Three Conditions to Know Before Writing It Off as "Growing Pains" — Osgood-Schlatter, Sever's, and Scoliosis

Lead

A fourth-grader who has just started playing sports says her knee hurts. Or a child begins complaining of heel pain after a track-and-field day. A school physical flags that his spine may be curved.

Answering each of these with "growing pains — let's watch and wait" is, in some cases, correct. But it also carries the risk of missing conditions that have names and treatment protocols. "Growing pains" is not a diagnosis; it is an everyday phrase. Accepting it as a diagnosis is where appropriate management stops.

This article covers three orthopedic conditions common in school-age children — Osgood-Schlatter disease (knee), Sever's disease (heel), and adolescent idiopathic scoliosis (spine) — alongside what "growing pains" actually means in the strict medical sense, and sets out the criteria for seeking care and what parents can check at home.

Background

During growth, the cartilaginous zones at the ends of bones — the growth plates (physes) — are more vulnerable than the surrounding mature bone. Repeated traction from muscles and tendons on these areas can produce inflammation, stress fractures, and fragmentation. This shared pathophysiology underlies most orthopedic conditions in school-age children [1, 4].

The growth spurt typically arrives around ages 10–11 in girls and 12–13 in boys. There is a period when bone elongation outpaces the lengthening of muscles and tendons, increasing relative tension at the apophyses. The window of highest risk for apophyseal conditions is roughly ages 6–14, especially when sports participation is increasing.

Osgood-Schlatter Disease — Traction at the Patellar Tendon Insertion

One of the best-known apophyseal conditions is Osgood-Schlatter disease. Repeated traction of the patellar tendon — which runs from the patella down to the tibial tuberosity as part of the quadriceps mechanism — produces swelling, tenderness, and pain at the tibial tuberosity, the bony prominence at the front of the knee [1].

Most affected children are boys aged 10–14. Prevalence in athletic children has been reported at 9–21% [1], with soccer, basketball, and running sports especially common contexts. The typical pattern is pain during or immediately after practice that settles overnight.

Rest, icing, and stretching of the quadriceps and hamstrings are the standard first steps. Most cases resolve with skeletal maturity (closure of the growth plate). Complete rest from sport is rarely necessary, but the "train through it" approach tends to prolong symptoms.

Sever's Disease (Calcaneal Apophysitis) — Traction at the Heel

Sever's disease involves the apophysis at the posterior heel (calcaneus), where the Achilles tendon inserts and the plantar fascia originates. Repeated traction and weight-bearing load produce inflammation and pain [2]. It typically affects children aged 8–10 — younger than Osgood-Schlatter — and is aggravated by running and jumping sports.

The "squeeze test" — applying firm lateral pressure to both sides of the heel simultaneously — is positive (painful) in Sever's disease and is a useful clinical screen [2]. X-ray may show fragmentation of the apophysis, though some fragmentation is a normal finding, making clinical diagnosis the primary method [2].

Heel cups (cushioned insoles) and Achilles tendon stretching are the main interventions. The condition resolves with growth plate closure, usually at ages 12–14.

Adolescent Idiopathic Scoliosis (AIS) — Three-Dimensional Curvature of the Spine

Adolescent idiopathic scoliosis is a lateral and rotational curvature of the spine without an identifiable underlying cause. A Cobb angle of 10 degrees or more on X-ray is the diagnostic threshold [3, 4]. Girls are affected seven to ten times more often than boys; prevalence (Cobb ≥10°) is approximately 2–3% of the school-age population [4].

School screenings use the Adam's forward-bend test: the child bends forward from the waist, and the examiner looks from behind for asymmetry — one side of the back rising higher than the other (rib hump). This test can be done at home once a year as a supplement to school health checks.

Treatment depends on the Cobb angle. The Scoliosis Research Society (SRS) criteria recommend bracing for curves of 25–40 degrees when the child still has significant growth remaining [7]. The effectiveness of bracing was confirmed in the 2013 BRAIST trial (Weinstein et al.): children assigned to bracing were significantly more likely to avoid surgery than untreated controls (72% versus 48%) [3]. When the Cobb angle exceeds 45–50 degrees, spinal fusion is considered [4].

"Growing Pains" — What the Term Actually Means

In the strict medical sense, growing pains refer to bilateral lower-limb muscle aches — most commonly in the thighs and calves — occurring at night in children aged 3–12, absent in the morning, and not associated with joint swelling [6]. Evans and Scutter found a prevalence of roughly 36% in children aged 4–6 [6]. The pathophysiology is not established; muscle fatigue and individual variation in pain thresholds are proposed mechanisms, but there is no structural bone or joint abnormality.

The key distinctions from the apophyseal conditions described above:

Putting It into Practice

For knee or heel pain, begin by asking how the pain relates to activity. "Worse during practice, better by morning" is a reason to consult a sports medicine physician or pediatrician. If pain prevents participation in training, or if there is joint swelling, seek evaluation promptly.

For spinal screening, the Adam's forward-bend test can be done at home once a year. Ask the child to bend forward from the waist while you look from behind. If there is a visible difference in height between the two sides of the back, do not wait for the next school physical — consult a pediatrician or orthopedic surgeon.

If the school health check returns a "scoliosis — further evaluation recommended" notification, the next step is an X-ray to measure the Cobb angle. Knowing the Cobb angle together with the child's skeletal maturity (bone age) is what makes the decision between "observation only" and "bracing indicated" concrete.

Summary

"Growing pains" is sometimes accurate. But when it is used as a catch-all for Osgood-Schlatter, Sever's disease, and scoliosis together, appropriate intervention gets delayed. Scoliosis in particular is time-sensitive: whether bracing can be started while significant growth remains affects the long-term outcome. Knowing the Adam's forward-bend test is the first branch point when "the spine looks a bit off."

References

1. Gholve PA, Scher DM, Khakharia S, Widmann RF, Green DW. Osgood Schlatter syndrome. Curr Opin Pediatr. 2007;19(1):44-50. doi:10.1097/MOP.0b013e328013dbea. PMID: 17224664.
2. Scharfbillig RW, Jones S, Scutter SD. Sever's disease: what does the literature really tell us? J Am Podiatr Med Assoc. 2008;98(3):212-223. doi:10.7547/0980212. PMID: 18487531.
3. Weinstein SL, Dolan LA, Wright JG, Dobbs MB. Effects of bracing in adolescents with idiopathic scoliosis. N Engl J Med. 2013;369(16):1512-1521. doi:10.1056/NEJMoa1307337. PMID: 24047455.
4. Weinstein SL, Dolan LA, Cheng JC, Danielsson A, Morcuende JA. Adolescent idiopathic scoliosis. Lancet. 2008;371(9623):1527-1537. doi:10.1016/S0140-6736(08)60658-3. PMID: 18456103.
5. Richards BS, Sucato DJ. Spinal fusion for adolescent idiopathic scoliosis. J Bone Joint Surg Am. 2010;92 Suppl 2:38-47. doi:10.2106/JBJS.J.00786. PMID: 21123583.
6. Evans AM, Scutter SD. Prevalence of "growing pains" in young children. J Pediatr. 2004;145(2):255-258. doi:10.1016/j.jpeds.2004.04.045. PMID: 15289779.
7. Scoliosis Research Society. SRS criteria for bracing and observation of patients with idiopathic scoliosis. https://www.srs.org. Accessed 2023.