Knee Pain in Young Athletes: Common Bad Advice

From the American Academy of Orthopedic Surgeons:  danger-bad-advice

Osgood-Schlatter disease, a common cause of knee pain in children and adolescents, is an inflammation of the area just below the knee where the tendon from the kneecap (patellar tendon) attaches to the shinbone (tibia). Osgood-Schlatter disease most often occurs during growth spurts, when bones, muscles, tendons, and other structures are changing rapidly. Because physical activity puts additional stress on bones and muscles, children who participate in athletics are at an increased risk for this condition. 

Osgood-Schlatter Disease is certainly not the -only- knee pain suffered by young athletes. Other common causes of knee pain in this population include patellar tendinopathy and ligament sprains. But whatever the case, young people with persistent knee pain (and their parents) very often receive bad advice.

“It’s Osgood Schlatter and the doctor said that I can play through it unless I can’t.” 

“It’s a natural growing pain that will go away on it’s own. See the bump on the front of my leg?” 

“Keep going until it hurts so much that you can’t.”

“I’m tall and this puts more stress on the knee.” 

These statements are all true. But they’re not very helpful. The typical, somewhat helpful advice includes ice, ibuprofen (or other NSAID), and rest if you have to.

I have a feeling that such limited advice from very qualified medical professionals has a lot to do with the fact that:

1) Diagnostic studies (X-ray and MRI) usually show little to no structural problem at the knee, and-

2) This is a stubborn and fairly complex problem that is not fixed surgically.

So they tell the athlete that playing through will cause no further damage, and they should take some ice and ibuprofen and 4 to 6 weeks off if they must. This invariably leads to frustration for the athlete, parents, coaches, and other players on the team, as the athlete straggles along at half the effectiveness as when they’re not trying to push through pain.

“Okay Bob, what do you think they should be telling the athletes with Osgood Schlatter and other youth-oriented types of knee pain?” 

bad advice
                Yeah. Ignore it completely.

Osgood Schlatter’s Disease is a common problem in young athletes. The pain is at the knee but there are usually a number of factors causing the knee to take on additional strain. The following should be checked:

  1. What is going on at the foot and ankle in terms of mobility and stability? Are there structural issues (high or low arches, bunion deformity, etc)?
  2. What is going on at the hip and pelvis? Does the hip show limitations in flexibility or strength? Are the core muscles controlling the pelvis in order to maintain good posture and alignment of the legs?
  3. What exactly are the parameters of training, games, and practices? Can we create an optimal realistic plan that significantly mitigates (rather than cuts out completely, or not at all) the frequency and duration of high impact demands?
  4. How severe is the inflammation? What modalities or manual therapies (and yes, medications) may help calm down the pain and swelling?
  5. Does the patient and their family understand the problem in terms of thresholds? For example, an athlete may have significant core and hip weakness, flat feet, and a schedule full of games and practices for one basketball and two soccer teams. This athlete would have plenty of margin to do what it takes to bring the stress on the knee below the threshold of injury.

As far as specifics, what generally works very well to SPARE THE KNEES from ACL injury also works quite well in terms of treating Osgood Schlatters and patellofemoral pain. The typical treatment protocol is ~75% similar. Work those hip dominant movement patterns, sled pushes, and attend to the feet during running and jumping.

Knee pain in young athletes can indeed be tricky to resolve, especially when the kid truly wants to maintain their activity level. But we can do far better than shrugging our shoulders and chalking it up to growing pains.

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