Understand the Knee Pain at a Young Age?

A few years back it was a pretty common thing to have age-related knee pain in adults over 50-55 years. But in recent times, due to a sedentary lifestyle and strenuous workout over a shorter period, it is not uncommon to find young adults suffering from knee pain.

Though the symptoms are more or less similar i.e knee pain, the spectrum of the
conditions affecting the knee is vast. Most often the knee pain in young adults is
associated with OVERUSE injuries. It’s due to repetitive straining of the muscles,
ligaments, and cartilage around the knee in strenuous exercises. Other traumatic
injuries like ligament, meniscus, and cartilage injuries lead to sudden onset pain.

A. Overuse Injuries

• Patellofemoral syndrome (Runner’s knee)
• Osgood-Schlatter’sdisease
• Patellar tendinopathy (Jumper’s knee)
• IT band syndrome
• inding-larsen johansson syndrome
• Hoffa’s disease
• Bipartite patella

B. Other causes

• Hyper-laxity
• Flatfeet
• Vitamin D3 Deficiency
• Arthritis

Patellofemoral Syndrome (Runner’s Knee)

It is characterized by pain around the knee cap. It is seen in the individuals who frequently strain their knee or ramp up the activities in a shorter period without being getting adapt to it. It is commonly found in Joggers, trekkers, and cyclists and hence the name.

As such no specific treatment is required. Break from workout or sport and gradual strengthening exercises of knee and core are part of initial management. The most important factor to prevent a similar episode in the future is a gradual adaptation to the specific workout or sport.

Osgood-schlatter Disease

It is osteochondrosis or traction apophysitis of the tibial tubercle secondary to repetitive extensor mechanism stress following the activities such as jumping and sprinting. It is a common cause of anterior knee pain in the skeletally immature population playing the following sports:

• Basketball
• Volleyball
• Football
• Sprinting
• Gymnastics

The classical presentation is anterior knee pain and tenderness at the insertion of the patellar tendon over tibial tuberosity. It is a self-limiting condition. Initial management includes ice, NSAIDs, activity modification, and relative rest from the sports. Further starching and strengthening program is essential to overcome the underlying biomechanical factors. In certain cases, recovery could get delay and lead to a prolonged break from the sports.

Patellar Tendinopathy (Jumper’s Knee)

It is a painful condition seen in individuals playing sports like basketball, volleyball, long jump, and skiing which require frequent jumping, landing, acceleration, deceleration, and cutting. Frequent eccentric loading of the extensor mechanism leads to micro-tears in the patellar tendon at the inferior pole of the patella. Treatment is mainly conservative. Initial management includes relative rest and NSAIDs. The muscle strengthening program is important for the restoration of the functions. Surgery is used as a last resort.

IT Band Syndrome

It is one of the many causes of lateral knee pain in young adults involved in long-distance running, cycling, and skiing. The etiology is not clear. There are many possible reasons for this condition like friction between the IT band and lateral femoral epicondyle, compression of the fat pad, and bursitis.

Initial management includes cryotherapy and rest. Physical therapy is focused on myofascial release, ITB stretching, and Hip abduction strengthening. At the same time, ergonomics and proper training posture form an important part of rehabilitation.

Sinding-larsen-johansson Syndrome

It is seen in adolescents between 10-14 years of age playing football, running, volleyball, and gymnastics. Clinically it is characterized by pain over the lower pole of the patella, which increases in intensity on knee flexion. Like Osgood-Schlatter’s disease, it is also a traction apophysitis but of the lower pole of the patella. Apart from rest, NSAIDS & bracing, stretching and muscle strengthening are important.

Hoffa’s Disease

Hoffa’s disease is an inflammation of the infrapatellar bursa due to micro-trauma following hyperextension and rotational strain at the knee. The weakness of core muscles further accentuates the strain at the knee. It is commonly seen in the dancers, runners, badminton, and tennis players.

It is managed conservatively by relative rest and strengthening of knee and core muscles. Arthroscopic resection is done in refractory cases.

Bipartite Patella

It results from the failure of ossification centers to unite which leads to the fibrous non-union of the fragment and rest of the patella. It is usually an asymptomatic and incidental finding. But it could be one of many causes of anterior knee pain in an adolescent following overuse or strenuous activity or maybe an acute trauma. Mostly it is managed conservatively. Surgical management is kept reserved for failures.

Hyper Laxity

It is defined as looseness or increased range of motion of joints. It is common in the young population especially females and associated with the increased incidence of joint pain and soft tissue injury especially ACL. Treatment includes improvement of muscle strength and proprioception.

Flat Feet

It is characterized by the flattening of the medial longitudinal arch support of the foot. It is seen commonly in children due to laxity of the muscles and ligaments but its prevalence decreases with age.

Flatfeet lead to increased impact on the foot while walking and running which in turn causes an increased incidence of foot pain, plantar fasciitis, knee pain, low back pain, and foot injury. The management is usually conservative with Medial arch support and strengthening exercises of the foot and ankle.

Vitamin D3 Deficiency

Due to modern lifestyles and inadequate exposure to sunlight, our population is deficient in vitamin D3. A low level of Vitamin D3 causes rickets in children & osteomalacia in adults. It is a major cause of joint pain, muscle pain, and muscle fatigue in adults. Scientific data also supports its association with osteoarthritis of the knee. Sun exposure leads to the synthesis of Vitamin D3 in our body. Dietary sources are very few. The best way to fulfill the demand is by taking supplementation after medical advice.

Arthritis

Following conditions alter the kinematics of the knee joint and lead to early arthritis which is one of the many causes of knee pain at a young age.

• Ligament, meniscus & cartilage
  injury
• Flat feet
• Hyper laxity
• Vitamin D deficiency
• Knock knee or Bowlegs

Treatment is mostly conservative in the form of lifestyle modification and strengthening exercises except for the complete tear of ligaments, meniscus, and cartilage injury where surgical management is required.