Knee Pain in Teens

Written by Suramya Yadav - UPG Senior Physiotherapist

Teenagers often experience knee pain, and it can happen for various reasons. Sometimes, it's simply from doing too much or getting injured, like having strains or sprains playing their favourite sport. Other times, medical conditions can also lead to knee pain. But it's important to remember that knee pain might not always be related to an injury but rather changes in activity levels or growth spurts.

Considering the many factors that can cause knee pain, it's crucial to have a physiotherapist check it out if your teen complains about it. Please don't dismiss it as growing pains, as there could be a more significant issue. In this article, we'll explore the reasons behind teenage knee pain and how to prevent it; and we will emphasise the importance of seeking help from a physiotherapist for proper diagnosis and treatment.

What are the causes of knee pain in teenagers?

When a teenager's knees hurt, aka anterior knee pain can be due to three causes:

Patellofemoral dysfunction is the abnormal alignment of the kneecap in its groove, patellar tendinitis or bursitis.
Injuries to ligaments and tendons of the knee or to the kneecap itself. This includes meniscal tears, sprains to knee ligaments - Anterior or Posterior Cruciate ligaments, medial and lateral collateral ligaments, and patella dislocation.
Medical conditions that affect the knee such as Osgood-Schlatter disease, Sinding-Larsen Johansson Syndrome, Osteochondritis Dissecans and Juvenile Arthritis.

It is important to remember that knee pain can be aggravated by repetitive impact activity such as jumping, running, twisting or participating in competitive sports and inadequate muscle strength and conditioning.

Who typically experiences anterior knee pain?

While anterior knee pain and patellofemoral pain syndrome can affect anyone, it is more common in:

Active people, particularly those who run, jump, ski or bike regularly.
Healthy teen girls and young women (more than males)
People who have previously injured their knee cap through dislocation or fracture
People who are overweight

Suppose your active teen needs to compensate for movement limitations. In that case, they can alter their standard mechanics, which places more significant stress on the knee. For example, suppose a dancer has insufficient turnout (external rotation at the hips). In that case, they might compensate by turning their shins out (external tibial rotation) and rolling over the arch (pronation), which can increase knee stress.

Other factors that increase stress on the knee include tightness in the Illio-Tibiall band, excessive knee extension and weak quadriceps muscles.

Signs and Symptoms of Knee Pain

Whilst there is no clear definition of anterior knee pain, patients can present with various symptoms depending on the underlying pathology, for example:

If your teen experience more pain when going downstairs, squatting, jumping, or sitting with their knees bent for extended periods, it's called the 'movie sign.'
Swelling in a specific area.
Feeling pain or tenderness when pressing on the patellar tendon (tendinitis).
Pain during muscle contraction, squatting and kneeling.
Weakness in the muscles, particularly the Quadriceps

How to Manage and Prevent Knee Pain

The best way to prevent and treat knee pain for your teenager is to see a physiotherapist who will analyse their specific case and give personalised advice. However, here are some simple strategies you can include in the daily routine to prevent knee pain and some things to do if the pain happens:

REST: Taking a break is essential for tissues to recover and heal. It might be necessary for your teen to avoid the activity that triggered the pain temporarily.
ACTIVE REST: Active recovery involves reducing activities that aggravate the pain until it is better managed. For instance, go for low-impact exercises like biking or swimming instead of high-impact activities like running and jumping.
COLD COMPRESSION THERAPY: Ease inflammation and swelling by applying ice to the knee. Apply for up to 20 minutes at a time.
MUSCLE STRENGTHENING:

Start by incorporating closed-chain exercises, as they are more functional and reduce stress on the joint. For example, squats, deadlifts, lunges, power cleans, and leg presses.
Progress to include isometric exercises such as presses, pulls, and holds. Then move to isotonic or aerobic exercises, for example, running, hiking, swimming, skiing, and dancing. Finally, include energy storage exercises to meet sports demands with specific drills.

STRETCHING: Do repetitions of specific stretches for the quadriceps, hamstrings and calves to increase the length of these muscles. These will give support to the knee joint and minimise pain.
TAPING AND BRACING: Whichever of these you choose will help ensure the correct kneecap alignment. A recommended knee taping recommendation for knee pain relief is the Mcconnell technique.
KEEPING APPROPRIATE WEIGHT: By maintaining a healthy weight through a balanced diet and regular exercise, they can reduce the stress on their knees and help prevent knee pain.
LOAD MANAGEMENT: Depending on the severity of the injury, its prognosis, and functional requirements of the sport, it is recommended to make a plan that includes a gradual and optimal loading of the healing tissue after an initial period of rest.
Consulting a physiotherapist can be very helpful in designing individual-specific exercise plans, progressive tissue/joint loading, faster recovery and return to play.
STRUCTURED WARM-UP AND COOL-DOWN: By incorporating a proper warm-up, cool-down, and stretching routine into your exercise routine, you can significantly reduce the risk of injuries and minimise the occurrence of knee pain.
A highly recommended warm-up protocol for soccer players is the 11+ FIFA protocol. It has been extensively researched and designed to reduce the risk of injuries. A version specifically tailored for children aged 11 years and older can be found and demonstrated at the following link: https://fit4football.co.nz/physical-conditioning/the-11/the-11-kids/. This protocol is an effective way to prepare young soccer players for training or matches while promoting their safety and well-being.

The AUSTRALASIAN COLLEGE OF SPORT AND EXERCISE PHYSICIANS (ACSEP) developed guidelines based on research that provide recommendations for how much training is appropriate for young athletes to prevent injuries. These guidelines consider factors like age, physical development, and the demands of the sport. By following these guidelines, coaches and parents can help young athletes train safely and avoid getting hurt. Finding the right balance of training, rest, and recovery is important to keep young athletes healthy and injury-free.

Here are some highlights from the guidelines that are easy to keep in mind when analysing the sports routine of young people.

Each week, a player should only participate in organised, structured sport for a maximum of their age in years - For example, an eight-year-old should participate in at most eight hours of organised, structured sport per week.
It is advised that players should only engage in a single sport for up to eight months per year. This recommendation aims to prevent overuse injuries, mental burnout, and a potential drop in interest or participation in the sport. It is generally recommended to avoid specialising in a single sport until players reach the age of fifteen to sixteen years old, considered late adolescence. This allows young athletes to explore and participate in various sports and activities, promoting their overall physical development and reducing the risk of overuse injuries associated with early specialisation.
Children should have regular opportunities for unstructured play each week. Unstructured play allows them to be creative, develop social skills, and engage in physical activity without rigid rules or guidelines.

As the enthusiasm for youth participation in sports continues to grow, prioritising their enjoyment, safety, and injury prevention becomes increasingly important. Seeking guidance from a physiotherapist ensures that teenagers have the necessary tools to address and treat knee pain when it arises. By implementing preventive strategies and utilising professional support, they can maintain their passion for sports while minimising the risk of injuries and pain, allowing them to enjoy their athletic pursuits fully.