Knee Pain In Preteens (Osgood-Schlatter Disease)

CONDITION

Osgood Schlatter's is a condition in which pain, swelling and enlargement occur where the tendon from the kneecap (the patellar tendon) attaches to the shinbone (tibia) (Figure 1). An area of cartilage sandwiched between immature shinbones (the growth plate) gets pulled on by the powerful thigh muscles during running and jumping activities and becomes injured. The condition usually occurs in preteens and early teens during rapid height gain.

Figure 1.

CAUSES

Injuries are usually the result of overuse, especially during a rapid growth spurt and may result from:

• a sudden increase in intensity, duration or frequency of sports or exercise
• beginning a new sports activity, especially an activity involving running and jumping
• frequent bending and squatting
• kneecaps that are higher or lower than normal, knock knees or flat feet
• tight hamstrings (the large muscles over the back of your thigh), tight quadriceps (the large muscles over the front of your thigh) or tight calf muscles and tendons.

SYMPTOMS AND SIGNS

• You will have pain and swelling over the tendon below the kneecap where it attaches to the shinbone.
• Sometimes you will notice that it feels like there are small bones within the painful area.
• Your symptoms usually develop and worsen slowly during and after overuse activities such as running, stair climbing, squatting and jumping.
• Occasionally, your symptoms can develop after you fall on the front of your knee.
• At first, symptoms may occur only after activities that cause them, but as the condition worsens, you will have symptoms during those activities.

WHEN TO CALL YOUR DOCTOR

Call your doctor right away (day or night) if:

• You have severe pain, swelling, redness or warmth in your knee, especially after an injury.
• You can't bend or straighten your knee after an injury.
• You have significant knee weakness after an injury, especially when you try to straighten your knee or go down stairs.
• You can't put weight on your knee after an injury.
• You heard or felt a loud pop during an injury.
• Your knee feels swollen like a balloon.
• You hear crunching that occurs with pain when you try to move your knee or to walk.
• Your knee gives out, buckles or gets locked, or something catches in the joint when you try to walk after an injury.
• You have numbness, tingling or loss of sensation around your knee or anywhere below your knee after an injury.
• You are younger than 15 years old and have a limp with knee and/or hip pain.

Call your doctor during regular office hours if after an injury:

You have mild pain and swelling that persists after trying the self-care measures listed below but:

• You have no warmth or redness around your knee.
• You can bend your knee well.
• You can put weight on your knee and leg without causing a lot of pain.
• Your symptoms worsen at any time or fail to improve.

SELF-CARE AT HOME

Anyone under 15 years old with knee pain and/or swelling that interferes with activity needs to be evaluated by a doctor and should not attempt the self-care measures recommended below. Avoid using any medication to control symptoms until you have been seen by a doctor. You may consider these things before seeing your doctor:

• Avoid any running, jumping, twisting or kicking until your knee has been evaluated by a doctor.
• If you have pain or a sense of buckling when you try to walk or put weight on your knee or leg, use crutches to take all the weight off your injured knee.
• If it hurts when you try to bend your knee, hold it as straight as possible or in the most comfortable position you can find until you see your doctor.
• Elevate your injured knee as often as you can by placing it up on a couch or chair when you are sitting or lying down.
• Place an ice pack or cold pack directly over the injured area of your knee.
• Use a snug elastic wrap or sleeve around your knee to help minimize swelling until it improves greatly or goes away entirely.
• Because most over-the-counter knee braces do not help stabilize your knee very well, don't wear one without advice from your doctor.
• Neoprene or elastic knee braces with a hole for the kneecap and a "doughnut" pad around the hole sometimes reduce pain in the front of the knee.

For signs and that are mild and do not interfere with activity, you may try home measures at first, but see your doctor if symptoms worsen or do not improve significantly within two to three weeks.

• Rest from all activities that cause symptoms until your knee symptoms resolve. Avoid running, jumping, squatting and climbing stairs. Do quad sets (Figure 2) to keep your thigh muscles strong while your knee is recovering.
  • Sit flat on the floor with your legs straight out in front of you. Place a soft ball or pillow underneath your injured knee. Lift your lower leg until your injured knee is fully straight. Tighten your thigh muscles for three to five seconds, then slowly lower your leg back to floor. Repeat 10 to 15 times and do two to three sets daily
  • If the exercise above causes knee pain, you may perform modified quad sets. Keeping both knees and legs flat on the floor, tighten the thigh muscles of the injured leg and press the leg directly downward "into" the floor for three to five seconds. Gradually make contractions harder and repeat 10 to 15 times. Do two to three sets daily.

Figure 2.

• Stretch your hamstrings, quadriceps and calf/heel tendons daily for 20 to 30 seconds, two to three times each.
  • Hamstrings: Lie on the floor on your back. Straighten your leg and place a towel or a piece of rope around your foot and pull your leg toward your head (Figure 3) until you feel a stretch over your injured hamstring.
  • Quadriceps: Stand beside a wall to brace yourself with the hand on your uninjured side. Bend your injured leg so that your foot is behind you. Reach around with the hand on that same side and grasp your foot (Figure 4). Pull your heel toward your buttocks until you feel a stretch in the front of your thigh muscles.
  • Calf and heel tendons: Take the position in Figure 5. Keeping your back leg straight, lean forward toward the wall. Feel the stretch in your calf muscle.

Figure 3.		Figure 4.		Figure 5.



• Avoid taking medications such as ibuprofen (Advil® or Motrin®) or acetaminophen (Tylenol®). You don't want to cover up the resolving pain at your growth plate that will help you know when you are getting better.
• Place an ice pack or cold pack directly over the injured area of your knee. You can hold it in place with an elastic wrap.
  • Use the cold pack for 20 minutes at least three times daily or more often if needed to reduce pain and swelling.
  • If you are not wearing an elastic wrap directly over your skin, place a thin washcloth between the cold pack and your skin to reduce the risk of frostbite.
  • If you are busy, you may choose to ice during meals so as to save time and avoid interrupting other activities.
• Once your soreness and swelling starts to get better, you may try riding a stationary bike (using low resistance) for 10 to 20 minutes daily or every other day.
• If your knee starts to feel normal within one to two weeks, you may attempt functional drills to see if you are ready to start sports or regular exercise again. You may progress through a series of drills by completing each one pain-free. If you have symptoms with a drill, stop and try again in a day or two.
  • Jog a straight 50-yard line at about 50-percent intensity.
  • Run a straight 50-yard line at 75-percent, then 100-percent intensity.
  • Using the same intensity progressions, run a straight line and progress through 45-degree and then 90-degree cuts to the right and to the left.
  • Then, run a large or "loose" figure-of-eight path and gradually make it smaller or "tighter" and faster with repeat attempts.

When you can do all of these drills pain free, you can try sports-specific activity. When you return to specific sports or exercise activity, at first try sports-specific drills or exercise at only 50-percent intensity and in a noncompetitive setting.

PREVENTION

• Regular exercise that strengthens the muscles around your knee and keeps your weight down can help prevent knee injuries and swelling.
• A regular stretching program that focuses on the hips, legs and ankles can help prevent some knee injuries. Hamstring stretches are especially important during rapid height gain.
• Avoid sudden changes or increases in exercise or sporting activities.