Article by John Miller
What is Osgood Schlatter's Disease?
Osgood Schlatter's Disease is a tibial tuberosity apophysitis, which is the medical name for inflammed bone at the site of the tibial tuberosity growth plate, in children.
Osgood Schlatter's disease is an inflammation of the bone at the top of the tibia (shin bone), where the tendon from the patella (kneecap) attaches. It is an overuse knee injury rather than a traumatic injury.
While Osgood Schlatter's disease is a relatively uncommon, it is a quite debilitating knee injury that occurs in young active children/adolescents.
What the Symptoms of Osgood-Schlatter's Disease?
Osgood Schlatter's disease presents in growing boys and girls as:
What Causes Osgood-Schlatter's Disease?
Strong repetitive quadriceps contractions are thought to cause a traction force on the tibial tuberosity, disrupting the immature bone. There is a higher incidence in active children during the adolescent growth spurt.
As a child grows, bones go through different stages of development:
Children are most susceptible to Osgood-Schlatter's disease when their bones are in the (2nd) apophyseal stage.
During this phase, the apophysis is unable to withstand high tensile forces. When presented with strong, repetitive muscle contractions, micro-fractures occur in the immature area. The separation results in symptoms typical of Osgood Schlatter's disease, as well as the irregular bone growth that explains an enlarged tibial tuberosity afterwards.
Another potential cause of Osgood Schlatter 's disease has been the lack of growth of the quadriceps in comparison to the femur. During a growth spurt in a child, the lengthening of the muscle is unable to keep up with the lengthening of the rapidly lengthening femur, resulting in an increased tensile force on the tibial tuberosity.
Who Suffers Osgood Schlatter's Disease?
Osgood Schlatter's disease usually strikes adolescents who are active during their growth spurts, which is the two year period where they grow most rapidly. Osgood-Schlatter's Disease is most common in boys but can affect either gender if the children are active. Tight thigh muscles also predispose you to Osgood Schlatter's disease. (de Lucena GL et al 2011)
The most prevalent groups are Boys: ages 11-15 years – Girls: ages 8-13 years.
Activities involving repetitive, strong quadriceps contractions, such as in jumping, running, volleyball, basketball, soccer, gymnastics, dance, netball and ice skating are most at risk.
Osgood Schlatter's Disease can normally be diagnosed without the need for further investigation.
Plain X-rays are commonly taken to rule out other conditions such as a tibial tuberosity fracture, malignancy, or infection. MRIs are not commonly used to confirm the diagnosis.
What is the Symptom Progression?
While a mild case of Osgood Schlatter's Disease can resolve within days, severe cases must be professionally managed to avoid growth plate damage. The pain and swelling symptoms can potentially last for years. Longstanding Osgood-Schlatter's Disease can result in an avulsion fracture of the patella tendon, which can severely affect your ability to walk or run.
Fortunately, Osgood Schlatter's disease is very successfully managed via physiotherapy.
Treatment for Osgood-Schlatter's Disease
Physiotherapy assessment and treatment is a proven benefit for Osgood Schlatter's disease sufferers. About 90% of patients respond well to non-operative physiotherapy treatment, but symptoms may come and go for 12-24 months before complete resolution. (Gholve et al 2007)
Consult with your physiotherapist for the best advice specific to your knee.
Ice & TENS Machine
A combination of ice treatment and a home tens machine will reduce pain and improve the healing rate. This usually hastens the recovery rate of sufferers. Ice is useful at home or after exercise.
Rest is important in the management of Osgood Schlatter disease and relief of pain.
Whether or not you should continue playing sport is dependent on symptoms. It is best to discuss your exercise workload with your physiotherapist for advice on how to best manage your return sport while respecting your injury.
Stretching, Massage & Foam Rollers
One of the common reasons for developing Osgood Schlatter's disease is excessively tight quadriceps muscles, ITB, hamstrings, hip flexors and calf muscles. Your physiotherapist will prescribe specific stretches for you if they assess that you are tight in these muscle groups.
Massage and foam rollers are beneficial especially in the early phase when stretches create pain at the Osgood Schlatter's disease site.
Your muscle control around the knee will usually need to be addressed to control or maintain your symptoms during the active phase of Osgood Schlatter's Disease. Your physiotherapist will commonly prescribe or modify exercises for you.
Foot Arch Control & Orthotics
Your foot biomechanics or arch control may be inadequate for your intensity of the sport. Your physiotherapist can assist both the assessment and corrective exercises for your dynamic foot control.
Active Foot Correction Exercises can be beneficial as both a preventative and corrective strategy. More information can be found here: http://bit.ly/1b8CxkF
Occasionally, your foot biomechanics may be predisposing you to torsional stresses that can cause abnormal knee forces, which can cause knee injury. In these instances, foot orthotics may need to be prescribed. There are mixed views on how effective these are since the foot structure is rapidly changing at this age. Ask your physiotherapist or podiatrist for advice.
Prognosis for Osgood Schlatter's Disease
Osgood Schlatter's disease is a self-limiting syndrome. Complete recovery can be expected with the closure of the tibial growth plate. Discomfort in kneeling may occur in the long-term with patients who have enlarged lumps as a result of the apophysitis.
Although symptoms of Osgood Schlatter's disease may linger for months, few patients have poor outcomes with conservative treatment, and surgical intervention is seldom necessary. Corticosteroid injections are not recommended due to case reports of subcutaneous atrophy.
For a thorough individualised assessment and professionally guided care for your Osgood Schlatter's disease please consult with your physiotherapist.
Common Treatments for Osgood Schlatter's Disease
For more information, please ask your physiotherapist or book your appointment for a thorough assessment and Osgood Schlatter’s Disease management.
FAQs about Osgood Schlatter's Disease
Helpful Products for Osgood Schlatter's Disease
Taping or a patella tendon support may provide pain relief and load reduction at the painful site.
Occasionally foot orthotics may need to be prescribed. There are mixed views on how effective these are since the foot structure is rapidly changing at this age. Ask your physiotherapist or podiatrist for advice.
Knee Ligament Injuries
Children's Knee Conditions
Other Knee-Related Conditions
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