Young athletes and children involved in frequent sports activity between the ages of 10 and 15 commonly suffer from anterior knee pain.
Osteochondroses are non-infectious derangements of bony growth at various ossification centres. These derangements occur during the period of greatest developmental activity and affect the epiphyses (the rounded end of a long bone).
There are two very common osteochondroses: ‘Jumper’s Knee’ and ‘Osgood-Schlatter Disease’, which can cause knee pain and discomfort, accompanied with some swelling in the area below the patella (see the diagrams below).
Image of knee structure and inflamed patellar tendon (1,2)
What is ‘Jumper’s Knee’? (Infrapatellar Tendinitis)
It is an overuse injury to the patellar tendon at the attachment to the lower pole of the patella (see the diagrams above).
Knee pain with infrapatellar tendon tenderness in physically active children is caused by an overuse that typically affects children between the ages of 10 and 13.
The cause is thought to be trauma due to excessive traction by the patellar tendon, leading to microvascular fractures.
Knee pain is most exaggerated when straightening the knee against force (for example, climbing stairs, jumping or doing knee bends).
What is ‘Osgood-Schlatter Disease’?
Osgood-Schlatter Disease occurs between 10 to 15 years of age and is usually unilateral. Although it is more common among boys, this is changing as girls become more active in sports programs.
The cause is thought to be trauma due to excessive traction by the patellar tendon on its immature epiphyseal insertion, leading to microvascular fractures.
When children reach their teens, they begin a time of rapid bone growth, especially in their femur and tibia. The bones eventually determine how tall the person will be. Most of the time, muscles, fascia and other connective tissue in the legs can easily keep up with the accelerated growth rate. When quadriceps muscles are particularly taxed through demanding athletics, the combination of stresses can cause irritation and inflammation. Tendons can pull away from the bone, causing a variety of tendonitis. In severe cases, it is common to have a permanent bump below the knee.
Characteristic symptoms are knee pain, swelling and tenderness. There is no systemic disturbance.
Treatment for both conditions
Resolution is usually spontaneous within weeks or months, depending on the level of sports activity. Pain is treated with avoidance of excessive exercise, especially deep-knee bending. Complete avoidance of sport is unnecessary.
ICE application, physical therapy, taping/strapping of the knee with kinesiology bands applied by a physical therapist or using a knee support cuff during the acute flare-up will help to stabilise and to support the painful knee area.
After the acute episode:
continuous physical therapy, providing sports massage to all muscle groups related to the thigh and lower leg area, and correct stretching before and after a sports event is appropriate management to tackle the anterior knee pain in adolescent athletes.
Hydrotherapy application to hypertonic /painful muscles:
Hot (skin bearable temperature) compress before physical activity to relax the muscles.
Cold compress after the physical activity. Be aware of prolonged application of cold packs, which can reduce sensation in the area. A cold compress also has a good hypoalgesic effect to tackle pain.
References for Images:
Knee Tendonitis Information and Treatment Advice – iTendonitis.com [Internet] [cited 25 August 2011].Available from: http://www.itendonitis.com/knee-tendonitis.html.
Patellar Tendinopathy – EmpowHER.com [Internet]. [cited 25 August 2011]. Available from: http://www.empowher.com/media/reference/patellar-tendinopathy.