There is no doubt in my mind that everybody is noticing the change/transition that is happening with children and the youth of today. We can obviously come from many different angles with regards to that statement but I will stick with the main attraction and why I will be busy for years to come. POSTURE and PAIN. The quantity of children and young athletes seeing practitioners with increased and constant knee pain and instability, foot and ankle pain and instability, Osgood Schlatter syndrome, Sever’s disease (calcaneal apophysitis) and even hip and back pain has increased immensely.
As an Exercise Physiologist that has worked with improving biomechanical integrity and reducing pain associated with growth issues and excessive training load with many young athletes I have noticed a certain trend with this increase of pain and postural issues. I would love for you to be standing in front of me so I could paint you a great word picture but instead I will do my best through these words.
TENSION and PAIN associated with muscular insertion points: there is one common theme between the two syndromes or diseases stated above (Osgood Schlatter and Sever’s) and that is the basis of them being insertion points for muscles or muscle groups.
Osgood Schlatter’s: The tibial tuberosity is that little bony prominence below your kneecap (patellar) that your patellar tendon inserts into. The point of the patella is to increase the leverage that the tendon can exert on the femur by increasing the angle at which it acts. What it also does is act as a midpoint between the tension of the quadriceps group of muscles (the front of your thigh) and the tension of the patella tendon which inserts into the tibial tuberosity (remember that bony bit where children with Osgood Schlatter’s feel pain). Therefore any change in the pulling of the patella and the amount of load it has taken (whether through sport or otherwise, even sitting too long) will result in tension acting on its insertion point. In simple terms, the quadriceps muscle length has been reduced past the optimal length or the tension has become quite high which causes pain at its insertion point.
So how do we fix this:
UNDERSTANDING THE CAUSE: There are a few great ways of fixing this conservatively and without spending hundreds of dollars to continuously see a practitioner so they can prod and poke the area and possibly strap it. With any chronic inflammatory condition (not caused from an impact or immediate injury), it has taken a decent period of time for tension to rise to a point where the individual feels pain or it is evidently swollen. There is nothing more beneficial than educating and empowering the individual to control their own pain and discomfort, in conjunction with the fact that everyday reminders to your body to reduce tension and increase range of motion are more beneficial than the once per week visit to a practitioner (and much less expensive too).
HOW TO FIX THIS: a combination of conservative therapy and active therapy (dependent on severity of pain and phase of issue) including:
ice for immediate pain relief and reducing inflammation,
natural topical anti-inflammatory (arnica, melaleuca, hypericum or my personal favorite Fisiocream which has all of these one place, otherwise the old school TigerBalm is very good)
specific muscle tension relief through foam rolling or trigger point/muscle release balls (or use a tennis ball or lacrosse ball but never work directly work on the site of pain),
specific mobility techniques (taught by a practitioner)
If necessary some kinesio or rock tape to assist
LONG TERM STRENGTHENING and CHANGES:
UNDERSTANDING THE LINKS: The body is an incredible unit of many pulleys and levers that influence above and below the actual cause of an injury. In other words that headache you might get is not usually caused by you sore neck and shoulders, it is caused by your chest muscles pulling your shoulders forward that influences your shoulder position and shoulder blade (scapula) positioning which therefore moves your head forward (every centimetre your head moves forward is between 6-10kgs of extra load to your muscles) to compensate for this displacement which loads up your neck muscle and mal-aligns the cervical spine which causes a neurological/muscular painful response such as a headache. Simple to understand right?
SPECIFIC LINKS: to control and reduce knee tension and loading through insertion points will be individualised dependent on sex, age, activity and many other factors but just so you can appreciate the intricacy of the human body; I have listed some below.
Muscles surrounding hip joint and external rotators of hip joint directly influence the down-stream loading of your knees and of course your ankles. In other words, if your muscles around your hips aren’t working properly or strong enough to support you during certain movements then pressure gets sent downwards (and upwards but that’s for later) to your knees.
Increasing proprioception and control of small intricate muscles surrounding your knees that influence pressure and load distribution.
Strengthening up the back of the leg (hamstrings and glutes) to ensure the knee joint is aligned properly. Remember we are just a bunch of pulleys and levers.
Ensuring utmost range of motion and joint integrity throughout all movements necessary in life (squatting like a baby, lunging etc)
Ankle stability and strength to assist the distribution of weight travelling upwards towards the knee and hip. The foot and ankle are our first point of contact with the ground and hence influence distribution immensely.
Tension release and understanding range of motion benefits through techniques such as foam rolling, remedial massage balls and tension reducing tools.
Footwear is also a huge factor during the activities that might be causing pressure and load distribution not as optimally as one would like
So that is just the knee for today. Whether your child is running, jumping, sprinting, squatting, hiding, seeking or doing any form of activity that involves their knees (maybe even sitting playing video games for too long) then the information explained above will be really important to them in the coming years as they grow. If you would like some more information or a specific assessment of your child, children or even yourself if you are experiencing any pain or discomfort that won’t leave you alone then contact one of our Exercise Physiologists that will provide you with what you need. Look out for the next blog of the POSTURE DEVELOPMENT and PAIN REDUCTION FOR CHILDREN AND YOUTH: how to do it right. Part 2 on the foot and ankle.