It is very common for children to complain of knee pain, especially adolescents that are active in sports. If your child has knee pain that is restricting his activities, if he is unable to bear weight on the leg, or if his knee is red or swollen, then you should see your doctor for an evaluation. Some common causes of knee pain in children include:

• Parapatellar knee pain syndrome or chondromalacia patellae: children with this common condition usually have vague pain in both knees around the knee cap or patella. It is not known what causes the pain and x-rays and other testing will be normal. The pain is made worse by certain activities, such as running, jumping, doing knee bends, sitting for a long time, or climbing stairs and improves after a period of rest. Treatment consists of rest from any activity that regularly makes the pain worse, avoiding knee bend exercises (especially weight machines), and using an anti-inflammatory medicine such as ibuprofen. You can also do strengthening exercises, such as isometric quadriceps exercises (see below) and/or flexibility exercises.
• Osgood Schlatters Disease: This is another very common condition that occurs most commonly in adolescents who are very active, especially in activities that require running, jumping, or weight lifting. Children with this disease will have a tender bump near the top of their tibia (a bone in their lower leg), just below the knee cap. Pain in this area usually occurs after certain activities, with kneeling or if the bump is directly touched or banged. There is no treatment, except to try and improve the symptoms. You can try an ace wrap or knee pad to protect the area from being touched. Restriction of activities is only necessary if the pain is too severe to play through. The pain will go away with time (1-2 years), as the bones complete their growth process.
• Osteochondritis dissecans: this condition occurs because a fragment of bone forms for unknown reasons and can cause vague knee pain. Children can also have more severe pain, swelling of the knee, locking of the knee or it may cause the knee to give way. The diagnosis is made with an x-ray. While minor cases in younger children can be observed without treatment and may heal, in older children, or those with more severe symptoms, repair with arthroscopic surgery will probably be required.
• Patellar dislocation: the patella, or knee cap, becomes dislocated in children (usually girls) with this condition. While the knee cap usually easily moves back into place, it will probably continue to slip out of place without treatment, which consists of immobilization while the knee is extended for about six weeks and quadricep strengthening exercises (see below) for rehabilitation.
• Collateral ligament injuries: these occur most commonly in sport's injuries (especially soccer and football) when a force is applied to the inside or outside part of the knee. The medial collateral ligament is the most commonly injured. Ligament injuries can cause pain, bruising and swelling and will usually require an evaluation by your doctor to make sure there is no serious injury. Treatment for most ligament injuries consist of Rest, Ice, Compression and Elevation. The knee may also be immobilized for up to a week only, at which time physical therapy should begin to improve motion and begin strengthening exercises. More serious cases, or those that aren't quickly improving will need an evaluation by an orthopedic doctor.
• Cruciate ligament injuries: these also commonly occur with sport's injuries. The most common injury is to the anterior cruciate ligament (ACL), and follows a twisting injury during which your child may hear a pop. The knee will then quickly swell and she will most likely be unable to bear weight on it. Serious injuries may need bracing or surgical reconstruction. The posterior cruciate ligament can also be injured, usually following during a car accident, in which the knee is pushed into the dashboard, or if the knee is hyperextended.
• Meniscal injuries (torn cartilage): these also commonly follow a twisting injury during sporting events, but are uncommon in children under 18 years old. The injury does usually not seem very severe at first, but overnight, the knee may have significant swelling. If the knee is locked and your child can not straighten out her leg completely, then she will need to be seen by an orthopedic surgeon. More mild cases can be treated with rest and immobilization for one week, followed by physical therapy for rehabilitation.
• Fractures: the bones around the knee can become fractured from direct injury. Diagnosis will require an x-ray and an orthopedic surgery referral.
• Dislocated Knee: the knee can become dislocated if three or more ligaments are injured. This is a serious injury that requires immediate orthopedic surgery evaluation.
• Other: your child can also have swelling and pain in the knee from arthritis, especially Juvenile Rheumatoid Arthritis, from infections in the knee joint (septic arthritis), certain types of bone cancer, including osteogenic sarcoma, and referred pain from the hip, especially slipped capital femoral epiphysis.

Quadriceps exercises can help to strengthen the quadriceps muscle and consist of doing straight leg raises with increasing amounts of weight attached to the lower leg. An easy way to do this is to sit down on kitchen table or counter, fill a plastic shopping bag with about four pounds of weight (you can use real weights, cans of food, bottles of water, etc), place your lower leg through the bag's handles, and then slowly lift the weight and straighten out your leg. Keep the knee straight while you count to ten and then slowly lower it. Repeat lifting and lowering the weight ten times and repeat this exercise two to three times each day. You can slowly increase the amount of weight that you are lifting, up to about fifteen pounds at a time.

If you are in sports and have a coach or trainer, then you can ask them for help in performing these exercises, and may even give you access to weight training machines that simulate this type of exercise.

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