Bulletin of Orthopaedic and Neuromuscular Education Series

Knee Pain and the Benefits of Therapy

posted February 2nd, 2022

Knee pain has a wide variety of causes, symptoms, and treatments. Many children report knee pain as sharp or dull sensations while bending and performing daily movements. They sometimes have trouble walking or participating in their favorite activities and sports.

The cause could be from an injury or overuse such as repetitive jumping, running, or twisting.
Knee pain can also be related to weakness in the muscles surrounding the knee joint, instability in the ligaments and cartilage inside the knee joint, the bones inside the knee joint, the joints above and below the knee, or even a growth spurt.

Oftentimes, symptoms of knee pain can be addressed with exercises that can help to improve the strength and flexibility of the muscles surrounding the knee joint. Some knee pain may require a physical examination and even a diagnostic procedure such as x-ray imaging.

If your child has had a traumatic event or injury, you should visit an urgent care facility right away. Sprains, tears, and fractures will require different types of care and follow-up exercises. If your child’s condition is chronic, consult with your pediatrician or orthopaedic specialist prior to beginning these exercise routines. A consultation will provide a more in-depth evaluation of the child's impairments that may affect their daily activities and participation in certain movements within an exercise program.

If your child is complaining of pain and is having difficulty standing on the affected leg, try this basic knee exercise program. These exercise routines are general exercises commonly given to children with knee pain. The best exercises for your child would be provided by a pediatric physical therapist after an evaluation of their knee pain:

    1. Quad sets. This exercise helps to activate the quadriceps muscle, which can be under activated or weak with knee pain.
      Make It Fun! Place a small car underneath the knee and instruct them to try to squish it with their knee.
    2. Long arc quads. This exercise helps to strengthen the quadriceps muscle, which can be weak with knee pain.
      Make It Fun! Have them pretend to kick the ball while they are sitting and after 10 reps, they can throw it to you.

  • Clamshells. This exercise helps to strengthen the gluteus medius muscle, which can be under activated or weak with knee pain.
    Make It Fun! Have them touch a toy they like with their knees in that position 10 times and then they can play with it for 10 seconds.
  • Bridges. This exercise helps to strengthen the gluteus maximus and hamstring muscles, which can be weak with knee pain.
    Make It Fun! Tell them that they need to make a bridge with their bodies so that a doll or a car can pass through underneath them.
  • Hamstring stretch. This exercise helps to improve flexibility in the hamstring, which can be tight with knee pain.
    Make It Fun! Have them sing their ABCs or a song they like to you while you hold the stretch for them.

    • If your child is complaining of mild pain, has tried the above exercises for a few weeks and says they are too easy, and/or wants to try something more challenging, try this advanced knee exercise program:

      1. Sidestepping (with or without band). This exercise helps to strengthen the gluteus medius muscle, which can be under activated or weak with knee pain.
        Make It Fun! Have your child pick up puzzle pieces on one side of the room and side step to get to the puzzle on the other side of the room.
      2. Monster walk (with or without band). This exercise helps to strengthen the hip external rotator muscles, which can be under activated or weak with knee pain.
        Make It Fun! Have the child walk as if they are a monster to scare toys at the sides of the room.

  • Squatting. This exercise helps to strengthen the quadriceps muscle, which can be under activated or weak with knee pain.
    Make It Fun!! Use a cause and effect toy (i.e. ball in ball machine) and having the child pick up parts of the toy (ball) from the floor and put them inside the toy on a taller shelf (ball machine).
  • Step ups. This exercise helps to strengthen the quadriceps muscle concentrically, which can be weak with knee pain.
    Make It Fun! Have the child pick up a puzzle piece from the floor and put it on a puzzle that they have to get to through a step.
  • Step downs. This exercise helps to strengthen the quadriceps muscle eccentrically, which can be weak with knee pain.
    Make It Fun! Have the child go through an obstacle course where they have to step down from a stepstool in order to get to the end.

    • Frequently asked questions:

      • Why is my child’s knee hurting? Depending on the severity of the pain and length of time it’s been hurting, you should consider seeking a medical evaluation from your pediatrician or a pediatric orthopaedic specialist such Growing Bones Pediatric and Neuromuscular orthopaedic Institute.
      • What makes pediatric physical therapy different than adults? Because we’re treating kids, pediatric physical therapy tends to take a play-based exercise approach rather than a sets and reps exercise approach that is typically used for adults. This helps to engage children, so they want to come back and play more.

  • Why should I choose a pediatric certified care team versus my regular doctors and therapists? A pediatric certified care team regularly sees children and their families, whereas your regular doctors and therapists may not. This means that pediatric certified providers are skilled to communicate with children and their families and use play to engage your children.
  • What qualities/skills should parents & doctors look for when assessing if they should work with a PT? Parents and doctors should look for a PT who loves to work with children and who takes the time to answer all of your questions. It’s important that you trust that the PT you are working with is the PT that will help your child reach their highest potential.
  • How do I encourage my child to perform these exercises consistently? Exercising can feel like a chore to your child, especially if there is any pain associated with the movements. Make time to help your child and perform the exercises together. Personalize the
    Make It Fun! suggestions by incorporating their favorite songs, television shows, and toys.
  • How do I know if my child should perform the basic or advanced exercise routine? I would recommend starting with the basic exercise routine, especially if your child is having difficulty standing on their affected leg or has not tried moving their knee too much since it started hurting. If your child is complaining of mild pain, has tried the basic exercises and says they are too easy, and/or wants to try something more challenging, try the advanced knee exercise program instead. If all the exercises in the basic routine are uncomfortable, painful, or are not helping to improve symptoms, make an appointment with your physical therapist or orthopaedic specialist.
  • Should I stop my kid from moving if it hurts? Initially, you should apply RICE (rest, ice, compression, elevate) especially if there is bruising or swelling; however, as your child can tolerate, you can allow your child to try moving and see how they respond to movement. If their range of motion does not improve and their pain worsens you should consult your pediatrician or orthopaedic specialist right away!
  • How long will we need to perform exercise routines before should I expect before I start to notice some improvement in my child’s symptoms? When is it time to stop Physical therapy or home exercises? Try these home exercise routines or physical therapy sessions with concurrent home exercises consistently for at least 4 weeks before you expect improvements in your child’s symptoms. It does take about 6-8 weeks of consistent strengthening exercises for strength gains to see improvement. A physical therapist is typically in charge of the decision to stop physical therapy. When a physical therapist graduates a patient from physical therapy, the goal is that the patient is independent with a home exercise program to prevent recurrence, you should expect your child to perform home exercises even after physical therapy sessions are over.
  • When should I go see a specialist like Growing Bones Pediatric and Neuromuscular orthopaedic Institute? If there’s an inability to stand on the leg, the pain is not improving over time, and/or you have other concerns about the child that are affecting their knee pain.