Knee Pain in Children and Adolescents (A 3-part series)

KIM’S KORNER

[dropcap]K[/dropcap]nee pain is a common problem and does not discriminate.  Although more prevalent in adults— afflicting women more than men— it can affect children.

Knee pain can be due to many factors, from injury to osteoarthritis, with many other causes in-between.  Over the next few weeks we will look at the more common causes of knee pain, risk factors, management and treatment.  This time around we’ll concentrate on musculoskeletal pain. If pain is associated with fever, swelling and difficulty walking then you should consult your doctor. This week we will look at knee pain in children and adolescents.

There is debate as to whether growing pains really exist; some experts believe pain in the legs is caused by too much running, jumping and climbing, which makes sense considering what children do naturally.   Others believe pain is caused by the different rate at which our muscles, tendons and bones grow. Bones grow faster, putting pressure on the muscles and tendons.  However, there is no evidence to support the theory of growing pains.

Signs to look for:

• Aching in both legs, particularly the thighs, shins, calves and behind the knees (not in the knee joint)

• Occurs at night

To relieve symptoms most professionals recommend warm baths, massage or paracetamol.

Osgood schlatter commonly occurs in children and adolescents, especially during growth spurts or in those who participate in sports that involve running, jumping and rapid changes of direction.  However, unlike so-called growing pains the source of pain is isolated to just below the knee with distinct symptoms: pain and swelling on the bony nodule just below the kneecap; pain increases with activity but eases with rest; tightness in the quadricep and hamstring muscles. The aim of home treatment is to reduce pain and swelling. Anti-inflammatory medications can help as well as the following protocol:

Protect: Either use a brace or patella immobilizer to take the pressure away from the insertion of the tendon when moving or walking around.

Rest: Where possible, avoid any activity of sport that causes pain. This can range from a few weeks to a few months and varies between individuals.

Ice: Applying ice for 20 minutes every two to three hours can help to reduce swelling and relieve pain. Reduce frequency as pain and swelling subside.

Elevate: Whenever possible sit with your leg raised, this also helps to relieve swelling.

Chondromalacia patellae (runner’s knee) is a condition mainly affecting young people and athletes, especially those that run.  It’s a condition where the cartilage behind the patella (kneecap) degenerates and softens.  The patella is designed to slide in a groove at the front of the knee and its function is to lessen the effort of the quadriceps when straightening the knee. Failure of the kneecap to slide smoothly in the groove of the femur can be caused by muscle imbalances and weakness of the adductors, quadriceps and hamstrings; repeated stresses caused by activities such as running and jumping; direct injury to the patella.

Pain is often felt at the front of the knee and is usually aggravated by activity or by sitting for a long time.  Management is focused on correcting the alignment and tracking of the patella.  Strengthening of the inner quadriceps and stretching of the hamstrings is usually effective in providing relief.

Juvenile arthritis: Yes, children can get arthritis, too.  It is not known what causes JA but it is thought to be genetic. If your child complains of pain and stiffness in both knees first thing in the morning or after resting, rather than after strenuous activity, it may be arthritis. Unlike some of the above conditions, JA tends to occur for no apparent reason and often eases with activity as the day progresses.  Pain and stiffness can affect the range of the knee joint and also cause weakness. You may notice that it’s difficult to straighten the knees and also to squat. Walking may also be affected.

Physiotherapy can relieve symptoms and improve function in children and adolescents.  A thorough assessment will identify any aggravating factors such as altered biomechanics, poor posture, muscle imbalances, weakness and tightness. The primary aim of treatment will be to relieve pain, reduce inflammation and provide a strengthening and stretching exercise program that may include:

• Massage—to relax muscles

• Joint mobilizations—to reduce joint stiffness and pain

• Electrotherapy—for pain relief and to reduce inflammation

• Stretching and strengthening exercises

• Posture re-education

• Movement analysis

Physiotherapy has been proven to provide relief from symptoms and to speed up the return to activity and sports.  Next week we will look at knee ligament injuries usually associated with sport and trauma.

Kim Jackson is a UK-trained physiotherapist with over 20 years of experience. She specializes in musculoskeletal pain and dysfunctional, including back pain and sciatica, stroke and other neuro conditions, plus physiotherapy. She has worked with local, regional and international athletes and teams, treating injuries and analysing biomechanics to improve function and performance.

Ms Jackson is registered with the Allied Health Council and is a member of PASL. She currently works at Bayside Therapy Services in Rodney Bay.

www.baysidetheraphyservices.com