Adolescent Knee Pain

What is it?

Teenagers who participate in sports often develop an achy pain behind the kneecap. Prolonged pain in the front of the knee (anterior knee pain) is fairly common in young athletes and is typically aggravated with physical activity.

Teens will generally not damage their knee by continuing with their activities, but it can cause an increase in pain. The pain might also be increased by walking after sitting for long periods of time, or going up and down stairs. This pain could simply mean that the athlete needs to adjust his or her training routine.

The anatomy of the knee is extremely sensitive to changes in alignment, training and overuse. If the kneecap pulls out of its normal groove this can also cause pain behind the kneecap. A number of other factors may be involved including:

• Imbalance of the muscles around the knee joint
• Poor flexibility of the quadriceps or hamstring muscles
• Problems with alignment of the kneecap
• Improper or high intensity sports training techniques
• Overuse

Why come to The Children’s Hospital for treatment of this condition?

Children’s has the only sports medicine program in Colorado that is focused solely on caring for young athletes.  Our team of sports medicine experts understand the demands that sports programs place on school-aged athletes and the importance of customized, age-appropriate care. Since many young athletes are still growing, they need special kid and teen-specific treatment that takes this into consideration.

Our pediatric specialists are fellowship-trained in sports medicine, giving them the focused expertise that makes The Children's Hospital the best choice for young athletes looking to maximize performance after recovering from a sports injury.

What are the signs and symptoms?

The pain usually begins gradually - during or after sporting activities. Typically there is no history of trauma or injury. Without treatment, the athlete may also develop thigh muscle (quadricep) weakness. The young patient’s knees could begin to buckle or give out from pain. In this case, buckling of the knee is not from a ligament or cartilage injury, but more from the pain behind the kneecap.

How do you diagnose it?

Diagnosis begins with a healthcare provider getting a good history about the details of the athlete’s sports participation and training regimen. Recent changes in intensity, frequency and duration of training is important to know about. A knee examination will help your physician determine the cause of pain behind the kneecap and x-rays will be performed to rule out other conditions.

Your physician will be looking at the following things:

• Alignment of the kneecap in relation to the lower leg
• Range of motion of the knees and hips
• Signs of tenderness underneath the kneecap when pressure is applied
• Strength, flexibility and tone around the knee
• Signs of flat feet

How do we treat it?

Ice, rest, and physical therapy are the best treatments for teenagers with pain behind the kneecap. Most young athletes will have to change their training routine or learn proper exercise techniques to correct problems causing knee pain. They may also benefit from using a knee brace during activities. Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen, can also help control pain and inflammation.

• Ice- Icing the knee will relieve swelling and inflammation under the kneecap. Ice can be applied a few times each day for no longer than 20 minutes at a time.

• Rest - A child should stop doing the activities that make their knee hurt. If they continue to perform activities that cause knee pain, the inflammation cycle continues.

• Rehabilitation - Athletes usually need to rehabilitate their knee to regain full range of motion, strength and endurance. Physical therapy can also be used to change the mechanics of the quadriceps and hamstring muscles by increasing flexibility and strength. Remember that it is important to cross-train with activities to keep in good cardiovascular shape. It is very important that the young athlete returns to their sport gradually.

Who gets it, and can it be prevented?

Prolonged pain in the front of the knee (anterior knee pain) is common among active, young athletes and is more common in girls with certain biomechanics.

Ways to prevent knee pain include:

• Wearing shoes appropriate for your activities
• Performing stretching exercises before physical activity
• Stopping any activity that increases pain in the knee
• Limiting training accordingly