Childhood Pain
September 08, 2015 / anne brennan
Updated (edited) August 18, 2020
Child hood pain is extremely common with little explanation.
One morning, when my son was three, he woke, unable to walk due to a sore hip. After two days of tests at the Children’s Hospital, he was given the all clear but no explanation. I also had hip pain when I was five. Similarly, I spent 2 nights in hospital with suspected appendicitis. My parents were also told I was ‘all clear ‘without any explanation as to the cause. My pain returned constantly over the years but, like many children with pain, I learnt not to mention it.
Years later, when collecting data on barriers to girls playing sport, I found 115 out of 120 15-year-olds reported back neck knee and headache pain .
What was going on? My physio training did not explain childhood pain, so I researched it. I found that:
Unexplained pain starts young. 15.1% of children aged 5 have unexplained limb pain One researcher, Perquin, found that over half middle school children had unexplained pain. A quarter of this group had ‘chronic’ pain: pain most days over a three month period. And they weren’t complaining. Their parents probably didn’t know about it. Perquin, (mistakenly I think), called it ‘benign’ pain.
Children commonly get unexplained stomach, back and headaches followed by knee and shoulder pain. If a child/teenager experiences one pain, chances are they will have, or have had, two or three painful joints. It comes and goes, at least at first. It spreads and changes, sometimes on a day to day basis making it hard to pin down exactly where the problem is. It increases in intensity and frequency between the age of 9 and 13. There is, currently, no good explanation for it. It is often, wrongly, called growing pain. Growing does not hurt. Exactly the same pain affects fully grown young adults . In fact it peaks in intensity in the 20s. Like ‘arthritis’, ‘growing pain’ is the diagnosis given when no one can explain it.
Research shows that most children and parents forget vague aches and pains within a few days. They are not taken seriously. But unless reversed early either by chance or good interventions, pain can be a serious problem with long term repercussions.
Forgotten aches and pain are a probable precursor to a ‘wry’ neck. This intensely painful neck spasm occurs from about 7 onward. Most can't attend school for two to three days. Children with a wry neck or back pain are more likely to have neck and shoulder/back pain and /or headaches in their twenties. Again there is no clear standardised medical explanation for this.
The more often children experience unexplained aches, the more likely it will affect joints, causing swelling and tendon inflammation. This can cause a knee or ankle to suddenly collapse or 'give way' (or sprain) during sport, creating intense pain and swelling, and worst care scenarios: a fracture. Aches and pain also leave behind residual leg stiffness and weakness poor balance and stability. This can affect knees and create feet pain often diagnosed as Severs (in the Achilles) or plantar fasciitis (under the feet) .
By the time they turn 18, around 80% of adolescents have had ‘acute’ joint or muscle pain, often diagnosed as a sports injury or a syndrome such as Severs. This 80% are more vulnerable to problem pain as adults. The research is clear: intense adult spine and joint pain has its roots in childhood pain. It is, can I emphasis, reversable. My son and I are both examples.
My (now) young adult represented his school in senior rowing and football. He still does his stretches and stability exercises and is hopefully paying attention to (my) advice to carefully pace pre season training to avoid shin splints.
Is it psychological?
NO! Children prone to inflammation/asthma/eczema are also prone to headaches/joint pain. All are hyper reactive inflammatory conditions.
There is no evidence that childhood pain or asthma or any other inflammatory condition is psychological or psychosomatic or due to emotional or psychological trauma. Certainly: anxious children and adults worry more about pain/asthma. Anxiety can make the experience of pain worse and anxious people are perhaps more likely to forgo or, conversely, overdo carefully paced exercise that helps both conditions. There is, however, no evidence that anxious children develop more pain/asthma/eczema in the first place. Why wouldn’t anyone feel anxious if experiencing pain, inability to play sport, not knowing what causes pain, parental/medical practitioner disbelief or anxiety. Added to this, many then undergo tests to be told there is nothing wrong. When clearly something is wrong: it hurts!
Its not attention seeking. Few make pain up. Research shows that children who (like me) grow up with pain are actually less likely complain about it. They get on with it until it finally gets too severe creating acute pain/inflammation. This means if a child/teenager 'whinges' about pain, it is real. In contrast, children experiencing pain for the first time in their teenage years are more likely to be anxious and worry about low levels of pain.
How parents and sports coaches react to these complaints is important. Again, according to the research, children with parents who continually dismiss or ignore complaints are more likely to develop problem pain than children whose parents address their concerns. That said: the tendency for parents to catastrophize or ‘medicalise’ pain is equally unhelpful. This can lead to unnecessary radiology and surgical procedures. I have worked with entire families, including young children, disabled by pain and anxiety.
If not dealt with, pain (as with asthma)worsens and can lead to lifelong problems.
How to explain pain?
The Australian guidelines for the treatment and diagnoses of Musculoskeletal ( joint) pain say that unless there is concern that bones have fractured or growth plates damaged, children should not be told they have an injury/disease and should not be subjected to unnecessary scans or x-rays. I agree and support these guidelines. x-rays should only be used to rule out anything sinister. Remember that severe joint pain occurs regularly in 80% of the population without ‘a good cause’. This does not mean it is not serious. Pain IS serious. If not dealt with it can cause children to drop out of sport, leaving them prone to even more serious pain as young adults.
The symptoms (pain swelling stiffness) and causes (over training, unpreparedness of sports, lack of fitness, too much time on the couch/at desks/sitting cross legged) should be addressed. Pain is there to teach us how to look after our bodies and prevent injuries. Ignore it and it causes injuries. Ironically, failure to reset pain, after it has delivered a warning, can cause an injury.
But shouldn’t we get a diagnosis?
The problem is, as our beloved doctor to Australia, Normal Swan, has pointed out, everyone EXPECTS a diagnosis for their money, so are given vague unhelpful ones. However technical sounding diagnoses/explanations for everyday pain and inflammation are inconsistent, are NOT standardizsed between medical or health practitioners and do not always direct treatment /prevention (See my blog on why a diagnosis is bad for you). If no fracture/ dislocation/growth plate damage can be found, and there is no bruising that indicates a true injury, AND if massage or a warm bath eases pain and if it loosens or swelling eases up with very gentle exercise/weight bearing then chances are its a simple non injury sprain/strain.
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