What is Osgood Schlatter disease?
Osgood-Schlatter disease is a common cause of pain and tenderness at the tibial tuberosity (bony prominence below the kneecap), that typically presents in late childhood and early adolescence. The condition is more common in boys and usually presents in one knee, however, both knees may be affected. Children who are highly active, particularly in sports involving running and jumping are mostly affected. Although considered a self-limiting condition, it can often take months to years to resolve entirely.
This disease may also be referred to as osteochondrosis or apophysitis of the tibial tuberosity.
Signs and Symptoms of Osgood Schlatter disease
Patients typically present with the gradual onset of pain, and tenderness of the tibial tuberosity. Activities that extend the knee against resistance, such as running and jumping can exacerbate this pain. Enlargement of the tibial tuberosity can develop and direct pressure to the area can be exquisitely tender to touch.
What causes Osgood Schlatter disease?
The tibial tuberosity is the bony attachment for the quadriceps (front thigh muscle). Contraction of the quadriceps results primarily in straightening of the leg at the level of the knee. A growth plate is an area of developing tissue near the ends of long bones or areas of muscle attachment. The growth plates in children allow the bones to expand in length thus allowing a child to reach his or her full height by the age of 16 to 19. Compared to the surrounding bone and muscles, the growth plate serves as a weak point. Thus repetitive pulling on a growth plate, especially from a large powerful muscle like the quadriceps, can result in injury to the growth plate and subsequent pain.
Risk factors include:
- Activities that involve running and jumping
- Boys, especially those between the age of 11 and 18
- Rapid skeletal growth
- Poor physical conditioning
Diagnosing Osgood Schlatter disease
Effective treatment of this condition involves establishing the correct diagnosis. This can usually be made on the basis of the history and findings on physical examination. X-rays are usually not required.
Conservative Treatment for Osgood Schlatter disease
From these findings, a treatment plan is developed specifically for you. Some aspects of the treatment plan may include:
- Activity modification. An initial change to your exercise regime or daily activities may be needed to avoid the condition getting worse. The introduction of a low impact alternate activity may also be of benefit such as swimming, whilst also avoiding hill running.
- Strengthening. It is important that strength is addressed for this condition so that the affected area can tolerate more load. This is done initially with isometric loading to load up the affected area in a pain-free way. When pain has reduced a program for quadriceps strengthening will be incorporated. Hip muscle strengthening will also be included if found to be weak or having poor postural control.
- Ice: to ease pain and swelling. Do it for 20-30 minutes every 3 to 4 hours for 2 to 3 days, or until the pain is gone.
- Manual techniques: mobilisations of the knee joint and patella can have a pain-relieving effect.
- Adequate footwear. Supportive footwear may also be recommended to stabilise the foot and ankle.
- Orthotic Therapy: A custom orthotic device placed in your shoe can help address possible causative factors such as flat feet or high arch feet.
- Taping/bracing. Patella taping can help promote correct tracking of the patella
- AlterG Anti-Gravity Treadmill. Continuation of training on the AlterG to decrease the load on the knee joint whilst maintaining an exercise program.
Prognosis of Osgood Schlatters disease
Osgood-Schlatter disease is a self-limiting condition that leaves no residual disability. Pain associated with Osgood-Schlatter’s goes away when growth is finished. However, the lump may remain prominent. This can cause persistent pain, especially with direct pressure and kneeling.