Osgood Schlatter’s Disease
Updated: Jul 26, 2019
In today’s blog we are going to be discussing a particular type of knee pain that affects children and adolescents known as Osgood Schlatter’s disease.
Osgood Schlatter’s disease is a common problem that can affect the younger population during growth spurs and puberty and is usually felt on the bump (tibial tubercle) at the front of the knee.
The tibial tuberosity is a bony prominence located on the proximal anterior surface of the tibia. It is the attachment point of the quadriceps muscle via the patella tendon.
Growth plates are a special area in children and adolescents’ bones where growth occurs. It is made of cartilage and once puberty/bone growth ends the growth plate’s close and hardens into solid bone.
During a growth spurt bones and cartilage grow much quicker than muscles and tendons. The delayed growth of the quadriceps muscle and patella tendon increases the load/force on the tibial tuberosity, as the bone increases in length, but the muscle is unable to adapt at the same speed.
The increased force creates microtrauma, to the bony insertion, causing pain and inflammation and may result in micro avulsions or avulsion fractures, where part of the bone is pulled away by the tendon. Physical activity including, but not limited to, running, jumping, stairs and squatting can exacerbate the symptoms as they create additional forces on the area.
Other symptoms of Osgood Schlatter’s include:
· Tenderness on palpation of the tibial tuberosity
· Knee pain and swelling below the patella (kneecap)
· Pain that is exacerbated by physical activity
· Tightness through the thigh (quadriceps) muscles
· Obvious bony protuberance at the tibial tuberosity (enlarged tibial tuberosity)
The prognosis of Osgood Schlatter’s disease is very good, and it responds well to conservative management. Treatment would initially consist of pain management, incorporating a period of rest or reduction from the aggravating activities, followed by restoring range of motion to the knee and flexibility of surrounding musculature.
A strengthening program would then commence once symptoms have completely subsided. Physical activity should be modified as pain allows (decreased frequency and intensity will result in decreased load). The symptoms will generally cease once bone growth has finished and the muscles are able to fully adapt to the length of the bone, however a bony deformity at the front of the knee may remain.
Surgical intervention is available but is only used as a last resort. Surgeons will generally not operate until growth plates have closed to decrease post-surgical complications such as growth arrest, limb length discrepancies and development of tibial recurvatum (bow leg). In rare cases surgery may be required to remove any bone fragments that have failed to unite.
Osgood Schlatter’s disease, falls into a group of conditions known as traction apophysitis’s or osteochondrosis and results from excessive tension on the growth plates by powerful tendons in association with high levels of activity during periods of rapid growth. As such, the key to minimising the risk of developing these conditions is to maintain good flexibility in the muscles, especially during periods of high activity. 3 tips to assist with prevention include:
1. Always ensure you wear good, supportive footwear. Poor foot posture will change the pull of the tendons higher up.
2. Always engage in a warm-up and, more importantly, a cool down routine, which should include stretching the main muscle groups, especially the quadriceps and the calves.
3. If your child does suffer from cramping or excessive tightness, consider preventative massage and regular soft tissue release.
So that’s an overview of how Osgood Schlatter’s disease occurs. If you have any questions or comments please e-mail us at firstname.lastname@example.org and we will be happy to answer them for you.
If your child suffers from pain through the front of the knee during or following exercise, feel free to call us on (08) 9486 8653 and our therapists will be happy to chat with you about the best management plan.