Treatment Of Patellofemoral Pain In Adolescents:
Most patients with patellofemoral pain will have a self-limiting course, which simply means that with a few days of rest, ice, heat and stretching their symptoms will go away. For those whose pain persists, or with those who have obvious patella instability more aggressive management might be necessary. Treatments include physical therapy, bracing or compression sleeves. After physical therapy for patellofemoral pain, most adolescents will be able to return to sports. In the group that continues to complain of anterior knee pain more invasive or surgical management might need to be considered. The exact nature of the surgery which will be discussed will depend on the type of instability or cause of the anterior knee pain that you have. Check out this post on patellofemoral pain due to instability for more information.
If you or your child are suffering from patellofemoral pain which is not resolving spontaneously, see your favorite sports medicine professional for a specific diagnosis and treatment plan.
What Is The Best Treatment
Once the physical therapist evaluates and determines the exact problem occurring in the knee, the treatment can be individualized to suit the child and the sport he or she plays. Additionally, the physical therapist will discover exactly what actions must be taken for the child to successfully play the sport without any further injuries.
Fortunately, it is usually not necessary to stop sports completely. But initial treatment may require some modifications such as taking time off to rest the joint. If the condition worsens, a prolonged period of rest may be needed.
In severe cases, leg splinting is used, but surgery is rarely necessary unless x-rays show an avulsed fragment of bone that remains extremely painful in skeletally mature adults .
Otherwise, gentle stretches for the hamstrings, quadriceps, and IT band are helpful to relieve the tension on the knee. Cold packs are a must while in the painful stages. Taping and bracing are also useful adjuncts in the early, painful stages of knee problems.
Once the pain reduces, strengthening and other resistance exercises must be introduced at a progressive rate. Here at Root Cause Medical Clinic’s department, we also incorporate many balance activities to re-train the joints and muscles. Research in this area clearly indicates that doing so prevents further injuries to the joint.
What Is Anterior Knee Pain Commonly Known As Runner’s Knee
Teenagers who participate in sports often develop an achy pain in the kneecap. This prolonged pain in the front of the knee, called anterior knee pain, is fairly common in young athletes and is typically aggravated with physical activity.
This condition is also known as patellofemoral pain, chondromalacia of the patella or “runner’s knee” and is due to abnormal tracking of the kneecap.
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Idiopathic Anterior Knee Pain
Idiopathic anterior knee pain, also described as patello-femoral pain syndrome, refers to non-specific, vague, mostly activity related anterior knee pain and is the most common cause of knee pain in adolescents . Gorman McNerney and Arendt state that idiopathic anterior knee pain affects around 30% of the adolescent population . Therefore, it is the most common cause of knee pain evaluated by primary care physicians, sport medicine physicians, and orthopedic surgeons. It is also more common in adolescent females, 2â10 times higher than their male counterparts .
Many factors have been postulated to contribute to the development of anterior knee pain in adolescents primarily it is thought to be due to anatomical and biomechanical factors. Intense physical activity overloading the patellofemoral mechanism appears to be the most consistent factor leading to the development of anterior knee pain. The patellofemoral unit provides the mechanism for knee extension and deceleration . The stability of the patella in the femoral groove is provided by the surrounding soft tissue attachments and the bony supporting structures. Malalignment and abnormal tracking of the patella have been postulated to contribute to anterior knee pain . Vastus medialis obliquus plays an important role in stabilizing the patella in the femoral groove and its proper tracking .
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Interpretation Of The Adolescents Response
Adolescents who reported knee pain with a duration of a couple of years was interpreted as 24 months. If they responded they had had pain for as long as I can remember or always it was interpreted as 120 months. If the adolescent could not remember how their knee pain started, the physiotherapist asked if they could remember a specific event where they first felt their knee pain. If the adolescent said no, they were asked if the knee pain slowly developed without a clear onset. If they did not know if their knee pain was related to a traumatic or insidious onset, it was interpreted as insidious. A total of 11 adolescents could not remember if their knee pain was initiated by a traumatic event or it had an insidious onset and were therefore interpreted as insidious onset.
All the following answers were interpreted as currently under treatment: if the adolescents had received an exercise program by a physiotherapist or general practitioner and still performed the exercises surgery and postoperative exercise foot or knee orthotics prescribed by GP or physiotherapist if the GP had prescribed NSAID. The following was interpreted as not currently under treatment: if the adolescents reported they were referred for investigations at the hospital, by a GP or by a physiotherapist if the adolescent reported they had consulted their GP and received advice to decrease physical activity.
Who Gets Knee Pain Or Runners Knee
Prolonged pain in the front of the knee, known as anterior knee pain, is common among active, young athletes and is more common in girls.
Ways to prevent knee pain include:
- Wearing shoes appropriate for specific sports or activities
- Stretching before physical activity
- Stopping any activity that increases pain in the knee
- Limiting training accordingly
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Causes Of Patellofemoral / Anterior Knee Pain:
- Patella instability: The kneecap or patella rides in a groove on the femur. If the patella does not track properly within the groove it can produce pain or a mechanical clunk depending on the severity of the problem. Read more on patella instability.
- Plica Syndrome: A plica is a small fold of tissue inside the knee. It is usually found along the inner side of the patella and is a very common cause of patellofemoral pain. In some situations, the plica simply becomes inflamed from repetitious activity, but occasionally the plica can thicken and produce a painful snapping with bending of the knee.
- Notice the fissures and irregularity of the cartilage surface.
Chondromalacia: This implies that the cartilage in the undersurface of the patella is getting soft. The cartilage can develop fissures and even defects or holes in the patella.
- Hip and Pelvic muscle weakness: This is a chicken vs the egg problem. Most people with patellofemoral pain are known to have weakness of the hip and pelvis muscles. They have poor core stability on testing. Did this cause the patellofemoral pain or did the anterior knee pain lead to weakness from activity modifications?
When To See A Doctor
It is not ideal to use pain relievers, such as ibuprofen, to mask the pain and participate in sports. This may worsen the injuries and pain over time. Seek medical care in the following circumstances .
- Knee pain lasting more than two weeks
- Limping due to pain
- Unable to do sport activities
- Pain while playing sports
- Performance is affected by the pain
- Knee injuries
Never force your teen to participate in sports with knee pain. All cases of knee pain are not related to growth. An orthopedic doctor should evaluate the teen to identify the exact cause.
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When Do You Need To Take Knee Pain Seriously
Parents need to take the knee pain complaints of their children seriously. Many parents may initially neglect the knee pain, thinking that it will likely go away on its own.
In other cases, they might suspect that their child is attempting to stay away from an activity for one reason or another and therefore exaggerating their symptoms. The safest action is to schedule an evaluation from a physical therapist to ensure that no real damage has occurred.
Precise testing by a trained physical therapist will reveal what is occurring. Granted there are times that injuries are mild enough to be self-limiting and heal on their own. But when should immediate action be taken?
- 1) The child is complaining of knee pain for more than a week
- 2) The child is limping the day following a game or vigorous activity
- 3) The knee pain is affecting the way the child is playing the game or engaging in certain activities, i.e he/she is running slowly or not kicking the ball as much, etc.
- 4) He/she is complaining of unusual noises in the knee or having balance issues
Can Teens With Osgood
Yes, teens with OSD can usually do their normal activities, including sports, as long as:
- The pain is not bad enough to interfere with the activity.
- The pain gets better within 1 day with rest.
If you play sports, it can help to:
- Wear shock-absorbing insoles in your sneakers and cleats.
- Put a heating pad or warm washcloth on the knee for 15 minutes before sports.
- Put ice on the knee for 15 minutes after the activity .
- Wear protective kneepads, especially for wrestling, basketball, and volleyball.
- Stretch before and after sports.
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What’s The Outlook For Teenagers With Pain In Their Knees
Most knee pain in teenagers can be managed with simple treatments. However, many soft-tissue tears and bone breaks require surgery. Most teenagers recover without long-term problems if they follow the recover plan provided by their healthcare providers. Because there are many causes of knee pain, be sure to ask your healthcare provider for specific information on long-term prognosis for your teen’s knee condition.
How Long Does Knee Pain In Teens Last
There is no specific duration for knee pain in teens. It may vary depending on the severity and type of underlying conditions. Knee pain due to overuse may relieve immediately with rest. Knee pain due to knee injuries, such as ligament tear, may even continue after treatment until the injury heals.
Growing pains in the knee are experienced during growth spurts in teenagers. This type of pain may resolve once the growth is completed.
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Most Common Causes Of Knee Pain
Health Check Certified By: Dr. Gerald Morris
The knee is the largest joint in the body and knee pain is a common complaint across all age groups. It may be due to a diverse range of causes including sudden injury, overuse injury, or an underlying medical condition.
The location and severity of knee pain varies depending on the root cause. The thigh bone and lower leg bones compose the knee joint. Structures found in or around the knee joint include discs , cartilage, ligaments, tendons, and muscles. Signs and symptoms that may accompany knee pain include swelling, stiffness, redness, warmth, weakness, instability, popping or crunching noises, fever, and decreased range of motion .
The 10 most common causes of knee pain are
What Are The Causes Of Knee Pain In Teenagers
Common knee pain problems in your teenager can be generally divided into three types:
- Anterior knee pain, also called patellofemoral pain.
- Injures to ligaments and tendons of the knee or to the kneecap itself.
- Medical conditions that affect the knee.
Anterior knee pain happens when your teens kneecap is pulled out of its groove from increased pressure. Increased pressure on the knee joint is caused by:
- Abnormal hip rotation due to imbalances in muscle strength and flexibility around the hips.
- Improper training methods or equipment.
- Poor flexibility of the thigh muscles, which support the knee joint. Thigh muscle weakness or tightness.
- Overuse of the knee from repetitive bending of the knee during running, jumping, and other activities.
- Problems with alignment, for example, the kneecap not being properly aligned within the knee or having flat feet, which changes the normal gait.
Knee pain resulting from sprains, strains and tears to ligaments and tendons or injuries to other soft tissues. These conditions include:
Medical conditions that can affect your teens knee include:
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What Are Signs And Symptoms Of Anterior Knee Pain
Knee pain usually begins gradually during or after sporting activities. Typically there is no history of a specific injury. The pain is usually dull, diffuse and achy behind the kneecap. The pain may occur in one or both knees. Prolonged sitting or squatting and going up and down stairs can worsen the pain. Some patients may even report mild swelling.
Without treatment, your child may also develop thigh muscle weakness. His or her knees could begin to buckle or give out from pain. In this case, buckling of the knee is not from a ligament or cartilage injury, but more from the pain behind the kneecap.
What Causes Knee Pain
The anatomy of the knee is very sensitive to changes in alignment, training and overuse. If the kneecap pulls out of its normal groove, it can cause pain behind the kneecap. A number of factors may be involved, including:
- Imbalance of the muscles around the knee joint
- Poor flexibility of the quadriceps or hamstring muscles
- Problems with alignment of the kneecap
- Improper or high intensity sports training techniques
- Overuse
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How To Treat Degenerative Meniscal Tears
Nonsurgical and minimally-invasive, arthroscopic surgical treatments may be required to repair degenerative meniscus tears. Physical therapy is always a part of a complete treatment plan. Anti-inflammatory medication, such as ibuprofen or naproxen , can provide some pain relief in the short term, but will not fix or heal the damaged meniscus tissue.
Can You Prevent Knee Problems?
Not all knee problems are avoidable, but you can lower the risk of joint problems by participating in regular strength training. To protect the knees, it is important to maintain a strong core and legs. Resistance workouts performed two to three times per week should focus on strength and flexibility.
Common Causes Of Knee Pain In Women
Knee pain is a common problem in women and occurs more frequently with age. Studies in women age 50 and older, have showed that nearly two-thirds have some type of knee pain, ranging from intermittent aches to chronic progressive pain and disability.
Even active women and female athletes frequently experience knee pain with aging. While there are a number of pain-producing knee conditions, of the most common causes include:
- Patellofemoral Pain
- Early Osteoarthritis.
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Risk Factors For Knee Pain
The following factors may increase the risk for knee pain in teens .
- Overweight and obesity may increase strain on knee joints
- Lack of muscle strength and flexibility may make the knee joint unstable during motion
- Certain sports involving repeated jumps, such as alpine skiing and basketball, may increase chances of knee pain
- History of knee injury can increase the risk of knee pain and further knee injuries
Signs Your Child’s Knee Needs To Be Examined
If your child or teen is experiencing any of the following symptoms, he or she should be seen by a specialist at Nationwide Childrens Hospital Sports Medicine.
Knee Injuries
While at home, initial treatment should be RICE:
- REST
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Despite Youth Teens Experience Knee Pain
Crackling, sore knees are often associated with a sure sign of aging. But it is not unusual for teenagers – especially those active in sports – to experience serious knee pain. Aching pain in the front, or anterior, of the knee is especially common in athletic girls.
Generally there are two categories of injury: chronic and acute. Chronic knee injuries occur gradually as a result of repetitive motion such as running, jumping or turning. Acute knee injuries are caused by immediate trauma like a sudden, hard fall or twist.
Anterior adolescent knee pain is gradual and typically felt behind the patella bone, or kneecap.
“Symptoms of anterior adolescent knee pain can include dull achy pain, swelling and popping sensations in the knee,” said Dr. John Hendrickson of Proliance Orthopedic Associates in Renton.
Usually a combination of ice, rest and rehabilitation will help ease anterior adolescent knee pain, Dr. Hendrickson said.
To help prevent recurrences of pain behind the kneecap, POA and the American Academy of Orthopaedic Surgeons recommend these tips:
- Wear the right shoe for the right activity one shoe does not fit all sports
- Warm up with stretching exercises before any physical activity
- Do not overdo sports and other activities
“If the pain does not let up and continues to build over time, an examination by an orthopedic specialist is recommended,” Dr. Hendrickson said.
During the exam, the orthopedic physician may check for: