Sunday, April 18, 2021

Does Your Growing Child Have Knee Pain?

Recently, we have seen some young athletes in our clinics, complaining about pain after playing sport. I've written about growing pain in young children/ athletes before. When these children/ athletes are having a growth spurt during adolescence, the long bones grow faster than muscles. The muscles take a while to lengthen so the muscles tend to pull on the attachments on the bone.

This is especially so when a child is active, the muscles will pull on the bony attachments where the muscles attach causing pain (also known as apophysitis).

An area of pain at the knee which is common in children is known as Osgood Schlatters disease (OSD). The pain is located where the patella tendon finishes at the tibia, known as the tibial tuberosity.

Researchers from Denmark studied 51 youth athletes (51 percent female) between the ages to 10 to 14 with OSD. The youths already had pain for an average of 21 months.  Intervention consisted of four visits with a physiotherapist with both child and parent. The first block of treatment focused on decreasing load through decreased activity, education and static hold exercises.

The next block the subjects progressed to exercises which led to a return to their sport. Follow up was done at 4,8,12, 26 and 52 weeks. 

All subjects showed improvement at 12 weeks (study endpoint) with less kids complaining of pain and increased function and quality of life. 31 percent of subjects still suffered from discomfort at 12 weeks, discomfort that they would be not happy to live with, while 80 percent were very satisfied with their treatment results.

Only 16 percent of the subjects managed to return to their sport (RTS) at 12 weeks, compared to 69 percent at 52 weeks follow up. Thigh and hip abduction strength which was the focus of the exercise interventions improved significantly by 12 weeks as did vertical and horizontal single leg jumps.

At one year follow up, only 5 percent of subjects were very unsatisfied with their progress and unable to return to sport.

The study called for significant restrictions (guided by pain/ symptoms response) at the start of sporting activity to decrease load on the tibial tuberosity. Data from the tracking device the subjects wore prior to start of the study to the first block of treatment showed a decrease of 15 minutes per day of moderate to vigorous activity. This may suggest that getting active kids to slow down is difficult. 

Parents may need to explain to the child that activity modification is key to reducing symptoms. Reining in the kids in the short term will help return to sport sooner.

Surprisingly, the tracking devices showed that activity levels decreased by 37 minutes per day by week 12, suggesting that although many reported feeling better and can do more, they were actually less active.

We usually do not encourage stretching the affected muscle as static stretching can place more traction forces on the tendon insertion on the bone. Correct strength training that is pain free often helps to take the load off the tendon attachment. Meaning the weight does not have to be heavy. Elastic bands are very useful too when the young patients cannot handle the weight.

Please come and see us in our clinics if your young and teenage athletes need help.


Rathleff MS, Winiarski L, Krommes K et al 92020). Activity Modification And Knee Strengthening For Osgood-Schlatter Disease: A Prospective Cohort Study. Ortho J Sp Med.6(4): 2325967120911106. DOI: 10.1177/2325967120911106

*note that OSD or Osgood Schlatter's disease is not a disease. It is named after Robert Osgood (1873-1956) and Carl Schlatter (1864-1934), an American and Swiss surgeon respectively that described the condition concurrently.

No comments:

Post a Comment