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Shannon Snodgrass PT, Rehab One

Anterior knee pain is common during basketball, volleyball and track seasons. The repetitive jumping and running that occurs when playing these sports may cause a series of problems. The sources of anterior knee pain are most commonly: patellar tendonitis or Jumper's knee, patella femoral syndrome and Osgood-Schlatter disease.

Patellar tendonitis

Athletes suffering from this ailment usually have pain at the lower end of the kneecap or patella where the patellar tendon inserts. Tenderness and swelling may be present around the tendon. Symptoms increase with jumping, especially on landing. Pain often increases during physical activity and decreases during rest.

Treatment generally consists of an aggressive lower extremity flexibility program, ice and curtailing activity as pain dictates.

Several off-the-shelf orthopedic devices, such as the Cho-Pat strap and/or Levine strap, allow athletes to participate in sports activities with fewer complaints.

Patella Femoral Syndrome

(Chondromalacia)In general, this term refers to damage to the undersurface of the kneecap, patella or femoral groove. Pain usually occurs when running, going up and down stairs, sitting, squatting, bicycling or bending the knee beyond 90 degrees. Pain may also occur when running downhill or when runners increase mileage.

For those suffering this syndrome, the patella may not move or track normally along the femoral groove when the knee bends. That is why some athletes report a "creaking" kneecap.

Causes may include an increase in activity, abnormal bone or joint structure, muscle imbalance or poor flexibility.

Treatment varies but may include an aggressive flexibility and stretching program, quadriceps strengthening program, ice and/or anti-inflammatory medication.

A rubber knee brace or neoprene sleeve is sometimes recommended to assist with the patella femoral joint tracking problems.

Osgood Schlatter Disease

Osgood Schlatter Disease is an extremely common source of sports disability. Classic cases are found in children, preteens or early teenage groups. Activity related discomfort, swelling and tenderness at the tibial tubercle readily suggest this diagnosis.

Boys are more commonly affected than girls, although Osgood Schlatter disease is now being seen more frequently in girls - a reflection of the increased level of female sports participation. Girls tend to develop the disease at an earlier age (11 to 13 years old). Boys tend to develop symptoms between the ages of 12 and 15.

Symptoms usually begin during rapid growth at the time of tubercle maturation. The patient usually complains of pain at the tibial tubercle which is the bony landmark at the distal end of the patella. The pain is generally intermittent and aggravated by jumping, squatting and kneeling. The patient rarely becomes sore enough to interrupt routine daily activities. There is usually exquisite tenderness, prominence and swelling at the tibial tubercle.

Many authors suggest that Osgood Schlatter disease has two presentations. Type 1, characterized by soft tissue swelling, tends to be x-ray and clinically normal with time. Type 2 includes x-ray evidence of fragmentation of tibial tubercle and may cause persistent symptoms as well as bony abnormalities.

Treatment for Osgood Schlatter disease is generally non-operative. The athlete and family must understand that it may take 12 to 18 months for symptoms to resolve. Treatment with ice, anti-inflammatory medication and a properly contoured knee pad is generally believed to control symptoms. Maintaining knee motion with hamstring and quadriceps flexibility exercises during the child's rapid growth phase is also very helpful. Sports activities should be balanced with pain tolerance and symptom severity.

Coaches, physical education instructors and parents must appreciate the unpredictable variability of symptom intensity. Sports requiring prolonged squatting or kneeling (i.e. baseball catcher) may not be tolerated. Changing playing position (move from catcher to second base) may be necessary. If symptoms progress to disability and prevent routine daily activity, a brief period of immobilization from 7 to 10 days may help. Athletes and parents should be educated to the fact that the tibial tubercle may enlarge - even after symptoms subside.

Any knee disease or symptoms in an adolescent should be evaluated by a physician, or physical therapist for a referral to a medical specialist.

For further information call 304-369-5719.

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