Common knee pain in children
Often we associate knee pain with getting older or a high impact sporting injury. It’s not always the case. Yes, our little mates can get very sore knees too! Be aware that children with reoccurring knee pain will tell you repetitively that there is pain in their knees. They will also begin to refuse activity which aggravates the pain and makes it worse. If this is happening in your child have a closer look at the two most common causes to childhood knee pain below.
1) Osgood Schlatters Syndrome
Have a look at your child’s knee. Locate the knee cap and follow the tendon the knee cap sits within down to the leg bone. Where it inserts is a little bump. This bump is called the tibial tuberosity. Pressing on this area will be extremely painful for a child with Osgood Schlatters. You may also notice the bump looks swollen. Your child will be extremely hesitant to do any jumping, running or extra load type activity.
When your child is very little the tibial tuberosity is mostly cartilage. As they enter the stage where that cartilage changes into bone they are more likely to be at risk to getting Osgood Schlatters. Girls tend to be within the age of about 8-13 and boys from about 11-14 year old. The reason is that the tendon the knee cap sits in also has origins to the thigh muscles above the knee cap. These muscles called the quadriceps group are responsible for propelling and dynamic movement through the knee. As the quadriceps activate they cause tension in the muscle, down into the tendon and further along into the tibial tuberosity where the tendon inserts. If there is too much force/tension the tibial tuberosity will become traumatised. The tendon will pull the tuberosity from the leg bone via tiny little fracture points in the cartilage to causing rapid boney bruising. Ouch!
Osgood Schlatters syndrome is not always caused through load mechanics as above. It can begin during a Growth Spurt! Bone tends to grow first and quicker than muscle. If your child already has shorter tighter muscle group (quadriceps) sitting over the thigh bone (femur) this will be the perfect environment for Osgood Schlatters. The bone grows rapidly. The muscle can’t absorb the extra tension, so it will pull from its origins and insertions into the bone. Because the tuberosity is not yet solid bone it is a weaker insertion point and will therefore become injured.
2) Patellofemoral Syndrome
Beneath your child’s knee cap there is a matching groove between the thigh and leg bone that accommodates the shape of the underlying knee cap. This groove allows the knee cap to glide back and forth along it during movement. In Patellofemoral syndrome the knee cap wont glide symmetrically through that little groove our body has so carefully designed for it. While knee cap will still move back and forth along the knee joint, it sits slightly to one side of the groove. Each movement will repetitively injure the surfaces below the knee cap. Movement like this will cause trauma and swelling. It can occur in both Children and Adults.
Muscular imbalance and poor mechanics in load during walking/running are the most common causes for Patellafemoral syndrome. The quadriceps group is made of 4 muscles that insert into the patella (knee cap) tendon which then makes its insertion into the tibial tuberosity at the leg. When the knee cap tracks to the outside of the leg there is likely to be a weak VMO (vastus medialis) at play. This means the muscles on the lateral thigh (outside region) are more powerful and overtake the direction in movement of the knee cap as it passes across the knee joint. Lateral tracking issues are more common in Patellafemoral syndrome than having a medial track of the patella.
How to help your child
In both knee pain cases above Rest should occur in the initial phase of pain. You can use Ice packs for 10 minute intervals, alongside some anti-inflammories such as Nurofen. After 48 hours change to heat bags to the knee instead of Ice. Once completing one week of rest (no sports) from activity its time to begin to manage load through the knees to aid in strength and reduce pain.
Poor foot mechanics does often contribute to the pain felt at the knee. Orthotics are recommended alongside a daily strengthening and stretch program to help reduce the pain. Have a look at our kidzoles shop for an orthotic for your child. For those children higher than a size UK 4.5 the Grey MEDIUM ARCH SUPPORT lifesoles range is recommended.
Strapping should be applied directly to the knee to aid in relief. Different techniques are used for either syndrome. With Osgood Schlatters syndrome we use sports tape horizontally over the tibial tuberosity to apply compression. With Patella femoral syndrome the McConnels taping technique is recommended.
Stretch and Strengthening exercises are the most important component for long term management of knee pain. For more information on appropriate exercises please don’t hesitate to contact me via our contacts page.
It is always recommended you see a Allied Health therapist where pain persists beyond these treatment strategies.