Osgood-Schlatter’s Disease is one of the most common causes of knee pain in young teenage athletes, usually in those who are training hard, or who are undergoing or have undergone a growth spurt. This is because of that during normal growth after the age of 8, a secondary ossification centre develops at the front of the shin bone (Tibial Tubercle) into which the Patella tendon inserts which is the main lower attachment of the Quadriceps (the muscles at the front of the leg) . Any excessive loading on this area due to, loss of flexibility following growth spurts, altered biomechanics due to poor lower limb functional stability or increased training, causes excessive traction on the Tibial Tubercle resulting in Osgood Schlatters’s Disease.
Although it is called a disease, it is a self limiting condition that will resolve with removal of the above underlying causes and as the child matures into an adult and the growth plates fuse. If the child continues to overload the area the pain is unlikely to reduce and the tubercle can become bigger and remain enlarged for life. This does not normally cause any problems in adulthood but may be a cosmetic consideration for some individuals and can be an area, due to its prominence, that is easily irritated by any trauma or direct contact. It should be noted that children are more susceptible to avulsion injuries than adults, the tendons pulling off from the attachment to the bone rather than the the muscle being strained as that often occurs in adults, so it is not advisable to train the same as adult athletes. Care should be taken with any plyometric and power type training. Osgood Schlatter’s Disease is generally diagnosed on symptoms, and sometimes on x-ray. Without x-ray the diagnosis and treatment would generally be the same.
Signs and Symptoms of Osgood-Schlatter’s Disease:
The following signs and symptoms are local to the bottom of the patella tendon, just where it attaches to the shin bone or tibia. If the adolescent has any of these symptoms in this area they may have or be developing Osgood-Schlatter’s Disease.
- A bump of bone growing where the tendon attaches
- Limping or pain when walking
- Pain during sport or activity.
Causes of Osgood-Schlatter’s Disease
Osgood-Schlatter’s disease can be caused by the following:
- Growth spurts
- Increased exercise intensity or changes in the type of training
- In-sufficient recovery
- Leg length difference
- Pelvic and spine alignment asymmetry
- Poor flexibility
- Poor strength and muscle recruitment patterns
- Poor functional stability – core, balance.
- Poor Foot biomechanics
These are also factors that can slow down the healing process and should be addressed. Resting alone is usually not sufficient to get rid of the symptoms of Osgood Schlatters’s disease in the long term.
Physiotherapy assessment of the causes of Osgood Schlatter’s Disease
The assessment will include:
- Postural and bio-mechanical alignment assessment
- Strength testing of all of the muscles of the lower limbs – quadriceps, hamstrings, calves and gluteal muscles
- Functional movements testing – balancing, squatting, lunging, running etc
- Flexibility testing of the muscles of the lower limbs
- Assessment of leg length difference
- Referral to the Podiatrist if required
Treatment of Osgood-Schlatter’s Disease
Treatment will then begin to address the above causes and can include
- stretching exercises
- strengthening and functional stability exercises
- massage – soft tissue work to improve flexibility
- advice – about the type and level of activity and sport, appropriate use of ice to the area
- re-alignment of the pelvis and spine
- mobilisation of other joints: knees, ankles, feet and hips
- podiatrist referral if required- if appropriate, an orthotic (a prescription insole) may be supplied to improve the foot biomechanics. A difference in leg length can also be adjusted for with an appropriate orthotic.
Although each child will vary in recovery rates, Physiotherapy treatment and advice will help to rehabilitate the child safely back to their pre-injury level of activity and may additionally help to prevent other problems from developing.
Exercise and Osgood- Schlatter’s disease
Previously, children diagnosed with Osgood Schlatter’s Disease, had been told to stop all activity which is almost impossible with active children. Exercising with Osgood Schlatter’s disease should be guided by pain. The child should not continue with any activities that are causing this specific pain. If an activity is pain free, it is generally possible to continue with that exercise e.g. it may be painful to jump, but running or cycling may be pain free.
How to help prevent Osgood-Schlatter’s disease from occurring:
- Stretch regularly. Static stretching immediately prior to sport and exercise is not now recommended unless followed by some muscle activation exercises. Dynamic movements are recommended before exercise to prepare the body for the range and type of movement involved in the sport. Static stretches are still important in the cool down and at other times particular to maintain flexibility and to address specific areas of reduced flexibility. Due to higher risk of avulsion injuries in children we would not advise aggressive dynamic stretching routines.
- Warm-up and cool down before and after activity. Wear appropriate clothing for the weather conditions, layering is good so that they can reduce clothing once the body is warmed up. Allow time to cool down after activity and do not just rush off home. Cool downs can include a gentle run, bike or swim and stretching. If these are done outside it is again advisable to layer up again so that do not they do not chill off too much.
- Monitor the growth rate and flexibility of children (measure their height on a weekly basis and monitor range of movements i.e. ability to, touch toes with straight knees(back and hamstrings), to bend knees fully when laying on their front(quadriceps and femoral nerve mobility), to get knees in front toes in squat position(deep calf muscles), to fully straighten one knee in upright sitting position without flexing their back (hamstring and sciatic nerve mobility).
- Modify the type and intensity of training during growth spurts and before restrictions in flexibility have been addressed.
- Children can go through periods of relative poor co-ordination during growth spurts which as well as affecting their performance can result in injuries such as this. Functional stability exercises should be incorporated into their activities and training. Can they stand on one leg without too much effort or movement? Can they stand on one leg and throw and catch a ball? Can they hop and land on one leg without falling over? Can they stand on one leg and bend that knee without the knee deviating inwards? Can they do a forward lunge and twist towards the front leg without losing the control of their legs and pelvis position?
- Do not let them train the same as adults. Until the growth plates have fused care needs to be taken with the type and intensity of training. Certain types of plyometric and power based training will not be appropriate for developing children due to the higher risk of avulsion injuries.
- Allow sufficient recovery times. Children are often always active and involved in multiple activities and sports. It is possible for them to overtrain. Signs of this can be recurring pain, undue tiredness, disturbance of sleep, failure to maintain weight, disturbances or cessation of menstrual cycle (girls), recurrent minor systemic illnesses such as colds and plateauing or reduction in performance. Recovery is just as important as training. Children need adequate rest, ample sleep and appropriate nutrition.
- Finally, If you are concerned over a child’s risk of developing this condition or other injury get them assessed by a Chartered Physiotherapist who can help provide them with an appropriate management plan.