What to do about pain in children,teenagers and young adults.

Pain is common in children, adolescents  and  young adults.

Once fractures/medical conditions are eliminated, the Australian guidelines suggest, simply, that most acute muscle/ joint pain should not be diagnosed or x-rayed/ scanned because most pain and swelling is technically NOT an injury nor a bio- mechanical fault (see below)

Muscle or joint pain is best called a sprain or strain. The body uses pain to prevent  an injury, fracture or dislocation. Which are rare (except in contact sports) so the body must be good at its job.

So why is it a problem?

There is a Goldilocks zone between too much and too little exercise. The body is meant to move but not too much. Pain helps calibrate this. Muscles and joints need frequent short bursts of exercise to prevent pain and keep up a healthy metabolism. Sharp pain is a warning that muscles, and muscle tendon junctions (particularly around joints), have reached their limits of strength, flexibility, agility and/or endurance OR not moved enough. This can create pain ranging from a dull ache to severe intense pain (for example a wry neck). Pain can feel like a fracture when there is no injury. The problem is that,with practice, the body, from early childhood, gets better at producing intense joint pain, tendon inflammation and muscle aches PLUS it gets harder to turn it off. It is real and it’s a problem. It is not ‘just pain’ because, unless addressed, it can escalate to cause devastating pain and swelling.

That is: just because there is no injury does not mean it is not serious. Pain is a serious problem that should be dealt with effectively when young.

Pain is caused by

1. Playing /training too hard

2. Not being match ready or fit for task

3. Residual stiffness /weakness/ inflammation

4. Poor technique

5. Not exercising regularly

6. Too much or too little exercise

Participation in competitions/training camps / weekend long carnivals/first week of training/returning after a prolonged break are high risk times.

Equally: unfit kids/adults are at risk of pain if pushed beyond their muscle limits .

Any mild to moderate exercise decreases joint inflammation. Too much exercise increases it.

The more pain experienced, the more likely pain will turn into an ongoing problem. 40 % of children experience what we call chronic pain: pain that lasts more than three months. They do not necessarily report it to parents, especially those who are either too dismissive or too worried. Attend to pain , figure out the causes and get help from someone who will follow a rehabilitative approach NOT a pure treatment hands on approach.

Prevent pain

• Ease into the season or after a lay off, using a Neuromuscular training program I.E. get agility, strength, balance and endurance up to the demands of sport/work/hobbies/playing an instrument.

• Use good technique/posture to optimize the body’s power positions and work muscles to their advantage. This decreases strain.

• Avoid working muscles beyond capacity. This can be a problem for committed athletes/musicians. Do not push or allow children/ teenagers (or yourself )to train/play too hard or too often.

• Avoid signing up for multiple competitions and/or intensive camps. Have rest days.

• Warm up with skill drills to prevent pain AND injury. Stretch after the game or when warmed up. Do not force stretches.

• Delayed onset pain is a warning that the body was pushed too hard NOT that exercise was good.

• DO NOT push through pain. Never say ‘no pain no gain’. The only pain should be emotional toughness not physical pain. Pain signals a drop in strength, flexibility and balance which is is counter productive.

• Some sports /instruments don’t suit some people: e.g. shorter rowers must rotate and lean more to reach which dis-advantages back muscles.

• If unable to lift heavy weights easily do NOT carry heavy bags. Avoid carrying heavy school bags/instruments/travel suitcases especially after a break. Consider wheelie bags/per term weight training (if bags cause pain).

• IDEALLY: learn lifting techniques that optimize muscle power to minimize back strain caused by lifting heavy back packs/instruments/sports gear.

• Avoid leaning or sitting hours at the computer. The hard bit? Get them off the bed and encourage a ‘proper’ chair (See my video on how to sit)

• Look out for clues that muscles are being pushed too hard: trembling, loss of co-ordination, weakness, vague aches BEFORE pain comes on. Rest muscles/take time before pain starts. Alternatively joint muscles can give way causing an injury.

• Split up training/playing if uncertain. Do two or three shorter sessions BUT with rest days in between.

• Help them learn their limits. Understand that every time these limits are breached and create an ache or pain, no matter how mild, they decrease your limits: you/your child will be slightly less strong and agile due to pain/inflammation not better for it.

Comfort children experiencing pain. Listen carefully to them and act on it. DO not ignore pain to’ toughen them up’ or think it wilL ‘just go away.’ ANd dont get too anxious yourself.

then

When pain is gone or they stop complaining the problem is not over.Look carefully at triggers for pain and work with your child to prevent pain returning.

Injuries heal , but pain can be a lifelong problem unless properly addressed early.

** IN rare circumstances pain is a “red flag” warning.

Any unusual or distressing pain that keeps a child  awake or sudden unexplained hip pain, limps or hot, swollen, painful  joints PLUS an elevated temperature and/or rash… straight to hospital  emergency. Always check out pain when in doubt.

That said, the degree of pain is not always a good guide as to what is happening. A bad sprain can be more painful than a fracture. The cold, pale child sitting quietly might be in shock with a fracture. Serious injuries (such as a finger tendon tear) may not hurt. If, following a fall on the outstretched hand, thumb/hand pain persists, even if early tests are negative, there is the possibility of a hidden (scaphoid) fracture. Don’t hesitate to get a second medical opinion if in doubt but once cleared it is important to understand that pain can be a problem even if nothing can be seen on an x-ray or scan and that the right treatment is to maintian fitness and gradually reintroduce normal movment and exercises that do not stir up pain or increase swelling .

Any pain that can’t be tied to an action or trigger and doesn’t settle: see a doctor.

For more information on how to treat pain in children please refer to patient page.