Ah yes…anterior knee pain again! Our previous blogs on anterior knee pain were really well received, indeed knee pain injuries are a common occurrence for the patients we see each week in clinic. Recently due to the easing of restrictions and people being more active we have seen a rise in adult anterior knee pain cases. However we have also seen an increase in adolescent/teenage anterior knee pain also and we figured that it would be interesting to share what we see with anterior knee pain for ages 10-17, and the most common diagnosis. It might feel somewhat repetitive to our previous blog as we’ve covered management strategies, however we’ll also point out a really common issue that we see consistently, and give some ways to treat and prevent that!
Sometimes when a young teenager complains of sore knee’s, you might tell them “it’s just growing pains…run it off, you’ll be fine”. From a biological standpoint, that is indeed true – their musculoskeletal systems are still maturing. Their bones and muscles will continue to grow, and this is what causes “growth spurts”. This usually peaks from 12-14 years old on average, with girls typically maturing earlier than boys.
Hormonal changes create a cascade of processes which trigger the bones to start growing. This is when you would usually notice a pre-teen/teenager suddenly starting to become more adult-like. How long this takes varies between teenagers. Often this doesn’t impact a non-athletic background but if your child participates in sports such as football, rugby or swimming then growth related injuries can be more common.
After they’ve completed their growth spurt, they may start looking more adult-like, but essentially their muscloskeletal system has not yet fully developed!
This is because the muscles and tendons take longer for it to “catch-up” with the bone growth and this process can continue well onto after the growth spurt ends!
This mismatch between bone and muscle length creates increased tension where the muscle attaches to the bone. Often it’ll be fine as the muscle eventually catches up.
The problem usually starts if we start loading into the area with repeated sporting activities. Such as, sprinting, jumping at a high volume and/or intensity! This additional load going into the knee while its already being stressed from the growth process start making things hurt!
Bringing this back to the knee, the most common area that is affected is the attachment of the quadriceps to the shin bone known as the tibial tuberosity.
The medical term for this is Osgood-Schlatter’s disease (It sounds much worse than it actually is.) Essentially, this is a form of traction apophysitis/osteochondrosis – meaning the muscle attachments are pulling onto the “softened” growing bone.
⚠️ Generalised anterior knee pain
⚠️ Worse on load to the knee such as jogging/running and increased the higher the load such as sprinting/jumping
⚠️ A boney swollen projection below the knee-cap
The best method to treat Osgood’s is by following the advice listed below;
🎯 Icing the front of the knee for 10 minutes several times per day
🎯 Managing the load, by gradually reducing the overall training volume/load
🎯 Addressing any movement patterns that could contribute to anterior knee pain
🎯 Increase the flexibility of the quads and hip flexor muscles
🎯 Re-introduce strength and loading of the quads and hip flexor muscles as the pain naturally resolves
The last thing you’d want to do is to think that if its growth-related, why not wait till it’s over?
A wait-and see approach does not address the underlying deficits and will still remain after they’ve completed their growth spurt!
These growth periods can last for months at a time and it is almost impossible to predict when they end. Essentially it’s not realistic to ask these patients to stop doing what they enjoy doing! So the key idea we are advocating for here is to take an active role to get this better!
From what we’ve discussed earlier, we know that the muscle is slower to stretch compared to the growth of the bone and the training effect of exercise – meaning there is going to be a large emphasis on a program for muscle flexibility. This we’ve found to be especially lacking amongst our patients and their parents – either not doing the stretches correctly, or at an insufficient dosage and intensity.
With anterior knee pain, the quads are definitely king here – we covered this pretty extensively on how to stretch and strengthen the quad muscles in a previous blog.
One interesting thing we sometimes notice is that adolescents with anterior knee pain tend to have really ungainly movement patterns!
As you can see between the comparison images, the key difference here is how the body moves which essentially can make things inefficient. The same movement patterns carries over when they are playing their sport.
The knee is incredibly robust at handling inefficient biomechanical loading patterns however that doesn’t mean that we shouldn’t strive for optimal performance.
Often in growth phases the athlete can appear clumsy or less co-ordinated. This isn’t the fault of the athlete however! It’s because the brain must learn how to move in a certain way with a given set of tools – but during growing phases the brain has to relearn things again! Imagine how unnatural it can be if all of a sudden, someone changes your entire work setup and how long it takes to get used to it again!
So the brain has to re-learn how to control the body with a longer and heavier bone, all while the muscle is tighter and possibly weaker than before, and still having to work to its limit. It pretty much has the odds stacked against it!
Complicated stuff aside, the solution to this is simple – practice. With consistent practice of these movements in a controlled environment (Games and team practice is NOT the same), the brain and body has time to gradually learn and gather feedback on how to move well again!
Coaching these squat and lunge patterns builds the foundation for more athletic movements in the future – this is something that we do once the soft tissue and strength deficits are well addressed.
Practice this as part of a regular stretching routine to ensure that the brain continually gets feedback on how the body functions. It also helps to build strength in the muscles!
Some simple things to look out for when practicing squats and lunges;
1️⃣ Try not to let your knee collapse sideways when squatting or lunging
2️⃣ Sit back into your squat, similar to sitting down onto a chair
3️⃣ Keep your weight through the whole of the foot and heel when performing lunges or squats
We’ve come to the end of this blog and hope you have a better understanding of knee issues in adolescents. If anything, know that this is a self limiting problem however the recovery process can be quickened with physio input and it really is better to get this seen early.
As with any injuries, its challenging to find accurate and trustworthy information on what to do. It’s worth your while to speak to a qualified physiotherapist to get an accurate diagnosis and treatment plan that’s tailored specfically,