Patient's question:
Every time after morning exercise, I feel severe leg pain. I mainly just run without doing any large-scale hybrid exercises. My classmates said it might be a muscle strain, but I don't really believe it. I want to ask the online doctor what the cause of leg pain is?Doctor's answer:
The issue of "long-term pain (leg pain)." Growing pains often occur in children during the rapid growth phase of spring before and after school age, primarily related to the increased activity levels during this period, faster growth of long bones, and the lack of coordination in the development of local muscles and tendons. Growing pains mainly manifest as limb pain, most commonly in the thighs of both lower limbs. The characteristics include mild pain, bilateral occurrence, prolonged duration, sometimes lasting for months or longer, and the pain often occurs in the afternoon and evening, disappearing after a night's rest. Growing pains are a physiological pain and are temporary; they will improve over time without treatment. Since growing pains are a physiological phenomenon during child development, some parents may mistakenly attribute leg pain caused by other diseases to growing pains, thereby delaying the treatment of these conditions.Here are some diseases that have symptoms similar to growing pains:
1) The cause of growing pains is unclear, and they usually resolve on their own as children grow. When a child experiences leg pain, it is important to distinguish it from the following types of leg pain to avoid delayed treatment:
- Transient hip joint bursitis: Symptoms include sudden leg pain, inability to walk or stand after waking up, no clear history of trauma, and sometimes fever. Physical examination reveals limited hip joint mobility, while X-rays show normal hip joints. In some cases, the hip joint may be swollen. This condition is treated with heat application, bed rest for 1–2 weeks, and oral taurine and vitamin B1.
- Tuberculous hip arthritis: This condition is more common in preschool children and progresses slowly, usually affecting one side. In the early stages, the affected limb may ache, causing changes in the child's gait. The pain gradually worsens, especially at night when the child is awakened by pain. This is a key feature of the disease.
- Femoral head necrosis: This condition has a slow onset and causes severe pain, gradually leading to a limp. Weeks before the onset, the child may have experienced trauma. X-ray images of the hip joint in the frontal view may show a smaller affected femoral head. This condition requires timely treatment, as delays can lead to hip dislocation and disability.
- Osteochondritis: This is an aseptic, localized ischemic nutritional deficiency disease that affects the bone and cartilage, often occurring in the upper part of the thigh. It is more common in boys and may be related to excessive activity causing local injury. Most affected children have unilateral involvement, with pain gradually worsening. The affected limb may have limited abduction, and pain may intensify after activity, often resulting in a limp.
- Osteoarthritis: If joint redness and fever are present, a blood test can help confirm the diagnosis.
- Bone tumors: Symptoms include persistent joint pain, limping, and swelling. Tapping the lower limb joints may cause pain, and further tests are needed for confirmation.
- Rheumatoid or rheumatoid arthritis: Symptoms include intermittent joint pain in the limbs. Blood tests such as erythrocyte sedimentation rate (ESR), anti-streptolysin "O" (ASO), and rheumatoid factor (RF) can help confirm the diagnosis.
- Children with leg pain should also be checked for X-shaped or O-shaped legs: If a child has knock knees (X-shaped legs) or bowlegs (O-shaped legs), the deformity may cause fatigue-related leg pain. X-shaped or O-shaped legs should be corrected promptly.
2) When a child experiences leg pain, parents should observe whether the pain is persistent, whether there is a limp or joint deformity, and whether the joints are swollen. If none of these symptoms are present and the pain is only intermittent, there is no need to be overly anxious, even if the child is crying.
Additionally, purulent arthritis often affects the hip and knee joints in young children, causing symptoms such as joint swelling, severe pain, and limited mobility. Osteochondromas are also common in children and often occur near the metaphyseal region of long bones. Osteosarcoma is more common in adolescents, with pain being the primary symptom, and local swelling may develop. Acute leukemia, a serious disease in children, often causes joint swelling and tenderness. Other conditions such as injuries, congenital disorders, and postural defects can also cause pain similar to growing pains. However, the pain caused by these diseases is different from growing pains, as it worsens during activity and may even limit movement, but improves during rest. It is important to differentiate between them.
If parents cannot identify the cause of their child's unexplained pain, they should take the child to the hospital for early examination and diagnosis.
Children with growing pains can take Vitamin C and taurine, and some low-zinc children may benefit from zinc supplementation, which can alleviate symptoms. Parents of children who frequently experience leg pain should avoid excessive exercise. Appropriate massage after exercise and warm foot baths can help prevent episodes. In cold weather, it is important to keep the lower limbs warm to avoid exposure. Generally, children recover by the age of six or seven.