Osgood Schlatter’s

Osgood Schlatter's

 

Article by J.Miller, Z.Russell, A.Clarke

What is Osgood Schlatter’s Disease?

Osgood Schlatter’s Disease is a tibial tuberosity apophysitis, which is the medical name for inflamed 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:

  • Local pain, swelling, and tenderness over the tibial tuberosity at the attachment of the patellar tendon.
  • Pain is experienced during exercise (e.g., running, jumping) or with a direct contact, such as in kneeling.
  • Stairs, squatting and kneeling may be painful.
  • Quadriceps weakness can be present is chronic cases.
  • Bilateral symptoms occur in 20-30% of cases.
  • The apophysis may be enlarged in later stages, which looks like a lump that is tender in its active phase.

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:

  1. The tibial tuberosity is initially cartilaginous (cartilaginous stage).
  2. It then enters the apophyseal stage when the secondary ossification centre (apophysis) appears.
  3. The unity of the proximal tibial epiphysis with the tibial apophysis marks the epiphyseal stage.
  4. Lastly, when the growth plates fuse, the bony stage has been reached.

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.

Investigations

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

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)

Knee Protection

  • Immediate restriction of high impact activities such as jumping and running.
  • Use an infrapatellar knee strap to dissipate forces away from the site of Osgood Schlatter’s Disease. An example of an Osgood Schlatter’s Disease brace can be found at this link: http://bit.ly/186YgaR
  • Kinesiology taping may provide both pain relief and load reduction at the site of pain and injury.
  • Only on rare occasions, severe Osgood Schlatter’s disease may require crutches.

Consult with your physiotherapist for the best advice specific to your knee.

Anti-inflammatory Treatment

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.

Functional Training

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.

Therapeutic Exercises

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.

Strengthening

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.

Common Causes - Knee Pain

Knee pain can have many origins from local injury, referred pain, biomechanical issues and systemic issues. While knee pain can appear simple to the untrained eye, a thorough assessment is often required to ascertain the origin of your symptoms. The good news is that once a definitive diagnosis is determined, most knee pain quickly resolves with the correct treatment and rehabilitation.

Knee Ligament Injuries

Knee Meniscus Injuries

Kneecap Pain

Knee Arthritis

Knee Tendon Injuries

Muscle Injuries

Knee Bursitis

Children’s Knee Conditions

Other Knee-Related Conditions

Knee Surgery

For specific information regarding your knee pain, please seek the assistance of a healthcare professional with a particular interest in knee condition, such as your physiotherapist.

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