Knee Pain – Children – Physiotherapy

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Knee Pain – Children 

Knee pain is a common problem in children and adolescents. Pain arises from different underlying pathologies in children. In adults, the majority of the pain relates to degenerative changes and accumulative or one-off injuries.

In the children and adolescents, the underlying pathology may be congenital or growth-related pathology. Children have various anatomical and biomechanical changes to their lower limbs as they mature. Changes may become more obvious during the growth spurt as muscles and bone grow at different rates.

Basis of Knee Pain – Children 

Some of these underlying conditions require a medical diagnosis but most will be initially found on Physiotherapy Assessment with your story of pain.

  1. Anatomic Changes – The shape of joints, length of muscle and neural tissue. A comprehensive Physiotherapy assessment will analyse these aspects and I will make recommendations as to what is relevant to the current knee pain.
  2. Discoid Menisci – Unusual shape of the knee cartilages
  3. Popliteal Cysts – Synovial swelling at the back of the knee
  4. Osteochondritis Dissecans – A small segment of bone begins to separate from the rest of the bone due to a lack of blood supply. This can be seen on X-ray
  5. Osgood-Schlatter – Seen as a painful lump below the kneecap. Affects children during growth spurts who play sports involving running and jumping. Usually self-treatable and self resolves, once the child’s bones stop growing.
  6. Sinding-Larsen-Johannson – Injury to the patellar tendon connecting the kneecap to the shin bone. Common in athletes playing basketball and volleyball (jumping). Knee pain, swelling and stiffness. Physiotherapy and pain relief effective. Resolves within days to weeks
  7. Idiopathic – Related to other problems including hamstring tightness and increased external hip rotation. Self-limiting condition associated with hamstring tightness.
  8. Blount’s Disease – a growth disorder of the tibia (shin bone) causing the lower leg to angle inward, a bowleg. Relates to uneven growth plate pressure. Needs medical assessment
  9. Inflammatory arthritis – needs rheumatology assessment

 Knee Pain – Children – Patello-Femoral Dysfunction

  1. Patellofemoral Conditions – are changes in the surface, shape and movement of the knee cap and knee joint. Physiotherapy treatment program is highly effective but may need orthopaedic assessment.
  2. Patellofemoral Instability – is usually related to Benign Hypermobility, a condition of ligament laxity throughout the body, combined with rolled in feet and week knee and hip stabilising muscles. May follow minor trauma or be recurrent. Physiotherapy treatment program is effective but may need surgical assessment.
  3. Patellofemoral Pain Syndrome – is usually related to poor hip, knee and foot biomechanics and altered dynamic posture during standing, gait and stair climbing. An accurate Physiotherapy assessment will lead to effective treatment and good outcomes

Special considerations when Knee Pain – Children

  1. Referral of pain from the Hip

Physiotherapists always examine the hip joint before assessing the knee.

  • Pain from the hip, like in the adult, refers to the medial joint line of the knee.
  • Restricted abduction in flexion indicates hip pathology until proven otherwise.

Other Possible pathologies with Knee Pain – Children 

  • Trauma may cause bone or growth plate fractures rather than ligament injury.
  • Isolated knee ligament injury is rare in children younger than 14 years as the ligaments are stronger than the physes.
  • If an X-ray is normal but the child limps or is unable to weight-bear, and the physis is tender, a fracture is possible and medical referral follows.     

Three common hip pathologies to consider are:

  • Perthes disease (age 6-10)
  • Slipped femoral epiphysis (age 10-14)
  • High index of suspicion for growth plate fractures

    2. Referral of pain from the Lumbar Spine

This is less likely in children than in adults but as a physiotherapist I always assess the spine if the history suggests possible involvement.

  1. Tumour when Knee Pain – Children

Benign and malignant (primary and metastatic) tumours do occur about the knee. Local trauma often focuses attention on an area in which a tumour is subsequently diagnosed.

Tumours can present with:

  • pain
  • swelling
  • pathological fracture

Physiotherapists are aware of “red flags”. I ask questions and examine with this rare possibility kept in mind when assessing knee pain, especially if the symptoms and signs are atypical.

     4. Infection

The most common organisms responsible for osteomyelitis are Staphylococcus aureus, Streptococci, E Coli, Proteus and Pseudomonas. Often no primary infective site is found. The most common presentation is

  1. pain
  2. warmth and
  3. tenderness over the affected part and
  4.  unwillingness to move the adjacent joint.

It is possible to get an effusion in the neighbouring knee joint however the growth plate usually prevents infective spread into the joint. All patients should be checked for diabetes or impaired immune function.

  1.       Inflammatory Arthritis

Rule out Juvenile Idiopathic Arthritis (JIA)

Article by Paediatric Knee by Physiopedia modified by Helen Potter in Touch Physiotherapy 2017 References Robert C. Orth. The paediatric knee. Paediatric Radiology 2013;43(su

Phone or email Helen Potter 93816166 if you would like to ask about a consultation


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