Anterior knee pain in kids

Following on from last week’s post about heel pain in “tweens”, today we’re moving up the leg a little to talk about knee pain in active kids.  

 

The topic of knee pain, though, is quite a broad one, especially where kids are concerned.  

 

So to keep this post from being longer than War and Peace, we’re going to narrow it down to just pain at the front of the knee, otherwise known as “anterior knee pain”.  

 

It’s still going to cover a lot of ground, so grab a cuppa and strap yourselves in for a long(ish) read.

 

Anterior knee pain can be anywhere either above, underneath or below the patella (kneecap).  

 

We’ll come back to pain on the inside or outside, as well as pain at the back of the knee at a later stage.  

 

If your child is particularly active, it’s not uncommon for them to complain of various aches and pains in their joints or muscles.  However, these should not persist for more than a day or two, and shouldn’t interfere with their ability to participate in their chosen activity/activities.  

 

If your child has been complaining of anterior knee pain for a while now, this post is for you.  

 

It will discuss the common causes of anterior knee pain in kids, things you can try at home, things to keep a special eye out for, and when we recommend getting some professional advice.  

 

Quadriceps Tendon:

The first site that we see anterior knee pain in is in the quadriceps tendon, which is between the muscles that make up the bulk of the thigh, and the knee cap.  This is usually considered an overuse injury, however, it is not all that common to see pain in this area in kids.  

 

Patellofemoral Pain:

 

The next site we can see anterior knee pain is underneath the knee cap itself.  This can be either sharp, pinching pain, or more of a dull ache.  The child may also complain of clicking or grinding sensations in their knee.  

 

This type of pain is more common in females than males.  This is thought to be due to their wider pelvis, which changes the angle of the knee cap.  

 

It is also more common in people with ‘flat feet’, as again, this changes the angles in the leg and means that the knee cap does not quite track through the groove in the leg and thigh bones as well as it could.  

 

This pain is aggravated by activities that require the knee to be bent, such as squatting, climbing or going down stairs, or sitting with the feet tucked under a chair.  Often, people with this condition will prefer to sit with their leg out straight.  

 

The pain is usually aggravated by activity, and relieved by rest.  Sometimes, the pain does not come on straight away after activity- it may come on as late as the next day.  

 

If this sounds like your child, some things you can do to try to assist them include:

• Ensuring that they wear comfortable, supportive footwear at all times.  Have their runners fitted by a reputable retailer to ensure that they are the correct type for them, and don’t just “look good”.  
• Have the child ice their knee for 5-10 minutes at a time, 2-3 times after training or playing sport.  
• Have them do some gluteal strengthening exercises.  Keep an eye out on our Facebook and Instagram pages for some upcoming videos on easy ways to do these.
• Have them do some exercises to strengthen the muscles on the inside of their thighs.  We have included one here to get you started.

VMO Strengthening (beginner):

1. Lay on your back with a pillow under your head, and with your with one leg bent and the foot flat on the floor.
2. Slightly turn out your straight leg by roughly a 10-15 degrees.
3. Tensing the quadriceps muscles and small muscles around your knee slowly lift your leg off the floor.
4. Lower very slowly and controlled while maintaining quadriceps contraction.
5. DO NOT let your foot touch the ground.
6. DO NOT press your hips, shoulders and back into the floor to lift your leg.
7. Repeat as often as possible, as more is better principal applies for this exercise.

 

Infrapatella Pain:

 

The final region we can see pain in the anterior knee is underneath the knee cap, known as the infrapatella region.  

 

The pain can be located either close to the knee cap itself, in which case it may be due to  a condition called “Sinding-Larsen-Johanssen” Syndrome (or SLJ for short), or close to where the patella tendon inserts onto the leg bone.  In this case, it may be due to a condition called “Osgood-Schlatters Disease”.

 

Confused yet? 

 

Don’t worry, these convoluted names basically outline the same type of condition, but it is just named differently depending on the location.  

 

Basically, both of these conditions come about as a result of the repetitive pull of tendon onto bone, which occurs when your child is quite active.  

 

Children, and in particular adolescents, are susceptible to this type of condition, because they are placing the demands of both growth and high levels of activity on their bodies at the same time, and sometimes, the body just struggles to keep up with the demand.  

 

This type of pain is often made worse by activity, and relieved by rest.  The pain may have been present for months or even years.  

 

If your child is complaining of pain in either of these locations, they can try:

• Icing their knee after training and playing sport
• Taping over the patella tendon, although this is best demonstrated by a qualified health practitioner
• Stretching their quadriceps and calf muscles regularly

 

Both of these conditions may take a while to improve, but generally settle down eventually.  In some cases, this may take quite some time, as the body struggles to heal fully until they have finished growing.  

 

Your child may find that they need to take some time out of their chosen sport to allow for a period of rest.  

 

Some things to keep an eye out for:

 

Although knee pain is a very common occurrence in kids, it can at times have a more serious underlying cause.  

 

Things to watch out for and discuss with your GP include:

• Pain that regularly interferes with the child’s sleep, i.e. night pain
• A significant drop in your child’s energy levels, or them feeling or seeming noticeably “unwell”, accompanied by elements such as lethargy or fever.
• Heat, redness or swelling in the knee joint
• An unexplained limp- this may either be painful or pain free.  
• Pain or stiffness that is worse at rest, but gets better with activity

 

Do any of these conditions sound like what your child is complaining of?  

 

If so, why not try some of the strategies we’ve outlined above, to see if they help.

 

If you’ve already tried these, or would like some more tailored advice, then give us a call on (03) 9375 7714 or book online today to see if we can help.