Adolescent Pain

Adolescence is a time of huge change. Hormonal changes, rapid growth associated with bone and muscle development, rapid brain development, emotional and social challenges just to name a few. Our research has shown that this period of time is commonly associated with the development of pain. Commonly this may involve the development of pain in the back, head, neck, pelvis, joints, muscles and tendons.

How common is it?

While pain is rare below the age of 10 years, during the adolescent growth phase, there is a rapid increase in reporting of pain problems. For example, up to 40% of 13 year olds have already reported back and neck pain. At the age of 17, this increases to 70%. For about 20% of young people, neck and back pain becomes persistent, disabling and distressing. It can negatively impact on an adolescents mental and physical health, their ability to concentration with study, as well as their ability to engage in sport and social activity.

Other pain problems such as knee pain, hip pain, tendon pain and heel pain are also common in active adolescents.

Some names for adolescent pain include: growing pain, joint hypermobility syndrome, over use injury, sever’s disease, spondylolisthesis, Osgood-Schlatter disease and Scheuermann’s disease.

What causes pain is adolescents?

In very small group of adolescence (less than 1%), bone or joint pain can be caused by serious pathology such as an inflammatory arthritis, malignancy, fracture or bone disorders such as Perthes disease. These pain problems need specific medical treatment.

For a group of adolescent’s (about 20%), pain development is associated with high levels of physical activity which may result in pain in the spine, joints (ie. knee, hip, ankle), tendons or muscles. This is especially common during time of rapid growth where the structures of the body struggle to adapt to high levels of load. Times of rapid growth can leave an adolescent vulnerable, as their ability to coordinate movement, and their muscle strength and flexibility can be impaired. Bones are also more vulnerable to loading during this time of rapid growth. For the majority of adolescents, pain is not related to identifiable tissue damage – rather tissue becomes sensitive and painful to load and movement.

For another group of adolescent’s (20%), pain may be associated with high levels of stress, anxiety, depressed mood, inactivity and poor sleep. These factors can result in muscle tension and sensitivity in the bodies structures. This may result in pain associated with simple activities of daily living such as sitting, studying, carry back packs and engaging in physical activity.

For a small group, pain may become persistent (last for more than 3 months). Research tells us that this is associated with complex changes within the nervous system (where the bodies structures become hypersensitive), linked to tension and weakness in muscles and changes in the way the body is controlled.

There are a lot of myths about pain in adolescents:

The FACTS about pain in adolescents often surprise people. These include:

Pain in adolescents is rarely a sign of serious pathology. However, if you are concerned, seek medical attention.
Unless there are signs of serious pathology (1% of people), scans are rarely helpful to identify the cause of pain.
For some people pain with get better on its own, however for others it may become persistent and requires the right care.
There is no evidence that any specific posture is a cause of back or neck pain. A variety of postures are OK for the spine and varying spine posture and movement are important for spine health.

Joint hypermobility is common in young people (especially females). Our research has shown that joint hypermobility is not a cause of chronic spinal pain. The key thing with hypermobile joints is to develop good muscle control to support the joints during physical activity.
Unless you have a traumatic injury, rest is not helpful with spine, muscle, joint or tendon pain. Identifying the contributing factors and addressing them is key to engage in physical activity. Movement, physical activity and loading of the body if performed gradually is important for ensuring healthy bones, spine and joints.
With the right care, pain in adolescents can be effectively managed.

Assessment of pain in adolescents:

At Body Logic Physiotherapy we have world leading clinical researchers in adolescent pain and we have leading clinicians who are experienced in treating adolescents with pain.

It’s very important to understand that adolescent pain usually improves with the right treatment even if it is persistent. Physiotherapists at Body Logic Physiotherapy play a very important role in the treatment of adolescent pain.

You will first be asked to fill in a screening questionnaire so we can understand your pain, how it impacts on you as well as other aspects in you life such as your activity levels, sleep, your levels of stress and your mood.

The first and most important thing for us is to take time to hear your story and pain experience in your own words. We want to know how your pain feels to you and how it impacts on all aspects of your life. We also want to understand your treatment goals so we can help you get back doing what you like. We will also screen you to ensure your pain isn’t caused by serious health problems.

Following this we will conduct a comprehensive examination. This will involve idenifying where you hurt, your levels of mobility and function, how you control your body, as well as your strength and flexibility. We may also check things like your sensation and reflexes and do tests to check if your nerves are sensitive. We may perform specific tests to determine whether these is any structural issues that require further investigation.

Based on all this information we will then explain to you in simple language the factors that are contributing to your pain, and discuss the best treatments options available to you.

Treatment of adolescent pain

If your pain has signs of serious pathology, we will refer you for medical attention.

If your pain is acute (sudden onset), we will determine whether you need as scan. The key then is to help you to get comfortable and moving fast, as this helps with recovery. We will plan a program of treatment and exercises that gets you back to full function. We will also identify the factors that caused the pain and make a plan to prevent it in the future.

If your pain is persistent (longer than 6-12 weeks), we will work out a plan with you to help you take control of your pain and get back to living based on your goals. This usually involves helping you understand the factors linked to your pain, providing strategies to control pain get you back to full function.

Treatment may involve some hands-on techniques to relax you and get you moving, coaching you in body relaxation, training you to restore normal movement control, help you get strong, flexible and confident, resumption of physical activity and where relevant sleep rehabilitation.

A long-term plan is the key to prevent pain from recurring and stop it interfering in your life. We also work with your doctor and or psychologist if additional care is needed.

At Body Logic Physiotherapy we are not interested in ongoing band-aid treatments. We know that the best way to manage pain is to help you understand why you have pain, and get you back in control, moving, active and living again.

For some people this may take 2-3 sessions, however for long term problems this may take up to 7-10 sessions over a 3-4 month period. We also offer supervised exercise rehabilitation classes and one-to-one sessions to support this process if needed.

If you are experiencing pain, get in touch with our friendly team today!

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Additional Resources

‘Understanding pain’: More information on adolescent pain and what you can do about it