Child and Adolescent Knee Pain

Knee pain in children and adolescents can be tricky for parents.  When should you call for help? What could it be? Is it worth a doctor visit? Will my son or daughter be able to return to their sport when the injury happens during a sporting season?

First off, we are parents ourselves with active kids, so we understand what you’re going through. We understand you don’t want to overreact. And we will assure you of this – a visit is always safe and we believe that many times it is better to be safe than sorry.  But to help you with your decision, we’ve put together a list of “red flags” that should definitely trigger an appointment:

1. The pain is always in one knee and not the other.  

2. There is a history of fracture or trauma. You are not sure the legs are the same length.  

3. The pain worsens from week to week or the overlying skin changes color color changes to the overlying skin.

4. Your child will not bear weight on the leg.

5. One knee seems to be bigger, or more swollen than the other.

6. There is pain shooting down past the knee.

Knee pain in children and adolescents can be related to:

1. Benign (not harmful) growth pain at the growth plate

2. Growth plate injuries

3. Contusions (deep bruising from a direct blow).

4. Fractures.  A break in the bone can be far from obvious.

5. Common injuries such as Osgood-Schlatters and Sinding Larsen Johansson syndrome.

6. Tendon overuse.

7. Tumors

8. And a basket of less common knee problems in youth.  

We can often tell during the first visit what the problem is, but, in our experience, we have found it makes good medical sense to follow a patient’s knee pain over time to be sure that it declares itself as being one thing.  As always, an accurate diagnosis is key, and we are dedicated to making that with and for you.

Knee pain that comes from within the knee joint should be taken seriously. Often, adults in our culture let their joints deteriorate instead of being proactive and working to stop the progression of problems.  We see people all the time who have ignored seemingly minor problems in weight-bearing joints – especially the knee. We recommend acting appropriately. Please don’t ignore or under-reacting to knee discomfort. With proper treatment, you may be able to avoid surgery and salvage a knee that is worse than it seems.

1. Arthritis, also referred to as osteoarthritis, is often left too long before a patient seeks treatment.  Modern biologic treatments as well as multiple old-standard treatments can help stop the progression of some kinds of arthritis. If you are experiencing knee pain, ignoring it could result in a full knee replacement. If, instead, you proactively get care, you may not need catastrophic measures.  We believe it’s generally better to salvage a knee if at all possible rather than ignore it until surgery is the only option. 

2. Meniscal tears can be diagnosed by a physical exam.  Most often, it does not make sense to treat tears to the meniscus surgically if there is moderate or severe arthritis. We can help walk you through your options in order to treat this type of injury.

3. Ligament tears can be diagnosed during a physical exam and/or with diagnostic ultrasound in our office. During the exam we can determine if you need bracing, activity modification, physical therapy or biologic treatments.  And don’t worry. If the best option is surgery, we will let you know and refer you to the best surgeons available.

Most knee pain that is felt outside of the joint are related to the patellar tendon, quadriceps tendons or hamstring tendons.  Many knee problems in adults are related to overuse, under-recovery or adverse movement patterns that cause strain on the tendons. We can spot these problems and have special tools such as diagnostic ultrasound to see the soft tissue and plan a course of treatment. Fortunately, these types of knee problems are easy to treat in our clinic. We have many non-operative treatment options including PRP (platelet rich plasma).  Not all of these problems need the PRP boost of growth factor. We can also use Functional Medicine and other natural techniques to encourage healing of the tissues.  

Because the hip, femur or tibia and all the overlying soft tissue structures share the same nerves as the knee, they can often send signals that make it seem like knee pain. A diagnosis for referred pain can take time to get to the root of the problem. To start, a thorough exam is needed in order to create a clinical diagnosis and treatment plan.