Thanks to physio Mark from Smart Health Training and Services for this blog post!
As a parent and a Physiotherapist I thought I was well and truly on top of managing the regular complaints of “this hurts and that hurts” when there is no objective sign of injury. Lots of regular stretching and offering a little TLC and gentle massage to keep them happy was my general approach. However, when my daughter who is very athletic and a promising swimmer from a young age began regularly complaining about a “sore shoulder” I started to become more concerned.
When all of my clinical assessments could not find anything significant, and a follow up ultrasound scan showed none of the common tendonitis or bursitis that plagues high level swimmers, I was quite perplexed. Throughout this process, my daughter was still continuing to train hard, up to 5 sessions per week and compete each weekend for both her school and her club and still achieve person best times. There were thoughts of maybe it is just growing pains, or maybe she is not really enjoying her swimming and this is her way of trying to get out of all the hard work and training, even though she was adamant she could not rest or miss any swim meets.
I decided that it was time to look deeper into the shoulder and arranged an MRI scan that showed a very healthy shoulder joint and rotator cuff mechanism, but there was a “hot spot” of inflammation in the bone that sits directly above the shoulder joint and that forms the AC (Acromioclavicular) joint. In my years of assessing and treating athletes of all ages I had yet to see this phenomenon, so it was time to seek additional help. An assessment with an upper limb surgeon provided us with an answer and a plan to overcome the problem.
In the end it was a “growing pain” issue to an extent, in that one of the growth plates in the outer edge of her shoulder blade had become irritated and inflamed and with the constant pressure of swimming had become mobile and was not healing. As we grow our bones need to enlarge and they do this by growing at specific points in the bone called growth plates. The shoulder blade or Scapula has several of these growth plates and the one closest to the AC joint had become inflamed and now presented as a stress fracture.
What we were faced with was very similar problem to Osgood-schlatters Disease, which is the result of rapid growth in the femur causing the growth plate at the attachment of the patella to be pulled apart. Characterised by the boney lumps appearing just below the knee on the front of the shins, and increased pain with running and jumping, the only way to effectively manage this is to refrain from any activities that actively load the quadriceps. Hence no running or jumping for between 6 and 12 months. This can sound like a death sentence to an energetic young boy, but if this irritation to the growth plate is ignored, then the result can be chronic patella tendonitis and the inability to run or play sport as an adult.
What followed was a very calm discussion about how important it was to rest the shoulder and that she could not swim for 6 to 12 months to allow the growth plate to settle. The Specialist was very clear in his explanation that if it was not allowed to settle then swimming would always be painful and that it could lead to long term shoulder pain and dysfunction. After quite a lot of tears and outbursts of “that’s not fair” we came to a compromise that has allowed my daughter to play hockey this winter and not surprisingly once she threw herself into that the swimming was soon forgotten.
The moral of this story is that simple growing pains will resolve, if the complaints continue then it is important to look deeper and get a clear diagnosis to prevent what could become a life long problem. Those of us who are parents of children who love their sport and are training and playing on a daily basis, need to be aware that we don’t know everything and that is something persists and does not resolve with stretching and a little rest we should get it investigated and ensure we don’t allow long term problems to develop.
Mark Johnston is a husband, father and Physiotherapist at Smart Health Training and Services.
P: (08) 8293 1100
Address: 12-22 Richmond Road, Keswick