LOADS of great information for those of you who have children suffering from knee pain. Thanks Anh from Smart Health Training and Services!
Is your child complaining of pains in the front of their knee that gets worse when they run, jump, hop or skip typically involved in sports like basketball, running, netball, tennis or even dancing? Is there swelling and tenderness over the area where the patellar (knee cap) tendon is attached to the top of the tibia (shin bone)? Your child may have a condition called Osgood Schlatters Disease.
It may sound like a weird disease but Osgood Schlatters Disease (OSD) is a common overuse injury of the knee joint affecting adolescent children ranging from as young as 9yrs old to 16 yrs old. Most literature will say that it is more common in boys than girls and can be prevalent anywhere between 13 to 21 percent of sporting adolescents depending what you read. It is thought to be related to repeated traction forces on the patellar tendon insertion over the immature shin bone by the quadriceps (thigh) muscle causing inflammation to the tendon and possible micro fractures to the bone. Over time and with persistent irritation from activity, a painful boney lump may also appear. Fortunately this does not lead to any long term issues or impairment for the child.
Typically the child may complain of some intermittent niggling pain on the front of their knee initially during sports but can usually continue with the activity. However, this may quickly change to them complaining of severe pain the more they do the activity and eventually tears because it is too painful and they have to stop completely.
There are a number of factors involved in the development of this overuse injury in sporting adolescents. A common factor is rapid growth spurt in adolescents during period of activity. The soft tissues (muscle, tendon, ligament and fascia) are always playing catch up with a quicker growing skeletal system consisting of long bones in their legs. This imbalance can lead to tightness, especially in the quadriceps (thigh) muscles and can place extra strains on its attachment on the long bones. In my opinion, the biggest factor is over training or too much sport. Some children are involved in more than just one sport at a time and may train or play over five times a week! That can be a lot of load and pressure placed on a developing musculoskeletal system. Other factors may involve poor lower leg mechanics such as feet collapsing in unsupportive shoes or even poor technique associated with the activity, both of which can place extra strains on the front of the knee.
Treatment for this condition usually involves rest, ice and or anti-inflammatories to settle the pain and swelling initially. Resting from activity appears to be the hardest for the child to understand or accept, but it is the most critical in my opinion, especially in the acute phase. For milder cases, a simple modification to their training loads may be sufficient to allow the child to participate in sport without continual irritation to the knee. It is a matter of finding a good balance. A good muscle stretching and self releasing exercise program is paramount and any abnormal mechanical factors should also be addressed. I find taping or using a patellar tendon strap quite helpful in unloading the patellar tendon for some children.
Fortunately, this condition is self limiting, especially around the time the child stops growing or stops aggravating it through sport. There are other serious conditions that may also cause anterior knee pain and if in doubt, please consult your general practitioner or health professional for an assessment and advice.
Anh Vo is a father of two and a Physiotherapist at Smart Health Training & Services.
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