Osgood-Schlatter’s disease is a painful knee condition affecting adolescents between the ages of 10-14 years old. It mostly occurs in children who are very active and participate in sports with lots of running and jumping such as basketball, netball, soccer, football, sprinting and gymnastics. It is especially common in children who are having a growth spurt.
What Is Osgood-Schlatter’s Disease
Osgood-Schlatter’s disease is a painful knee condition where pain is felt at the top of the shin bone, just a little under the kneecap, and can be associated with a prominent swelling or firm lump in this area. The knee consists of the femur (thigh bone), tibia (shin bone) and patella (knee cap). The quadricep muscles at the front of the thigh form into the quadricep tendon which then crosses over the patella. Once the tendon crosses over the patella it turns into the patella tendon and attaches to a bony bump at the top of the shin bone called the tibial tuberosity. When the quadricep contracts, it pulls on the tibial tuberosity to straighten the knee.
During a growth spurt your bones, muscles and tendons change rapidly. Osgood-Schlatter’s disease occurs due to excessive pulling of the quadricep muscle through the patella tendon where it attaches to your tibia at the tibial tuberosity. The growth plate in this area is very active during adolescence as the tibia grows rapidly, and it is less able to withstand these excessive pulling forces. This relatively fast bone growth is often associated with tight quadriceps muscles, which causes a greater pull on the growth plate around the tibial tuberosity causing inflammation and micro-fractures.
Why Does Osgood Schlatter’s Disease Only Occur In Adolescents?
Because the growth plate is active during adolescence, especially during growth spurts, it is less able to take the strong pull of the patella tendon where it attaches to the tibia at the growth plate. Once we reach skeletal maturity (i.e. we stop growing), our growth plates fuse over to become solid, and therefore they are able to withstand the strong pulling forces of the patella tendon attachment. This is why Osgood-Schlatter’s disease only occurs in adolescents.
Symptoms of Osgood-Schlatter Disease
– Pain with straightening the knee
– Pain with full squatting or lunging
– Painful when running and jumping
– Pain eases with rest
– Swollen tibial tuberosity
– May have a visible lump
– Pain with palpation (pressing) of the tibial tuberosity
Treatment of Osgood-Schlatter’s
Activity modification, or “Load Management”, is the most important part of treatment for Osgood-Schlatter’s. Basically, this means re-balancing the ratio of load (activity) to recovery (rest). By reducing the amount of sport that the child is doing and allowing more rest (recovery) time, the tibia is able to repair the micro-trauma caused during loading and so the pain settles down over time.
The amount of reduction in loading that is needed depends on the severity of the condition. In severe cases the pain may require an initial period of complete rest from aggravating activity (although non-painful cross-training should be performed), followed by graded re-introduction of load and activity. But in most cases some level of the child’s normal sports can continue, and the volume of activity can be monitored and gradually increased depending on the level of symptoms. Activity that is not painful should be continued, for example going to training and participating in non-painful drills that don’t involve running or jumping should be encouraged. The most common strategy is to limit any running outside of sport, however if the pain is causing a limp then you may need to fully rest from sport for an initial period.
How Long Does Osgood Schlatter’s Take To Get Better?
With the right treatment, load management and monitoring you should notice a reduction in symptoms within 6-12 months. This may sound like a long time, but remember that continuing to participate in sport and activity that is not too painful is fine – as long as your symptoms level is acceptable. You can discuss what is an “acceptable” level of symptoms with your physio.
Ongoing monitoring and adjustment of activity levels is the most important management tool while the condition settles down. If not managed properly, the knee can remain painful until growth finishes.
During this time, a strengthening program is very helpful to improve the strength and resilience of the muscles around the knee. This will allow for the knee to tolerate more of the demands of sport, leading to a smoother return to competition when pain reduces and will also improve sports performance by retaining strength and conditioning. An active recovery is very important for Osgood-Schlatter’s to ensure you are able to return to sport as fast as possible and reduce the effects of time away.
Stretches For Osgood-Schlatter’s Knee Pain
Stretching can also be helpful in settling down knee pain associated with Osgood Schlatter’s. When we grow we often create relative tightness in large muscle groups like our quadriceps, calf and hamstrings, so a basic stretching program targeting these muscles can help in the treatment of Osgood-Schlatter’s. The strength and length of stretching can vary across different people with different injuries, so check with your physio or trainer to get on the right program for you. Ice and nonsteroidal anti-inflammatories may assist in reducing pain and swelling.