Julie and Anne recently attended the Windsor Knee Clinic Educational Study Day. It included interactive lectures on children’s orthopaedics, cardiology in sport and practical adult orthopaedic management in primary care.
Many adolescents presenting with non-traumatic knee pain are those suffering with “growing pains” or Traction Apophysitis. In the knee these commonly occur at the tibial tuberosity, (bony prominence just below knee), commonly known as Osgood Schlatters or at the inferior pole of the patella, known as Sinding-Larsen- Johnasson (SLJs), or at the heel known as severs. Pain is localised to the site of the tendon attachment prior to skeletal maturity. Use or overuse can result in repetitive micro trauma caused by the force of the pull of the attached tendons resulting in partial avulsions and inflammation.
There is increased risk (1.5-3.5x) with early sport specialisation – so, mums and dads, encourage your children to enjoy multi sports until they are fully grown. It also usually occurs at the start of a school term or season or pre-tournament when there is sudden increased loading or use, so it is important to keep regular exercise going through the school holidays and to be well prepared for competition.
Often rest is advised, but this doesn’t mean do nothing and use it as an excuse for sitting playing computer games all day! Rest can be ACTIVE, and in fact a lot our young athletes want to keep some sort of exercise going. Treatment includes load management and the use of isometric exercises for pain. To manage load, one needs to recognise what has been increased. The load then needs to be limited and then once decreased, rebuilt gradually to avoid any sudden increased loading. Remember the tortoise beat the hare!
It is important that movement patterns are assessed and an appropriate stretching and strengthening programme given. Helping understand the condition, receiving the correct advice and ‘local’ physiotherapy treatment are all part of helping get the young athlete back to the sport they love, as soon as possible.