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Knee'd to Know

School nurses are well aware of the active nature of kids. Whether it's recess, PE, physical play in the hallways, or athletics participation, students are always jumping, running, scrapping, and moving in every way. But a child's knees are more susceptible to injury from accidents or sports than one might think. In fact, there are an estimated 2.5 million sport-related knee injuries in children and adolescents each year. That's why understanding the nuances of knee pain is essential for school nurses, from minor injuries to more serious conditions; equipped with the knowledge to support and guide students with knee pain effectively can help ensure they remain active and healthy. 

Common Causes

The knee, being the largest joint in the body, comprises several crucial and intricate structures. Any injury to this joint, especially for children and teenagers who are still in their growing phase, can result in both immediate and long-term harm. Knee pain in children can arise from a variety of causes, ranging from acute injuries like sprains and strains to overuse injuries and, more rarely, from systemic diseases like juvenile arthritis. Common conditions leading to knee pain in students include: 

Patellar Instability: Dislocation or subluxation of the patella can lead to significant knee pain and is often related to physical activity. 

Osgood-Schlatter Disease: This condition is characterized by pain and swelling just below the knee, where the tendon from the kneecap attaches to the tibia. It is most common during pre-adolescent growth spurts. 

Patellar Tendonitis: Overuse of the knee, particularly in sports that involve jumping, can lead to inflammation of the patellar tendon, also known as jumper's knee. 

Patellofemoral Syndrome: Prevalent in female athletes, pain from patellofemoral syndrome presents as anterior knee pain and is typically associated with an inability of the knee tissues to fully adapt to the overload from activities such as running, jumping, and squatting. 


Initial assessment of knee pain in the school setting should include a focused history and physical examination. School nurses can gather valuable information by asking about the pain's onset, location, nature, associated symptoms (e.g., swelling, locking, popping), and any recent injuries or activities that might have triggered the pain. Observing the student's gait, assessing range of motion, and noting any signs of inflammation are also key components of the physical assessment. 

Management & Intervention

Rest, ice, compression, and elevation (RICE) are generally the first steps in addressing acute injuries. Over-the-counter pain relievers may be recommended, but it is essential to have appropriate orders and parental consent in place before administering any medications. Students may need additional support, including elevator access, excusal from certain activities, or other accommodations. If the pain is persistent or frequent, it's important to have documentation from a healthcare provider outlining the plan of care and necessary school supports. 

Referral and Follow-Up

Understanding the various causes of knee pain can help school nurses provide focused interventions in the school setting and informed guidance on appropriate follow-up. Severe discomfort, swelling, deformity, instability or weakness, chronic complaints of knee pain, "popping" or "clicking" sounds from the knee, or if a student cannot bear weight or demonstrate full range of motion in the knee, are all signs and symptoms that further evaluation is warranted. 

'Wrapping' it Up

In a world where the whirlwind of childhood is filled with leaps, sprints, and somersaults, knee pain can suddenly slam the brakes on fun. But it doesn't have to be an end to the adventures that await. By understanding the roots of knee pain and providing guidance on care and appropriate follow-up, school nurses hold the power to bring relief and safeguard those youthful knees against the trials of tomorrow. After all, healthy knees in kids pave the way for a lifetime of unlimited exploration, endless play, and the pursuit of their wildest passions.

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