Common lower limb pain conditions in children playing sport and how Physiotherapy helps

Injuries in children playing sport



Common lower limb pain conditions in children playing sport

lower limb pain is a common finding in children playing sport. Physical activity is vital for children. Sport is a wonderful way for children to grow and develop into strong, healthy adults. Since their bodies are still growing, children can get injuries. In this blog, we will discuss Osgood-Schlatter Syndrome and Sever’s disease, two common pain conditions that occur in the knees or heels of children who participate in sport. We also provide information on how these conditions can be very effectively managed with physiotherapy treatment.

What is Osgood-Schlatter Syndrome?

Osgood-Schlatter syndrome is an inflammatory condition that happens to children or adolescents going through a growth spurt. During a growth spurt, a child/adolescent’s bones, muscles and tendons change and grow at different rates. The tendon that attached the patella (kneecap) to the shinbone can pull on the area where it attaches, causing inflammation. This area where the tendon attaches is where the shinbone’s growth plate is. The growth plate is a layer of soft bone where bone growth happens. The plate is thus weaker and more prone to injury.

What causes Osgood-Schlatter Syndrome?

When strong muscles and tendons start pulling on the area near the growth plate, it causes inflammation and pain. In other words, children or adolescents who are very active and have constant muscle pull on the area can develop Osgood-Schlatter syndrome. However, it can also occur in those who are not very active but are going through rapid growth. Osgood-Schlatter can occur in one or both knees.

Osgood-Schlatter causes pain at the front of the knee

What are the symptoms of Osgood-Schlatter Syndrome?

your child will complain of pain at the front lower part of their knee. Pain is usually worse when running, jumping, climbing stairs, or playing sports. There may be tenderness and swelling over the small bony bump at the top of the child/adolescent’s shinbone.

How is Osgood-Schlatter Syndrome managed and treated?

Symptoms typically go away once the child/adolescent reaches the end of their growth spurt. In most cases, it does not cause any long-term problems. Osgood-Schlatter syndrome is usually treated very easily with rest and symptoms management. Your physiotherapist will focus on reducing pain and swelling and provide advice on how to manage daily activities to prevent aggravating the symptoms. Applying ice will help relieve pain and reduce swelling. We can also help to release tight muscles by doing massage and showing you stretching exercises specifically targeting those tight muscles.

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Sever’s Disease

What is Sever’s Disease?

Sever’s disease, also known as Calcaneal (Heel) Apophysitis (inflammation), is another inflammatory condition that occurs in children going through a growth spurt. It is the most common cause of heel pain in children between the ages of 8 and 15 years, especially those who are physically active. The pain is a result of swelling and irritation of the growth plate at the heel. The growth plate is a thin layer of cartilage where bone growth happens. Because this layer is softer and weaker than the rest of the bone, it is at more risk for injury.

What causes Sever’s Disease?

Achilles tendon insertion into the heel

Bone grows at a faster rate than the muscles, tendons and ligaments. The heel is one of the first parts of a child’s body to reach full adult size. Because the muscles and tendons grow slower than the bone, they tend to become tight and pull a lot more on the bone where they attach.

Your Achilles tendon connects your calf muscles to your heel. When the Achilles tendon starts pulling on its attachment near the growth plate, it can irritate the plate. Repetitive strain on this area results in inflammation.

What are the symptoms of Sever’s Disease?

Because of the inflammation at the growth plate, your child will complain of heel pain and swelling. One or both heels can be affected. The pain will be worse with activities like running, jumping, or walking. You may notice your child limping or walking on their toes as a way to avoid pain. Children also often complain of stiffness in their calf first thing in the morning.

How is Sever’s Disease managed and treated?

In most cases, Sever’s disease does not cause any long-term problems. It is important that an accurate diagnosis is made, and be followed with proper treatment as soon as possible. Your doctor or physiotherapist might send your child for an X-ray to rule out more severe problems such as fractures.

Mild symptoms can resolve within a couple of weeks with adequate rest. Symptoms will go away once your child reaches the end of their growth spurt. However, early and proper treatment can spare your child a lot of suffering and prevent long-lasting problems. The most important thing to do is for your child to rest from any activities that aggravate the pain. Your physiotherapist can recommend alternative activities to help keep your child active and fit.

Area of inflammation in Sever’s disease

Applying ice and taking pain and anti-inflammatory medications will help relieve pain and reduce the swelling. Your physiotherapist can also help to release tight muscles with massage and show you how to stretch tight muscles. We can recommend special heel pads, or better footwear to further manage your child’s symptoms.

Once the symptoms are better, your child can slowly start returning to their physical activities and sport. It is vital that your child does not have any pain during or after these activities. Playing through pain or failing to commit to their treatment can cause symptoms to return. It is recommended to follow a specific conditioning program as well. Your physiotherapist will tailor a program specifically to your child’s needs.

How can you prevent Osgood-Schlatter Syndrome and Sever’s Disease?

The risk for active growing children to develop Osgood-Schlatter Syndrome or Sever’s disease can be reduced in the following ways:

  1. Avoiding overtraining – avoid lengthy training sessions and make sure your child gets adequate rest
  2. Trying not to do too much running and jumping on hard surfaces
  3. Doing a proper warm-up and cool-down before and after activities – incorporate flexibility and stretching routines into your child’s training
  4. Wearing well-fitting, supportive shoes
  5. Allow your child to participate in a variety of sport and activities – avoid early sport specialisation
  6. Good nutrition & hydration – incorporate lots of variety and colourful, fresh foods into your child’s diet, and make sure they drink enough water
  7. And most importantly, if you notice any symptoms, or your child starts complaining about pain in their knee or heel, make an appointment with us as soon as possible. The earlier we address the problem, the better your child’s outcome will be.