Knee pain is a very common problem, mostly occurring later in life but problems with your knees begin earlier than you think.
It is common for pre-teens and teenagers to engage in more than 10 hours of sports in any given week.
Whilst this has many health benefits, with increased frequency and intensity of participation there also comes the risk of injury. This is due to various growth factors unique to this age group such as adolescent growth spurts, non-linearity of growth of bone vs muscle and responses to injury.
This is compounded by still-developing biomechanics, body awareness, and sport specific skills. Younger athletes are more likely to injure bone and joint cartilage and are susceptible to avulsion injuries. Two common reported pediatric injuries include Osgood-Schlatter’s lesion affecting the knee and Sever’s disease affecting the ankle.
Osgood-Schlatters is an inflammation of the bone, cartilage, and/or tendon at the top of the shinbone where the tendon of the kneecap attaches. This results in a pain in the bone below the knee cap aggravated by exercise.
It is very common during adolescent growth spurts with young athletes in jumping and running sports due to their repetitive knee extension movements. There is often tightness in surrounding muscles, particularly the quadriceps.
It is a self-limited condition that often settles when bony fusion in the problematic area occurs. Reduction and modification of the activity reduces pain but there is no need for complete rest from sport. Symptoms can be managed by local icing. Tightness of the quads often contribute to this condition so should be addressed through regular stretching/foam rolling and muscle strengthening as pain allows.
The main characteristic of Sever’s Disease is heel pain in the developing athlete. It was originally thought as inflammatory in nature but MRI findings suggest that similarly to tendinopathy is a non-inflammatory chronic injury to the bone.
Pain is related the to level of activity and there is local tenderness and swelling at the insertion of the achilles tendon. Often there is associated calf tightness with limited range in the ankle joint.
Management principles dictate activity modification to reduce pain. A heel raise shoe insert or orthotics are often useful along with correction of incorrect biomechanics. Like Osgood’s it is a self-limiting condition that often resolves itself after 6 to 12 months but with specific exercises assisting with symptom reduction. Calf strengthening and stretching form the basis of the home exercise program.