Should teenagers ache in the morning?

The Pediatric Insider

© 2011 Roy Benaroch, MD

Heather wrote in, “I am a 14 year old girl that has joint pain in the morning. The pain might be in my knees, elbows, wrists and hands, ankles, or my lower back. The pain is usually mild but can become severe. I am active in sports so the joint pains are really slowing me down. Is this growing pains or something more?”

While it might be OK for grandma to wake up with achy joints, I don’t think this is something that I’d call normal or expected in a teenager. Heather needs to think about other things, and get a more-thorough evaluation from her own physician.

Morning joint stiffness is quite characteristic of many kinds of arthritis, or inflammation of joints. Overall, the most common forms or arthritis are called “osteoarthritis,” and are a condition of aging. That’s my grandpa takes a little while to get going in the morning, and awakes with pops and creaks and moans. Hopefully, we’ll all live long enough to enjoy some degree of osteoarthritis as we age—but under ordinary circumstances, 14 year old girls should not have this.

Some kids really do overdo it, and may have symptoms of joint overuse at a young age. This is especially seen in year-round athletes, who play one sport for many months without giving their bodies a chance to rest. These kinds of pains are seen as part of “overuse” syndromes, especially when the same sort of action is done over and over again. Think about a baseball pitcher’s shoulder, or a runner’s knee: over and over, the same forces applied in the same way across a joint. Eventually, you’ve got pain and damage. Contrast that to a baseball player who varies position, or a runner who swims or cycles on some days. It is not a good idea for anyone, young or old, to repeat the same exercise over and over, especially for months at a time.

Heather, though, isn’t talking about one joint: she’s achy all over. This makes it possible that she has another kind of arthritis, perhaps one in a family of immune or inflammatory arthritis. I’d especially be concerned about this if Heather reported joint swelling or stiffness in the morning, even more so than pain.

There are also musculoskeletal conditions that can lead to chronic joint aches, most commonly conditions where the joints are too lax and flexible. Many of these conditions can be helped by working with a physical therapist to work on strengthening and coordination.

So while I don’t have an exact answer for Heather, I would say that no, that sort of pain in a teenager isn’t normal, and she ought to go for a thorough evaluation by her pediatrician, an orthopedist, or a sports-medicine doctor. She should bring along a log book of a few weeks’ history: what was her exercise routine, and how much pain was there each morning? What joints hurt the worst, which day? If there’s swelling, take a photograph to bring to the doctor (or make the appointment early in the AM, so the doc can see it.) I think with a good evaluation and some guidance, Heather ought to be able to get some relief and get back to enjoying being an active teenager. It’s not time to be grandma, yet!

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2 Comments on “Should teenagers ache in the morning?”

  1. Michelle Says:

    I was a very active athlete as a high school student, and I have to say, I ached and hurt all the time, too. She should certainly be evaluated for some problems, but I’m betting (with all my extensive anecdotal and non-scientific experience) that these are overuse injuries possibly mixed with pain from growing.

    Tendonitis was my final downfall, and it turned out that I am prone to overuse injury and soft tissue inflammation. I finally quit competitive sports, walking away from a college scholarship in my sophmore year when my freshman year in division 1 sports made me want to die. By that point, I was developing lumps in my achilles tendons and retrocalcanus issues. We won’t talk about the shin splints.

    I decided, after a few foot surgeries and realizing I was probably flirting with liver damage from all the painkillers I was pounding, that walking when I was 30 was a better idea than hanging on to an amateur sports career. Funny enough, I now study the neuromuscular junction and work in a research lab devoted to it, regeneration, and aging.

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  2. My daughter has juvenile arthritis; sore joints are not fun! I hope she feel better soon and gets some answers and treatment.

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