Sports are back in 2022 (when the rain allows!), kids are back at school and there activity levels have likely been flipped on their head. Trading in the Playstation during lockdowns for the schoolyard and sports field now your child may now be experiencing pain limiting difficulties as they return to sport. A common joint for injury or overload during activity would be the knee joint; so what should we do as parents if your child is complaining of knee pain?
One of the most common causes of anterior knee pain in active children and adolescents is Osgood-Schlatter’s Disease (OSD). OSD is a condition where traction apophysitis occurs caused by repeated stress or force of the patella tendon on its attachment site of the tibial tuberosity. What does that mean? Essentially the tendon attaching your thigh muscle to your shin bone becomes inflamed and painful due to repeated pulling on its attachment site. OSD peaks in boys aged 12-15 years and girls 8-12 years. The theory behind this prevalence in adolescents is due to bone maturation and growth which occurs at this age. How this would present in your child is an enlarged painful lump under their kneecap just below the joint line at the front of their shin bone; it may occur one-sided or in both knees. This pain may be reproduced either by touch locally or bending and straightening the knee. With a recent increase in activities or sports with repeated jumping and running efforts coinciding with your child’s growth this may lead to overload/overuse injury and subsequent development of OSD [1,2].
Our Physio can provide advice and guidance as to what appropriate activity modification and rest means for your child. OSD is often encountered in young athlete’s whom participate in multiple sports; a shared decision of load management with the individual would be discussed together; identifying short and longer term goals and how rest or modification to their training schedules can be negotiated where their pain symptoms are managed appropriately and they still achieve their goals [2]. Physical therapy, strapping and or bracing can be utilised to address muscle flexibility and mobility impairments that be contributing to their symptoms. To decrease load on the knee, targeting quadriceps and hamstring muscle length via stretching can be a simple yet very effective management strategy [1,2]. Further progressive exercise therapy and strengthening of the lower limb and trunk can be incorporated to facilitate pain free participation in sport and exercise as your child grows [2,3]. Physiotherapy in addition to exercise prescription is able to address range of motion and strengthen the trunk/core and lower body in its correct position so that there is decreased load on the knees. In clinic, OSD is very rarely if not never seen in adolescents without aforementioned impairments such as poor core control or single leg stability.
What else should you know about OSD then? If my child has these symptoms what can you or Our Physio do about it? Prognosis and long term outcomes for OSD are great with 90% of adolescents symptoms resolving prior to adulthood. The unfortunate 10% occurs where the individual has not sought treatment or been compliant with recommendations. OSD may occur for up to 2 years awaiting bone maturation. Essentially a self-limiting condition that will not completely resolve until growth is completed. OSD can be managed conservatively with RICE (rest, ice, compression, elevation), appropriate activity modification and case dependent prescription of non-steroidal anti-inflammatory medications from your Doctor [2,3].
If you have any questions regarding OSD or any other knee condition and would like to discuss with one of the physiotherapists at Our Physio Central Coast; please contact (02) 4339 4475.
References
[1] Ladenhauf HN, Seitlinger G, Green DW. Osgood-Schlatter disease: a 2020 update of a common knee condition in children. Curr Opin Pediatr. 2020 Feb;32(1):107-112. doi: 10.1097/MOP.0000000000000842. PMID: 31714260.
[2] Smith JM, Varacallo M. Osgood Schlatter’s disease (tibial tubercle apophysitis).2019 Available: https://www.ncbi.nlm.nih.gov/books/NBK441995/
[3] Vaishya R, Azizi AT, Agarwal AK, Vijay V. Apophysitis of the tibial tuberosity (Osgood-Schlatter Disease): a review. Cureus. 2016 Sep;8(9).