A Real Pain in the Knee
We all like to encourage our children, particularly our adolescent children, to get out and get involved in sports. There’s no doubt that athletics teach teamwork, help keep kids fit and keep them busy. However, the downside is that sometimes a child’s growing skeleton can’t quite keep up with the demands placed on it by the sport.
More and more doctors are reporting instances of knee pain in young athletes, most commonly ages 9 to 14. This condition, called Osgood-Schlatters after the doctors discovered it, is highly treatable but can be very uncomfortable while it is active.
Thirty years ago, these pains were often dismissed as just “growing pains,” says Terry Robinson, owner of Grapevine Physical Therapy and Sports Medicine in Grapevine, Texas. However, in today’s more competitive school sports world, pain that limits activities can become a real problem. This is when kids, parents, and coaches search for ways to treat the condition while keeping the athlete on the field.
What is Osgood-Schlatters?
Osgood-Schlatters is a condition where the bony protrusion below the knee (called the tibial tuberosity) becomes inflamed. The tendon that covers the patella inserts here and, through overuse, can tug away at the bone, causing inflammation. When new bone grows back, it often causes a bony lump. It most commonly affects males, but more female athletes are reporting problems as well.
According to Dr. Hank D. Bratt of Children’s Orthopedic Specialists in Tucson, Ariz., what happens is simply that the tendons can’t keep up with bone growth because, at this age, bones grow so quickly. As a result, the tendon gets stretched too often, and pain results.
“This can happen to any part of the body where you have a major tendon attaching to a growing bone, but when it occurs in the knee, we call it Osgood-Schlatters,” says Dr. Bratt.
The primary symptom of Osgood-Schlatters is pain during exercise and when you touch the affected area under the kneecap. The pain tends to get better with rest. Other symptoms are swelling below the kneecap or a bony protrusion in the same area, and weakness in the quadriceps.
Kyle Edmiston, 15, had Osgood-Schlatters so severely a couple of years ago that his mother, Autumn, can still feel the bony protrusions – and he still has a limited range of motion. “He’ll never play football, that’s for sure,” Autumn says, laughing. “He could never crouch down with the other players.”
“The important thing to remember about Osgood-Schlatters is that it is self limiting,” says Dr. Bratt. “Therefore, we don’t want to do anything that will make the patient worse, even in the short term. This is why neither surgery nor injections are commonly used for this condition.”
It is fairly easy to prevent this problem from progressing to a point where the athlete has to stop their activities completely. But, first, the pain and swelling need to be treated, and special exercises are added to the athlete’s routine to keep the condition from worsening.
The first step is to treat the pain and swell with an over-the-counter anti-inflammatory such as ibuprofen. This ingredient is found in several medications, like Advil® and Motrin®. Ice can also help control the swelling. If the pain is bad, the child should rest and refrain from activities until control. Both Robinson and Dr. Bratt agree that a good rule of thumb is not to do anything that makes the pain worse or unbearable.
Although physical therapy isn’t always recommended or necessary, it can help ease the symptoms so the athlete can return to sports more quickly and safely.
My daughter, Wende, had Osgood-Schlatters three years ago at the same time as her classmate, Kyle Edmiston. Our doctor recommended physical therapy, which Wende went to for six months. In the Edmistons’ case, their insurance wouldn’t cover physical therapy, so they just took their doctor’s advice and treated the pain and swelling with ibuprofen and ice, and Kyle did extra stretching exercises before soccer. Today, Kyle still has occasional problems, whereas Wende is relatively pain-free. Whether physical therapy can be credited for that or not, it certainly helped Wende manage her pain during the softball season.
Terry Robinson says the most important aspect of physical therapy is patient education, which may include the parent and coach. “It doesn’t do any good to put the child in treatment and modify his sports routine if he’s going to go home and sit on the floor with his legs crossed to play video games,” says Robinson. “In addition to treatment, we make them aware of what other activities can impact the healing process.”
As for braces, Dr. Bratt says that while they don’t hurt, they don’t help either. “They’re not prohibitively expensive, so if they want to try them it’s OK, but there’s no real evidence that they make it better,” he says. “However, if it makes the child feel better, whether it’s physical or psychological, by all means, have them wear one.”
It’s also a good idea for the child to protect their knees during sports by wearing a soft kneepad, such as the type worn in volleyball. This will protect the painful area from being hit by a blow from a ball, another child, or a fall, making it worse.
In the end, the only real cure for the condition is time. After that, all children will outgrow it, and the pain will go away as their tendons catch up to their bone growth.