Doctors called the signs of dangerous knee pain in the child

Knee pain in children is a common complaint. In most cases, these are growing pains or the effects of exercise, but it is important not to miss the inflammatory disease. On October 19, Nadezhda Shulpina, a rheumatologist, deputy chief physician of Olympus Clinic MARS, and Peter Sokov, a neurologist, surgeon, and pain specialist at the Scandinavian Health Center, told Izvestia about how to distinguish the norm from the disease and when to see a doctor urgently.

Growing pains or inflammation

According to Shulpina, growing pains usually occur in the evening or at night, they often wake up the child, but they completely disappear in the morning. They are localized in the muscles of the legs and thighs, rather than strictly in the joint, more often bilateral and symmetrical, not accompanied by swelling, redness or morning stiffness.

During the day, the child runs and plays normally, the pain decreases after massage, warmth or stretching. The inflammatory disease, primarily juvenile idiopathic arthritis, is characterized by morning stiffness, morning lameness, swelling and swelling of the joint, and persistent symptoms for more than six weeks.

Sokov added that growing pains exist, although the name itself can be considered a myth: the peak of complaints does not coincide with the periods of the fastest growth, and the exact cause is unknown. They are most often found in children from three to twelve years old. If the picture is typical and the examination is without deviations, tests and scans are usually not required.

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When you need an urgent visit to the doctor

Inability to step on a foot or severe lameness, severe swelling, redness and local heat of the joint, high fever along with joint pain, acute intense pain, especially after injury, severe restriction of movement or joint blockage, a combination of pain with rash, fever and weight loss, persistent morning stiffness and swelling — cases when you need to immediately ask for help.

In addition to growing pains and arthritis, Shulpina listed other conditions. Osgood-Schlatter disease is typical for active adolescents aged 10-15 years: pain is strictly below the kneecap, it increases when jumping, there is no morning stiffness.

Transient synovitis more often affects the hip joint in children 3-10 years old after a viral infection and resolves in one to two weeks. Septic arthritis is an urgent condition with acute pain, swelling, a hot joint, and fever. There are also reactive arthritis, injury, hypermobility, and Perthes disease.

Is it possible to exercise and when surgery is needed

Shulpina emphasized that complete rest in case of joint inflammation is harmful: it promotes contractures and muscle atrophy. During the period of exacerbation, shock and high-intensity loads are limited, but they maintain gentle activity: swimming, cycling, walking, yoga, pilates, physical therapy. In remission, many children return to their usual activities, but the decision is made together with the rheumatologist.

According to him, with growing pains, there is enough warmth and massage after an active day, the sections do not need to be canceled. In Osgood-Schlatter disease, the load is temporarily reduced by removing jumps and sprints, then gradually increased. Insoles for flat feet without pain are usually not needed, in case of pain they can be prescribed for trial along with exercises.

Surgery for knee pain in children is rarely necessary, mainly for dissecting osteochondritis or loose bodies in the joint. Intra-articular corticosteroid injections are included in the treatment of juvenile arthritis, which is handled by a pediatric rheumatologist.

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How to strengthen a child's joints

Sokov believes that joint health is built in childhood, and three things work here: movement, weight, and nutrition. A child needs about an hour of activity per day, and at least three days a week it should include loads that strengthen muscles and bones. It is better not to gain extra pounds, as overweight children are more likely to have knee pain.

Shulpina also recalled the importance of early diagnosis. If arthritis is suspected, ultrasound of the joints, MRI, and laboratory tests are used. However, normal tests do not exclude arthritis: with the oligoarticular form, ESR and CRP often remain normal, so the diagnosis is based on examination and visualization. The earlier treatment is started, the higher the chance of maintaining joint function.