Helga Irene Wolf
A good explanation of growing pains and of the development of, for example Mb. Scheuermann is still missing. The most used model, which recommends moderate exercise as treatment has not been successful despite beginning use for 10 years(1,2). Allow me to present a new model here. This results from a study of more than 3300 school children aged 5-19 years over 10 years from 1998 to 2008. Registration of 927 children in the youngest school class show a problem: In the beginning, more than 95% of the children were healthy, with normal backbones. In 2001 it declined to 90%, and from 2004 the number of bad backbones increased to about 45 %. In the following a number of postulates are combined with a few well-known references (marked with reference number) to describe a new model for explaining and handling bone and joint problems in childhood. The aim is to lessen pain in childhood and prevent permanent damage for grown ups.
One early sign of physical problems in childhood is growing pains(see below ►). This is scarcely mentioned in medical reports, but it causes much distress to the families, especially at night. Other early signs are flatfeet, angling of the heel bones, and hypermobility(see below►►). The next step in the development of flat columna vertebralis or other bad back-bone formations, beginning with one locked facet-joint or two. This develops from a slight hypermobility in the facet-joint, and a displacement of the joint, when it occasionally locks in an overstretched position. The process proceeds like a zip, both up and down the columna vertebralis, because the movement in the columna vertebralis takes place in the nearest moveable joint, which then is moved much more than it should. When more than two pairs of the thoracic columna vertebralis facet joints are locked, the loin has to re-establish the connection between pelvis and the flat thorax columna vertebralis in a kyphosis and if there is room enough it forms a deep loin. If nothing is done, the soft bones are held in the wrong position, while the columna vertebralis is still growing. As a result there is not enough room to build normal vertebrae, they become misshapen and locked, and develop the Mb. Scheuermann corpora shape where the columna vertebralis is fixed with the thoracic back flat and the Th/L hanging. Once the columna vertebralis is fully calcified growth can not rebuild the vertebrae, and the diagnosis can be made. Mb. Scheuermann is just one of many possible displacements in the skeleton(see below►►►), many coming out of the same aetiology, where the bones are connected in a wrong position in childhood.
These changes are explained here as a chemical-based physical dysfunction.
► The growing pains: To the back-bone-growing-disease-model belongs an old observation that growing pains can be cured rapidly with a glass of milk or a calcium tablet. Therefore, growing pains are here regarded as the first sign of low Calcium/Vitamin D intake. In this model, pain in the bones and joints is just as important as objective changes in the skeleton. When the children grow further, the model says that depletion of Calcium/Vitamin D can give ache in the heel, the knees and the columna vertebralis. Later, the ache can come from everywhere in the skeleton. Another observation is, that growing pains often appear at night, when the child has been more physically active than usual in daytime. The explanation can be that physically activity use the calcium, and the pain shows that the daily intake of calcium is not sufficient.
►► The disfigurement: Weak muscles caused by Calcium depletion (with or without vitamin-D depletion) can give hypermobility of most joints in the body. Other minerals and vitamins probably play a role too, but in my material, Calcium and Vitamin-D are the most important for children. The hypermobility allows the joints to move too much. If the child has hypermobility in the legs, they can angle in the knees, and the normal arches in the feet fall down to flat foot and angling of the heel-bones. Pain in this region can be a direct result of the disfigurement.
►►► Long-time changes: Mb. Scheuermann seems to develop over time. Hypermobility is a separate change. Extreme hypermobility in the columna vertebralis gives soft but conspicuous increased curves. The hunchback is obvious, and the lordosis in the loin is often evident. The flat back comes from columna vertebralis locked in a back-bow formation without the normal arches. Scoliosis not coming from anisomeli or skew pelvis can have a similar explanation. Discusprolaps may perhaps sometimes be based in simple, early changes. With a number of locked corpora connected to another number of locked corpora, or connected to a deep lordosis, the connecting iv joint(s) come under enormous pressure. When the pressure is placed awry on the discus, the discus can protrude or prolapse opposite to the pressure. If this is correct, operation alone will not help. Replacement of the neighbouring corpora by loosening the locked facet-joints in the zipped areas will then help for longer time. Low body height seems to be connected with low calcium/Vitamin D intake, and is not just hereditary.
Calcium seems to be best from milk - and milk products(3). Calcium seems to be held back in intestine, and not absorbed from there, by some chemicals: Oatmeal (phytin(4)), tea, coffee and cocoa (Tannin=Polyphenol(4/5)), cola (phosphoric acid(5)), alcohol(3), and tobacco(3). They are effective “calcium thieves”. In addition, pharmaceuticals such as corticosteroids(6) and sex steroids (3) seem to be important.
The time frame for developing pathological changes in the skeleton seems to range from 2 weeks to 2-3 years.
Pain-killing drugs seem to increase the objective changes, perhaps because they removes the natural protection against overuse.
The effect of calcium depletion is normally described as spasms and cramps, and calcium is important in the muscle contraction process(7). The hypermobile effect with weak muscles is not described in the literature it seems as if the calcium is at least as responsible for the weakness as the lack of Vitamin D in my study, here a raise in calcium alone has a marked effect. The effect is more noticeable when Vitamin D is added.
The importance of Vitamin D is known. Here the use of make-up and sunblock seem to play a separate part.
The most surprising in my study is, that there is no cure in sport alone, and excessive sport seems to be contradicted. Training only works fine when the Calcium/vitamin D is on the required level.
Statistically the model involves two partly overlapping symptoms: Subjective pain, and objective bone/joint displacement. In the statistic calculation the four possible combinations are: Healthy, Pain alone, Both Pain and Objective changes, and Objective changes alone. The “Healthy” model is described separately(8).
The back-bone-growing-disease-model gives the treatment: Normalized intake of Calcium and Vitamin-D, combined with normal movements, easy exercises, sometimes replacement by manipulation of the facet-joints, and care for that the joint is not overstretched for months.
The good information here is that there seems to be a lot to do to prevent many back-diseases, if the model is used early enough in childhood. The described skeleton changes can be a social/environmental change more than hereditary, mediated by Calcium/Vitamin D consumption habits.
1. Low back pain in children and adolescents: prevalence, risk factors, and prevention. Ugeskr Læger 2002; 164:755-8
2. Statens Institut for Medicinsk Teknologivurdering: Ondt i ryggen: Forekomst, behandling og forebyggelse i et MTV perspektiv. MTV serie B 1999; 1(1)
3. Essentials of human nutrition. Third edition. Oxford 2007. Cap 8; p 118-9
4. Essentials of human nutrition. Third edition. Oxford 2007. Cap 25; p 388
5. Essentials of human nutrition. Third edition. Oxford 2007. Cap 8; p 116
6. Essentials of human nutrition. Third edition. Oxford 2007. Cap 8; p 121
7. Essentials of human nutrition. Third edition. Oxford 2007. Cap 8; p 112
8. Health model (in Danish) www.helga.in
© Helga Wolf may 2009