Last time we reviewed growth plate issues of the heel, so called Sever’s Disease. Please reference back to that article for a review of apophysitis.
Another location for this problem is just below the knee, so called Osgood Schlatter syndrome. Here, we have the same basic problem: the powerful patella tendon pulls against the tibial (shin bone) growth plate as it undergoes rapid lengthening during puberty; the tendon moves up the bone as it lengthens, causing inflammation and pain.
The location of the pain is quite specific: the “tibial tubercle”– that bump at the top of your shin just below your kneecap (see heading illustration). The area is typically swollen with at least mild redness and tenderness. Like Sever’s in the heel, this apophysitis is a problem of early adolescence (10-13 girls, slightly more common in 12-14 boys), and is caused by the repetitive jumping action of some of the same sports– basketball, volleyball, soccer, plus additional ones like skating(figure and speed) as well as dance.
The problem is differentiated from another common knee problem “patellofemoral syndrome” (“chondromalacia”) which is PROBABLY (its controversial) caused by wearing of the lubricating cartilage behind the kneecap (not meniscal cartilage) where the pain is higher up and behind the kneecap, without the bump below the knee and with a somewhat duller pain. Meniscal cartilage tears, ligament and tendon damage almost always follow acute, more severe injury. Old guys like me can have meniscal injury just from overuse and age; young athletes do not suffer from those problems–only damage from big hits to the joint can injure a kid’s knee.
Usually treatment involves pain management. Nonsteroidal antiinlammatory drugs (NSAIDs) like ibuprofen and naproxen are the mainstay. A big part of the problem is generated by quadriceps tightness, so stretching and flexibility training is very important. Modify the athlete’s training/practice routine to limit overuse and allow for best competitive performance is key, so a good trainer and understanding/smart coaching is essential. A good knee pad that limits hits to the tender inflamed tibial tubercle provides relief from that problem.
Regarding overtraining, let’s recall as I think its important–max 2 seasons at one sport, a third season of a completely different one, and one season with only not organized general fitness training is my recommendation for limits to training schedule (less is certainly acceptable). Remember, Mom and Dad, we are talking about CHILDREN–they are supposed to have fun and free time.
If your younger teen is troubled by knee pain, give me a call and let’s discuss it. Thanks for following.