It was not long after my daughters 10th birthday that she started to complain casually of pain in her right knee. Because Sarah* was active in sports but had no apparent injuries, I initially thought that her discomfort was nothing more than growing pains. After several months, I noticed that my daughter had gone through a significant growth spurt and appeared much taller than her peers. Sarah continued to complain of right knee pain that seemed to be associated with activity or sports, and she developed a limp whenever she ran.
As the months passed, we noticed a tender lump just below Sarahs right knee, and she started to express frustration about the pain and discomfort she felt when she played soccer. Sometimes, Sarah would ask the coach to take her out of a game because she was having trouble running or bending down to get the ball. At that time, I also noticed that my daughter was occasionally having difficulty when she climbed stairs. As her mom and as a nurse, I felt that the situation was more than just growing pains.
We visited the pediatrician and discussed Sarahs symptoms, and she did a complete examination of my daughters knee. Based on our talk and the assessment, the pediatrician said she believed that Sarah probably had Osgood-Schlatter disease (OSD), a common cause of knee pain in active children and adolescents. Although I have been an RN for many years, I knew very little about the disease. An X-ray was done to confirm our pediatricians diagnosis and to make sure there was nothing more serious going on in or around the knee. The results were consistent with OSD.
So little known
After we confirmed the diagnosis, I learned that OSD is not really a disease, but rather a benign, painful, condition or injury of the knee from overuse. It can affect one or both knees and is characterized by pain, swelling, and tenderness below the knee, which was what Sarah had been experiencing for several months (http://www.stnicholashospital.org/newsweeklyosgood_schlatter.htm).
OSD is caused by inflammation of the tendon below the kneecap (patella tendon), where it attaches to the shinbone (tibia). During an adolescent growth spurt, bones can grow more quickly than muscles and tendons. When someone has OSD, there is a tightening or pulling away of the quadriceps muscle from the shinbone as it contracts, resulting in pain and swelling (www.familydoctor.org/online/famdocen/home/children/parents/special/bone/135.html).
The disease occurs most often in growing adolescents and is seen in both boys and girls, particularly in those who are active in sports or who overuse their knees. It is more commonly seen in boys from the ages of 13 to 14; OSD usually occurs in girls from the ages of 10 to 11. Severity of symptoms varies from person to person (http://www.kidshealth.org/PageManager.jspdn=familydoctor&lic=44&article_set=21001). Sarahs symptoms would come and go and would range from mild to severe, but they were always directly related to how active she had been at the time.
When my daughter was experiencing a moderate amount of pain, she was usually limping. We realized that living with OSD can be extremely frustrating, and symptoms can last up to 24 months or longer. We felt some relief when Sarahs pediatrician explained to us that it is a temporary condition and symptoms usually subside once the childs bones have finished growing.
Management and supportive care
Although I was happy to learn that OSD was not a life-threatening condition, I was still concerned about Sarah getting relief from her pain and from her frustration. The pediatricians advice was for Sarah to take ibuprofen and to limit the amount of physical activity until she felt better.
When I heard these instructions, I thought to myself, Is that it? The physicians recommendations seemed like an easy cure for such an annoying and disruptive condition. Sarah was experiencing mild to moderate pain on a daily basis. Certainly, it helped when she temporarily avoided activities that aggravated her knee.
OSD is a condition that does resolve itself without formal treatment, and surgery is rarely needed. However, it is critical to control the pain and inflammation that accompanies the disease. After some investigating, we discovered four simple and conservative steps that can help alleviate symptoms rest, ice, compression, and elevation (RICE) (http://family doctor.org/online/famdocen/home/children/parents/special/bone/135.html).
RICE includes the following conservative treatments
Rest the knee and avoid activities that cause pain
Ice the knee 3 to 4 times a day for several minutes
Compress or wrap the knee for support
Elevate knee to reduce swelling
Although there is no magic cure, a conservative treatment plan has proved to be helpful in managing my daughters symptoms. In addition, before any games, Sarah follows a 30-minute routine of stretches and warm- up exercises, and she wears a knee brace for support.
With approximately 30 million children and adolescents in the U.S. participating in organized sports each year, it is no surprise that OSD is so common. Sarah will continue to live with OSD and participate in sports when she is able. As Sarah continues to grow, I will monitor her pain and progress, because we anticipate that Sarah will be dealing with the symptoms of OSD for some time to come.
*Name has been changed.