Tel: 01 283 4303There are common causes of knee pain in children but it can be difficult to determine which aches and pains need medical attention and which they may “grow out of”.
Osgood Schlatters
A common cause of knee pain, particularly in boys, is Osgood Schlatters. Your child may complain of pain and tenderness below their knee cap and could recently have had a growth spurt. The pain is due to irritation of a ligament, called the patellar ligament, which connects the kneecap to the shin bone. This is sensitive to touch and your child may have pain with walking or jumping activities or on the stairs.
The initial treatment for Osgood Schlatters is “RICE” Rest Ice Compress Elevate which can help ease pain symptoms. Symptoms usually subside when the growth spurt ends…unfortunately this could take 1-2 years! Gentle stretching of the quadriceps muscle is also advised as it can reduce the tension on the patellar tendon. It is also important to consider lower limb biomechanics and gluteal/ hip muscle strength and intervene with Physiotherapy treatment where necessary to help accelerate the healing process.
The Mayo Clinic offers more detailed information about Osgood Schlatters.
Knock knee resulting from weak hip muscles
Teenagers, girls in particular, may complain of a generalised aching around their knees with no history of injury. This could be caused by numerous factors. However, this patient population often have weak muscles around their hips. This changes the biomechanics around the knee, giving a “knock kneed” appearance. When you walk or run with your knees in this position it places increased pressure on the inside of the knee which can cause pain. A strengthening programme for the gluteal or hip muscles is necessary to correct the lower limb alignment and relieve the pressure on the knee.
This pressure may also come from “flat feet” which can also cause the knees to turn in. A physiotherapy assessment to determine the source of the problem is recommended. Physiotherapy management can include local treatment to the knee to relieve pain, advice about an exercise programme and or shoe orthotics, if required.
Dislocation of the kneecap
Also known as patellar dislocation, is a common injury in children and is associated with a fall or with jumping/ twist activities. The knee will be quite swollen and it can feel like something is “popping out”. Most first time dislocations are treated conservatively i.e. no surgery. Patients are treated with the RICE principles initially then a strengthening programme for the quadriceps and gluteal/buttock muscles is essential for treatment but also to prevent reoccurrence.
Limp or dragging leg
Most knee pain is related to structures in the knee becoming irritated or injured in some way. However, occasionally pain can refer from other sites such as the hip which can manifest as knee pain. Some boys between the ages of 12-14 can develop a limp. This is usually a pain free issue which can result in dragging of the leg behind them. There is no history of trauma but they can complain for an aching around the knee. In this case a slipped upper femoral epiphysis should be suspected. This is a small fracture in the hip joint but can present with knee pain. The joint should be X-rayed and treatment may involve the insertion a small pin in the joint to stabilise it. Follow up physiotherapy can help with gait/walking re-education and strengthening work for muscles around the hip.
Persistent pain with unknown cause should not be ignored. If you suspect your child to be suffering from one of these conditions and you are concerned about their pain then the best thing to do is have your child examined by a healthcare professional.
By Katie Gill.
References:
Molony D, Hefferman G, Dodds M, McCormack D. (2006) Normal variants in the paediatric orthopaedic population.Irish Medical Journal. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16506683
Dr Yuranga Weerakkody and Dr Frank Gaillard. Slipped upper femoral epiphysis. http://radiopaedia.org/articles/slipped-upper-femoral-epiphysis
Brukner and Khan (2009) Clinical Sports Medicine.
Calmbach and Hutchens (2003) Evaluating Patient Presenting with Knee Pain . Am Fam Physician 68:917-22. Available from http://www.aafp.org/afp/2003/0901/p917.pdf
