, and a series of stretches and strengthening exercises can be fit easily into a lifestyle. Diligence is the key. Current doyen of clinical psychology Jordan Peterson has a self help handbook called 12 Rules for Life. In chapter one called "Stand up straight with your shoulders back" he postulates that learning to adopt strong confident posture also translates into higher chances of success in life. You project confidence, people will believe you are competent, and the postural subject will begin to reap from the positive reactions to them.

REPETITIVE STRAIN FROM COMPUTER GAMING
Now more than ever, our children have access to more technology, and marketers have successfully achieved a computer, smartphone, tablet and console in just about every home. How many children have developed carpal tunnel syndrome - a painfully squashed nerve in the wrist - playing for hours on technology? These devices also encourage the poor postures that cause the sore backs and necks. It is rare to see any device or computer used in good posture. In workplaces people are set up for the hours of sitting they do by professionals, but what about the hours our children are investing? Screen time needs to become a phrase that means limitation rather than freedom.

GROWING PAINS
Toddlers and pre-adolescents can experience pain in the night in their thighs and calves. There appears to be no pathology, but seems to go hand in hand with extreme activity on the day before. Perhaps it is a juvenile form of delayed onset muscle soreness. Magee, Zachechwski and Quillan in their excellent series of orthopaedic books recommend a vigorous massage before bed. The problem never seems to last more than a year.
As in the above example, most adolescent pains of development are self limiting: they end up being a distant memory. Knowing how to navigate those rocky waters require reassurance and information is key. The child wants to know how long it will hurt, why it hurts and what can be done to help. So does the parent. Some of the growing pains are bad luck and untimely, but completely part of belonging to the human race. Coaches and parents need to be sensitive to not pressuring children to qualify for a distant Olympics, and children also may need to learn the hard reality of therapeutic bench warming.

The discovery process in the physio's office is often as therapeutic for the parent as the child, as the team approach to the solution can begin. Some parents will have to lay down their dream of a vicariously lived out minor premiership, and another enthusiastic pater or mater will have to allow their child to have "nothing" scheduled on a regular basis. This scenario of parental pressure will probably have been played out on screen in one of the seven seasons of Growing Pains, and we can probably learn from Alan Thicke's own lesson of successfully parenting a fictitious family, while producing a plagiarising, misogynistic rock star son simultaneously. You cannot fake good parenting. The point is that growing pains are as much about good parenting as physiological changes, and we can assist our kids in sailing through this painful time.

Greg Bell is a physiotherapist practising at Bell Physiotherapy. www.bellphysio.co.nz