Help! My kid is in pain! What does this mean? (Part 1)

I’d be willing to bet that you generally don’t like to be in pain. I’d be willing to bet more that you really don’t like it when kids and teens are in pain. Chances are, if you are the parent of a young athlete, your child or teen has been in pain at some point in their sports “career.” Maybe you knew what to do about it and your child got better without any problems. Maybe you had no clue and turned to your friends, Dr. Google, or relied on your own steadfast remedy system.

I’ve encountered a gazillion parents who fall all over the map of knowing how best to care for their children’s pain. Sometimes parents make decisions about how to care for a child’s pain that ultimately leads to worsening of the problem. These decisions may be based on an interest to keep a child playing a sport for a number of reasons. On the other hand, some parents fall more into the “hypervigilant” category. These are the parents who fast track their children to the urgent care center every time Johnny or Sarah complains of an ache or pain.

hello kitty band aid

Hello kitty can sometimes make everything better

Despite a parent’s style in caring for pain, one thing all of these parents have in common is that they mean well, regardless of which way they handle each situation. Culture and experience lead people to act in different ways, but there are a few constants that hold true in caring for a child or teen’s pain regardless of one’s background.

Given that I happen to work with young athletes of all ages, I often get questions from patients, colleagues, friends, and family members about pain in their own or their friends’ children. Here is a sampling of the questions I am asked quite frequently:

  • “My 12 year old has been having ankle pain off and on for 3 weeks. She’s been wearing a brace and keeps doing her sport but she says it’s getting worse. When should I panic and do something about it?”
  • “My 8 year old just fell off the monkey bars, says his elbow hurts, and refuses to move his arm. I have 3 meetings I need to attend and he has a baseball game tonight. Can we wait and see how it feels tomorrow?”
  • “My 15 year old’s back has been hurting for 6 months and it’s getting worse. She has bad posture. I told her to stretch and do some yoga with me since that’s what helped me. We also put her on our home traction table, I let her use my TENS unit, and she’s been getting chiropractic adjustments from my chiropractor 3 times per week.”
  • “My friend’s 13 year old has mysterious abdominal pain and has been out of school for 6 months. Nobody can figure out what is wrong with her. Is there another specialist she should see or is this all in her head?”
  • “My 17 year old has hip and groin pain. I think it’s a hip flexor injury. She just needs to stretch her hip flexors and do some Pilates, right? Can you show me some stretches for her to do?”

<Spoiler alert: If any of these situations sound familiar, you’re not alone! We will revisit each of these situations—and what to do about them– in a future blog. Stay tuned!>

Parents, friends, coaches, and kids and teens themselves have lots of questions about how to deal with pain. This can be very confusing, and everyone has an opinion on it. Before we address the somewhat confusing question of how to deal with it or what to do about it, we must first address the possibly more confusing topics of what pain is and what this could mean in a kid or teen.

Defining Pain

The first thing we need to do is define pain. Get ready for a blast back through science class. A person can perceive and experience pain for any number of reasons. According to the International Association for the Study of Pain, Pain is “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” What that means is there is not always damage somewhere in the body when pain is present. If that’s the first time you’ve heard that, you’re not alone. What we know about pain barely scratches the surface of what lies beneath the understanding of why it occurs.

Pain is an output from the brain

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Pain is an output and sum of all the things that happen to us!

 One thing we do know is that pain is absolutely, positively, 100 percent produced as an output from your brain. See this great youtube video to explain this. While the video is about chronic pain, the same concept applies to just about any type of pain.

Think of the body like an email communication system. You bump your knee, and your ultra-fast email system sends a message through your nervous system to a part of your brain that acts as a switchboard. The switchboard decides if the message is relevant and if it merits being sent on to any other part of the brain. What you need to know about the switchboard is it is not in the conscious part of your brain. If the switchboard deems the message relevant, it sends the message along to your cerebral cortex. This is the part of your brain where you make thoughts, perceptions, and do all the cool, complex processing that makes us human. It’s not until the email message gets to your cortex that your body then decides “oh wow! Bumping my knee hurts!” Thus, it is an output, or a decision, just like any other decision you make.

PainKillers

That pink spot in the middle (the thalamus) is the switchboard. The thalamus intercepts and interprets almost every signal that comes into your brain. This includes stuff like smells, tastes, sounds, thoughts, and signals from organs you may not even know exist!

Now you may be thinking here “Ok Julie, I didn’t decide that I wanted to be in pain.” That’s right. You didn’t. But your conscious brain did. Due to wiring in your brain that you’ve been formulating since before birth-your brain decided whether or not that knee bump was going to be painful. The combination of your life history, culture, environment, previous experience, previous pain and injury, overall health status, emotional status, and many more factors – things that you sense and direct every day—was responsible for deciding if that bumped knee was going to hurt or, well, just feel like you bumped your knee.

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You can think of pain in a kid like a wheel–it’s totally dependent on so many factors. These factors include intrinsic ones (stuff within the kid that can’t change, regardless of what is going on around the kid), and extrinsic factors (stuff that can change–IE the environmental factors going on around the kid).

 Notice that I said perception of pain is based on factors like life experience, previous pain and injury, and emotional status. Those are just a few factors that might make pain perception a little different in kids. Why is that? Kids have less life experience, likely fewer pains and injuries, and emotional and cognitive/thinking statuses that are not fully developed. This makes pain perception very different for them.

If things are going well, most kids experience the occasional bump, bruise, scrape, splinter, or “owie” as my 21-month-old niece likes to call it. Most “kid pain” gets better with a kiss from mom and dad, maybe a band-aid, and encouragement to “shake it off.” Healthy kids without serious problems are often seen to be running, jumping, and playing through pain. It’s not until pain slows them down or changes their behavior that it usually registers on parents’ or coaches’ radars.

pain experience

What this means is that as kids develop, they may not know exactly what is going on with their pain. They often don’t have the experience or previous pain and injury to be able to describe it. This can make it hard for parents, coaches, and healthcare providers to understand how to help them.

Oftentimes kids learn how to describe pain based on what an adult tells them it should feel like. Case in point: I’ve had an 11-year-old tell me that her knee feels like “bone on bone.” In actuality, this is how physicians or patients may describe an extremely arthritic joint in someone who is a middle-aged adult and has lost all cartilage cushioning in the joint. While not impossible, it’s not something that we would typically expect a ‘tween to say. Ask a 7 year old to describe the pain and they will give you a blank stare. They just don’t have the experience, the complex thinking processes, or the knowledge to know how to describe it. Typically they will just agree with whatever an adult says.

Not only do we have the challenge of getting kids to describe what’s going on, but kids’ behavior around pain is also all over the map. Depending on influence from adults, siblings, and friends who may have pain or have loved ones in pain, kids learn how to behave and perceive pain from those around them. Some kids learn from a very young age that pain is scary. They may panic or complain constantly about every ache and pain. They may also learn that being in pain is a way to get support, attention, or avoid an unwanted activity. This would mean the real underlying problem may not actually be related to the pain at all (more on that later).

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Other kids may learn that “being tough” while in pain is admirable and brave. These kids may not complain at all when they probably should be. This means you may have one kid who has a total meltdown over a splinter, and another kid who seems calm and collected over a broken leg. As you may imagine, there’s clearly a fine line to walk here in teaching kids and teens how to cope with pain. We don’t want to panic them, and we don’t want them to be heroic at the expense of hurting themselves more. And even if you think you’re toeing that line just right as a parent or coach, chances are they’re learning about pain coping (and everything else kids, ‘tweens and teens learn) from other outside influences, too.

Needless to say—pain is complex in any person, regardless of age. Add a developing brain, body, and lots of family and sports influence in the young athlete—and we have the potential of launching those complexities to exponential levels.

conquering child's chronic pain

Here’s a great book by Lonnie Zeltzer, MD. It’s technically about chronic pain—but keep in mind “chronic” in a kid could be 2 weeks. It’s a much smaller percentage of the length of their life. These same concepts can apply to kids and teens of all ages, and even those in acute (IE, just happened JUST now) pain.

WHy do I hurt

This book: Why Do I Hurt? by Adriaan Louw, is appropriate for middle schoolers, high schoolers, and college students. It is written on the patient’s level and really explains pain in a way that fosters understanding. Great for parents and coaches too!

 

Now that you’re armed with more knowledge than you ever wanted to have about what pain is and what it means in a child, teen, or young adult, you’re probably asking–So what do we do about it?

Stay tuned for Part 2 to learn how to address and cope with a child, ‘tween’s, teen’s, or young adult’s pain situation.

6 Reasons Why the Diaphragm may be the Coolest Muscle in the Body

What if I told you that there is a muscle in your body that is key to giving you good posture and participates in weight lifting between 17,000 and 25,000 times per day? What if I told you it does this without you even knowing it? What muscle do you think that is? Hint: it’s not a heart muscle.
Stumped yet? Check out this great blog by my colleague Jessica Reale to find out the answer. Young athletes of all ages and backgrounds need to learn from a young age the importance of this muscle.

Jessica Reale, PT, DPT, WCS

I have a small confession to make– I love the study of human anatomy. Always have. It was studying human anatomy and physiology that made me shift my undergraduate degree at Gordon College away from “Biology” and into “Movement Science” (which has now become “Kinesiology”… Who would have known that years later, “Movement Science” would have been the coolest name for a major ever? Am I right fellow PTs?). The human body is fascinating and incredible. So, it should come as no shock to you that I have favorite muscles. In PT school, my favorite muscles were the ones with the most fun names… like the Gemelli brothers (who are small hip external rotators) or Sartorius (a thigh muscle…best, if sung to the tune of “Notorious“). Of course, you know that now the pelvic floor muscle group ranks pretty high on that list…but the diaphragm, well… it just takes…

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Pilates: Not Just for Grown-Ups

“Hey, do you know of any places where my daughter can do Pilates after she is finished with PT?”

“Should my 6 year old do Pilates classes?”

“She has a stress fracture in her back and the doctor said she needs to strengthen her core. I heard Pilates is good for that so I bought her a DVD. Is that ok?”

“I need to do Pilates as conditioning for dance. What should I do?”

I get these questions all the time from parents and young patients. My answer to them has often been “Well it depends.” That is, until recently!

One month ago I had the absolute joy of attending the Pilates Method Alliance® Pilates 4 Youth teacher training in Berkeley, California. What a fabulous 2-day course in the most beautiful setting with the most interesting and brilliantly creative minds!!! It was perhaps one of the most inspiring courses I have taken in my entire PT and Pilates career thus far. It helped that we had a nice view of the San Francisco Bay, San Francisco, the fog, and the Golden Gate Bridge the whole time. I called it my #nerdcation.

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Claremont Hotel & Spa in Berkeley.

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I’m not sure if I spent more time learning or more time gazing out the window from my seat

The course was full of 60 or so instructors from all over the USA and the world who work with children and adolescents in all different settings: schools, clubs and camps, inner city wellness initiatives, health care/PT clinics and private practices, girl scout troops, and private Pilates studios.

The course was led by Celeste Zopich, Brett Howard, and Dawn-Marie Ickes, who co-authored the course manual and textbook Pilates for Children and Adolescents. These three brilliantly creative master teachers spearheaded the Pilates in the Schools movement, an initiative begun in the early 2000’s in the wake of decreased physical education time in public and private schools. You can read more about Pilates in the Schools and the research project they did with the kids here.

Watch a video about Pilates 4 Youth & Pilates in the Schools here:

I can’t say enough good things about the instructors. Celeste has a wealth of experience teaching in a parochial school. Brett teaches classes for children of all ages and brought a wealth of research and creative cueing and activity design perspective to the group. Dawn-Marie, the PT & Pilates teacher of the book, seems to be leading a life rather parallel to mine on the west coast. She works not only with young clients and incorporates Pilates into PT with them, but also has a special interest in women’s health and is a Redcord Neurac teacher trainer. I can’t wait to continue following these three as the Pilates 4 Youth initiative continues to take off.

See interviews from the book’s authors & course instructors here:

Too often children (especially girls) drop out of sports by age 13 due to burn out from early specialization, self esteem and body image issues, lack of success and fear of failure, or lack of funding from parents or other guardians. Or—on the other hand, children do not become active in the first place for so many cultural and societal reasons (that I don’t have time to discuss in this blog post) and we have even bigger problems of childhood obesity, low self esteem and body awareness, and low exercise interest or confidence.

Perhaps most interestingly, the course taught us about the “magic window” age of 9-13. This is when kids and teens are at the most vulnerable for both physical and psychological injury. The mind-body approach of Pilates targets these problems in a very kid & teen-friendly way. This is the best stage to intervene from an injury prevention standpoint in PT, too.

Favorite video quote from videos above (from a 13ish year old):

“Well I’m a swimmer and doing regular Pilates has helped me a lot with having regular breathing and opening up my shoulders and using my back muscles to move my arms.”

If that quote doesn’t sum up my personal and professional vision for helping my most beloved target clientele, I don’t know what does.

In the course, we learned how to design classes or private sessions for children of all ages and ability levels, from 5-6 year old girl scouts to 18 year old elite Olympians,. We had a great segment taught by Dawn-Marie on program design for children with special needs, or “special opportunities” as she liked to call it. She reminded us that all children and teens have challenges that vary on a long, diverse scale, regardless of the diagnosis or “category” in which they are placed. For youth of all ages and ability levels, it is our duty to determine how best to tap into each of their movement systems, regardless of the challenges and opportunities they face each day.

superhero pilates

Superhero themed Pilates! It’s not hard work when you’re having fun while learning! I bet I know a few adults who would probably want to come to a class like this one…

 

 

 

 

 

 

 

 

 

 

The Pilates 4 Youth initiative is in a pretty grassroots stage now. So far the course has been put on twice to a total of about 150 people thanks to a grant from a generous donor. Hopefully it will continue to grow in popularity so that we can improve access for children of all ages to Pilates in a non-competitive environment. But we’re not exclusive to Pilates. And we are all over social media!

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#hashtags are everywhere Follow the PMA on twitter at @PMATWEETER

Stay tuned! I’ve already been incorporating Pilates into my clinical practice for several years, but I’m anxious to start incorporating many of the new concepts I learned into practice and hopefully into group classes in the community soon. I’m excited to exercise my creative juices and have already invested in some fun tools to help me do so:

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That’s a scooter board

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Fabulous imagery and kid-friendly Pilates terms

To learn more about the Pilates 4 Youth initiative, check out the information on facebook.

“First, educate the child.”

Joseph Pilates