Pay attention to a child with knee pain

Children have spines, muscles, joints and tendons like adults and are not immune to having muscle and joint pain.  One of the most common presentations in my office when treating children, is knee pain.  There are many causes of knee pain in kids, from growing pains, growth plate pain, sports injuries and even bone cancer. It is important to pay attention to your child when they complain of knee pain.  Most conditions can be easily treated with conservative care.  

Growing Pains
 True growing pains are not well understood and the main theory is that the pain is originating from the muscles. The muscles are thought to be adapting to their increased length and growth.  The sensory receptors, that measure stretch, are effected more when the child is in a growth phase. This is most common around the ages of 3-4 and 8-12. Growing pains are felt in both legs, especially in the back of the legs(calves) and in the front of the thighs.  
These pains are more common after sport activities and mostly present later in the day and evenings. The pain can also sometimes present in the middle of the night.  Growing pains disappear in the morning and usually don't interfere with the child's ability to play sports or be active. When it comes to knee pain and growing pains, the pain is usually located at the top of the knee in the front or around the back of the knee. 
Treatment for growing pains is using heat and massage to the leg muscles. 

Osgood- Schlatter Disease

There are growth plates located at the ends of all growing bones.  In Osgood-Schlatter Disease, the tendon from the quad muscle pulls on the growth plate at the top of the shin bone, just under the knee cap.  The growing bone and short/tight muscle causes extra force to be placed over this growth plate area. 
The signs and symptoms are point tenderness over the Tibial Plateau (end of the shin bone close to the knee cap), a bump found at the Tibial Plateau, and pain after activities involving running and jumping.  An x-ray can also show if the growth plate has been disturbed. 
Pain from Osgood Schlatter's is  aggravated by activity and relieved by rest with ice and is most common during excelled growth periods. It can affect both knees or just one. 
Treatments for Osgood-Schlatter's Disease  includes rest, bracing, stretching, and muscle strength balance.

Bone Cancer-Osteosarcoma

Bone Cancer in children is very rare and makes up roughly 30% of all childhood cancers and the most common malignant one is called Osteosarcoma. This tumor is most often located in the femur,(thigh bone) around the knee area.  Osteosarcoma affects approximately 400 children younger than age 20 every year in the United States. Osteosarcoma occurs most often in children and young adults between the ages of 10 and 20 and often during a growth spurt. It occurs more frequently in boys than girls.
Signs and symptoms include one sided pain around the tumor area, secondary fracture due to bone weakening, decreased appetite, night pain, loss of energy, and swelling around the tumor area. 
Osteosarcoma presents with a gradual onset often not related to any explained trauma or injury.  Progressive pain occurs over time along with progressive symptoms. 
Treatment includes surgery to remove the tumor and also chemotherapy. 

Sports Injuries

Sports injuries are the most common presentation of childhood knee pain in my office.  Like adults, one of the most common areas for kids to get a sports injury is to their knees.  When obvious trauma is placed onto the knee it is very easy to diagnose a sprain, strain, or muscle injury. Sometimes sports injuries can be a repetitive strain type injury that develops slowly over time.  One of these injuries is patellofemoral syndrome, also called runners knee. It is characterized by pain around the knee cap and aggravated with running and jumping exercises.  Swelling can be present and pain is worse when squatting, climbing/descending stairs, and kneeling. It can be present in one leg or both.  
This condition is common in active children that are growing fast and their leg muscles are not balanced in strength and length. 
A thorough exam by a practitioner that treats muscle and joint problems is the first step with this type of knee pain.  A treatment plan of therapy, exercises, and stretches will be implemented.  

Summary:

Knee pain is a common presentation in children.  A lot of knee pain can be related to kids growing fast and the muscle balance is affecting the joints. Examples of this are growing pains,  Osgood Schlatters and Patellofemoral Syndrome.  These problems are all aggravated with activity and relieved with rest. They can also all be one leg or both with growing pains being more common in both legs. 
Be concerned of an underlying bone tumor when your child has one knee that hurts, rest doesn't relieve it, the knee is swollen all the time and they are having night pain. 

Activity Fact: Full bone growth is achieved at around the age of 21 but our body continues to make bone tissue throughout our life. Physical activity helps keep this process ocurring and helps prevent osteoporosis.