Growing pains in the knee

November 11, 2019

One of the most common presentations we see in the clinic with adolescents is pain at the front of the knee. This is particularly common with active kids and kids who go through a rapid growth spurt. Many of us just attribute it to growing pains but what many don't understand is that in a  lot of cases it is very manageable and with a few simple steps the pain can resolve or at least be reduced significantly.

 

 

So what are growing pains around the knee? The most common form is called Osgood-Schlatter's syndrome. It's a condition that was discovered (or at least named) in 1903 and consists of a minor separation of the epiphysis at the tibial tuberosity. This is caused by overloading of the patellar tendon at its attachment at the tibial tuberosity.

 

It is characterised by pain in the front of the knee which can often be pin pointed to the tibial tuberosity which is worse with activity, particularly activities that load the knee in flexion such as running, jumping, hopping, dancing, waking up/down hills, lunging and squatting etc.

 

A health professional can usually diagnose Osgood-Schlatter's quite simply and quickly but there are other issues that can present with similar symptoms such as patellofemoral pain syndrome, Hoffa's fat pad impingement, patellar tendinopathy, meniscal injuries, osteochondritis dessicans which all require different management so an accurate diagnosis is important. I would encourage anyone who has pain at the front of the knee that hasn't settled in 2-3 days to consult a health professional to get an accurate diagnosis and management plan.

 

What causes this separation of the epiphysis at the tibial tuberosity and why is it worse when we grow? As we grow our bodies lay down new bone cells at the epiphyseal plate (growth plate) which is a thin strip of cartilage which separates the epiphysis (end of the bone) from the diaphysis (shaft of the bone). This lay down of bone cells is triggered by hormonal influences in the body and is what enables bones to get longer and us taller. The only problem with this is that the muscles aren't afforded the same luxury so as the bones grow, the muscles are stretched. Over time as the muscles are stretched out they eventually catch up but when we go through rapid periods of growth such as during a growth spurt these muscles can become tight. This tightness leads to increased tension on the tendons and their attachments. Couple this with active kids, particularly those that play a lot of running and jumping sports and the epiphysis at the tibial tuberosity gets overloaded and becomes inflamed and in some cases separates.

 

How do we manage Osgood Schlatter's syndrome? The first thing we want to do is reduce symptoms. Some simple things to do are reduce the load on the tendon are modifying the activities that you do, this might mean taking a rest from aggravating activities or just doing less of them, icing when the knee is sore, taping the patellar tendon and anti-inflammatory medication can also help. Once the symptoms have reduced to a manageable level it's important to stretch out the tight structures around the knee such as the quadriceps, calf and hamstring muscles. These stretches need to be pain free and the intensity of the stretch gradually increased over time. And finally a structured strengthening program is important to build the resilience of the tendon and bone.

 

Generally speaking Osgood Schlatter's syndrome is a self limiting condition, in that it fully resolves when (or before) the growth plate fuses. The time it takes for this to happen however can vary greatly between individuals, some people may have symptoms for years while others only weeks. There are also rare circumstances where the separation at the epiphysis becomes too great and surgery is the only option to fuse it back together.

 

My experience with Osgood Schlatter'ss syndrome is those who take a proactive approach, seek treatment and are compliant with their rehabilitation recover much quicker and are able to manage their condition with minimal down time. Getting physio twice a week for 2-3 weeks is all it takes to reduce symptoms and have a plan in place to manage the condition moving forward.

 

 

TAKEAWAYS:

  • Early diagnosis and treatment plan is essential

  • Most patients can manage to continue with activity of choice

  • Reduce symptoms by icing, taping, massage and anti-inflammatories

  • Stretch and strengthen the surrounding muscles once symptoms are manageable

  • Don't stress, it will get better!

 

 

 

 

 

 

 

 

 

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