Melissa Arca: Knee pain common among young athletes

02/14/2013 12:00 AM

02/26/2013 8:10 PM

Knee pain is a fairly common complaint among young athletes. And aside from an acute or traumatic injury, most adolescents who play sports regularly may at one time or another suffer from an overuse injury.

Add in the fact that when adolescents are going through their peak growth spurts, their tendons, muscles, joints and bones are all changing and growing at various times, not always in conjunction with one another. This is where Osgood-Schlatter disease comes in.

Osgood-Schlatter disease is not a disease at all. It's one of the most common overuse injuries in young athletes (observed in up to 20 percent of all young athletes), causing chronic knee pain during their growing years.

Symptoms: OSD is characterized by anterior knee pain, in the area just below the knee; at the place we call the tibial tubercle. It's the highest point of your shinbone.

Kids, typically between the ages of 9 and 14 (earlier for girls than boys), will complain of intermittent but persistent pain in this area, particularly if they play a sport that involves a lot of running, jumping or twisting. Think soccer, basketball, volleyball, football and gymnastics.

You may be able to feel a bump at this highest point of your child's shinbone and will elicit some pain if it is touched. The pain waxes and wanes over a period of 6 to 18 months and typically resolves completely once your child's skeleton is completely grown.

Causes: Because of the incongruous growth of tendons, bones, and muscles during pubertal growth, the patellar tendon (knee tendon) pulls on that tibial tubercle (highest point of shin) and through repetitive jumping, running or twisting can pull some of that bone away. That causes pain, swelling and inflammation that are exacerbated by vigorous physical activity.

Treatment: OSD is a self-limited condition that resolves with time and intermittent periods of rest, so conservative measures are the best treatment.

Pain control with a non-steroidal anti-inflammatory drug such as ibuprofen will help your child continue with his activity. More severe pain may need some periods of rest from the sport and a gradual return to play. Icing a couple of times per day, especially after exercise, is helpful in keeping swelling and tenderness to a minimum.

Physical therapy in the form of strengthening and stretching of the thigh (quadriceps) muscles will help reduce further injury and minimize pain. Sometimes, a protective pad surrounding that tibial tubercle will prevent that tender point from further injury during play.

What to expect: Most young athletes with OSD are able to play through the pain. While this is not recommended for most other sports injuries, in the case of OSD, it's usually just fine. We know that OSD will resolve on its own without any major sequelae (a secondary condition).

Red flags: OSD does not cause pain at rest, while sleeping or wake the child in the night. And it's not the result of an acute knee injury. Always check with your child's doctor, as a complete knee exam is necessary to make the diagnosis.

Having your child involved in a youth sport has tremendous positive health and emotional benefits. From being part of a team, gaining confidence in their physical abilities, and engaging in regular physical activity, sports are a great way to keep your child physically and emotionally healthy.

Just keep in mind that as kids are growing, we need to keep an eye on safety and prevention of injuries. While OSD may not be amenable to complete prevention, you can minimize risk for all types of overuse injuries by making sure your child stretches, plays at an appropriate level and always uses the safety gear involved with his or her particular sport.

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