Osgood-Schlatters Disease

Written by Carolina Vaccari

Osgood-Schlatters disease is an inflammation of the front part of the knee where the patellar tendon attaches to the top of the shinbone (tibia). This area is called the tibial tuberosity. It is more common among growing children and adolescents.

Athletic young people who play sports involving lots of jumping and/or running are more likely to develop the Osgood Schlatters condition. This type of physical activity puts additional stress on growing bones and muscles and it can predispose to the mentioned disease. However, less active children may also experience the same problem. while the child is still growing the tibial tuberosity is made of cartilage instead of bone. It is softer and less strong than the bone and high levels of physical stress might create pain, inflammation and swelling of this area.

Osgood-Schlatter disease typically occurs in boys between the ages of 12 and 14 years old and girls between the ages of 10 to 13 years old. This difference is related to the delay in starting puberty that boys usually present.

Most individuals will develop Osgood-Schlatter disease in one knee, however, some will present it in both. The condition usually resolves on its own, once the child’s bones stop growing.

Knee pain and swelling below the kneecap (at the tibial tuberosity) are usually the main indicators of Osgood-Schlatter. Tight muscles to the front or back of the thigh can also be found. The pain usually worsens during physical activities, such as running, jumping or kneeling and eases when the individual rests. When the tibial tuberosity is touched tenderness is usually appreciated and the patient refers to an increase in the pain.

The quadriceps ( thigh muscles) attach to the patella and when they pull on it, this increases the tension on the patellar tendon, which in turns pulls on the tibial tuberosity. Repetitive tractions of the latter leads to pain, inflammation and swelling and the tibial tuberosity can become very pronounced.

A repeated overuse and stress of the patellar tendon seems to be the main cause of Osgood-Schlatters Disease. Activities such as volleyball, gymnastics, basketball, football or athletics, which involve a lot of running and jumping can stress the knee and the muscles of the thigh even more, leading to development of Osgood-Schlatters.

A postural imbalance might also be a contributing factor for the Osgood-Schlatter condition. An imbalance may lead to an asymmetrical distribution of weight through the lower limbs and increase the stress of one knee more than the other.

Overall, several risk factors can be identified. They are:

• Sex. Boys are more likely than girls to develop Osgood-Schlatter disease.
• Age. Osgood-Schlatter is a condition that develops during puberty, when the bone growth is not completed and the cartilagine is less resistant and more easily deformable by the power of the patellar tendon. The condition usually occurs in boys between the ages of 12 and 14 and girls between the age of 10 and 13.
• Sports. Children who practice sports that involve running and jumping are more likely to develop the Osgood-Schlatters disease.
• Muscle tightness/flexibility. Increased tightness in the quadriceps muscles can increase the pull of the patellar tendon and consequently the stress on the top of the shinbone.

Osgood-Schlatters disease is a clinical diagnosis. The symptoms reported by the patient combined with a physical examination of the knee will be sufficient for making the diagnosis and usually radiographic evaluation is not necessary. However, the practitioner might suggest referral for other investigations to rule out additional diagnosis such as fracture, infection or bone tumor if the presentation is severe or atypical.

Osgood-Schlatter disease usually resolves without treatment once the child’s bone growth has finished. However, there are some precautions that can be taken in order to manage the pain and reduce the inflammation of the area. They include:

• Ice. Cold will help to reduce the swelling and the inflammation of the knee.
• Rest. Limit any activity that could worsen the condition if the pain is extremely limiting and severe.
• Stretching. Stretching the quadriceps will help to reduce the tightness of the muscle and reduce the stress on the patellar tendon.

• Manual Therapy. Hands on therapy may be used to help address any postural imbalance and release any muscular compensation which can increase the stress to the involved lower limb. Your therapist may also prescribe you specific exercises for helping you to recover faster. The treatment might therefore include both hand-on treatment and exercise prescription.
• Anti-inflammatory drugs might help to manage the pain when it is extremely severe, and will be prescribed by your doctor.
• Knee pad or strap. A knee pad or a patellar tendon strap can be worn when participating in sports in order to reduce the stress on the shinbone. They will not treat the disease, but they might reduce the pain experienced during the sport activity.

Osgood-Schlatters disease usually resolves when the bone growth finishes. Most symptoms will completely disappear when the bone development of the area completes, which is around the age of 14 for girls and the age of 16 for boys. According to this, surgery is rarely recommended. However, the prominence of the tubercle (the bone spur) will persist even though it will not be painful anymore.

While Osgood-Schlatter disease can not be prevented, there are some precautions that can be taken to reduce your risk of developing the condition. They include:

• Daily stretching. Stretching your quadriceps and hamstrings will help you to increase the flexibility and relieve pressure on the patellar tendon. It will also help you to reduce the risk of other muscular conditions, such as muscle tears.
• Resting. Taking a break from a sport or activity when you experience knee pain can help to reduce the inflammation.
• Wear the right shoes. There are supportive athletic shoes that can help with a better shock absorption.
• Choose a different sport. Other activities, such as swimming, reduce the risk of increased pressure on the knees.

Even though it is always better to rely on a manual therapist, for a specific and personal treatment plan, a good combination of general stretching and strengthening exercises can help to manage the Osgood-Schlatter disease and improve its symptoms.

Daily stretching of the leg muscles will help you to reduce muscular tension of the lower limb, as well as strengthening exercises will help you to stabilise the knee and avoid compensations. Stretching should include the stretching of quadriceps, hamstrings, iliotibial bands and calves.

Strengthening exercises should include:

• Straight leg raise. Lie on your back with your legs straight out in front of you. Bend the knee on your uninjured side and place the foot flat on the floor. Tighten the thigh muscle on your injured side and lift the leg about 20 cm off the floor. Keep your leg straight and your thigh muscle tight and hold for 5 seconds. Slowly lower your leg back down to the floor, relax and repeat it. Do around 2 sets of 15.
• Prone hip extension. Lie on your stomach with your legs straight out behind you. Tighten the buttocks and thigh muscles of the leg on your injured side and lift the leg off the floor about 20 cm. Keep your leg straight and hold for 5 seconds. Slowly lower your leg, relax and repeat it. Do around 2 sets of 15.
• Knee stabilization. Wrap a piece of elastic band around the ankle of your uninjured leg. Tie a knot in the other end of the band and attach it to a secure object, or shut a door on it to hold it in place.
  • Stand facing the door on the leg without the elastic band and bend your knee slightly, keeping your thigh muscles tight. Stay in this position while you move the leg with the elastic band straight back behind you. Do 2 sets of 15.
  • Turn 90 degrees so the leg without the elastic band is closest to the door. Move the leg with the elastic band away from your body. Do 2 sets of 15.
  • Turn 90 degrees again so your back is to the door. Move the leg with the elastic band straight out in front of you. Do 2 sets of 15.
  • Turn your body 90 degrees again so the leg with the elastic band is closest to the door. Move the leg with the elastic across your body. Do 2 sets of 15.
• Terminal knee extension. Tie the ends of an elastic band together to form a loop. Attach one end of the loop to a secure object, or shut a door on it to hold it in place. Loop the other end of the exercise band around the knee of your injured leg. Keep that leg somewhat bent at the knee. Put your uninjured leg about a step behind your injured leg. Then slowly straighten your affected leg by tightening the thigh muscles of that leg. Hold for about 5 seconds, then return to the starting position with your knee bent. Rest

Osgood Schlatters disease is not an emergency condition, therefore you do not need to visit your local hospital. However, the NHS website suggests that you should contact your GP if:

• The knee pain does not improve in a few weeks.
• Your knee locks, painfully clicks or gives way. Painless clicking is normal and it is not a reason of concern.