Osgood Schlatter's
Osgood Schlatter’s disease / syndrome is a painful condition that affects the knee. It is seen in the adolescent aged 10-14, more boys than girls, usually in highly active individuals playing running or jumping sports. Similar to Sever’s disease and Sinding Larsen Johansson syndrome, it is an overuse injury that affects the growth plates, known as an apophysitis .
Many of the injuries seen in children are very different to those in adults. As we grow in adolescence, most of this growth happens from the growth plates at the end of the long bones (see pictures below). Some of the growth plates close or fuse after the adolescent growth spurt although some such as the pelvis and clavicle remain open as late as 21 in some individuals. While we are still growing these areas are made of cartilage that has not yet matured and does not yet have the strength properties of bone. This means that these weaker areas are more prone to irritation from over use or repetitive stress.
In the case of Osgood Schlatter’s disease this over use comes in the form of repetitive contraction of the large quadriceps muscle during running, jumping or kicking. Similar to as in patellar tendinopathy, these large, often explosive forces are transmitted from the quads down through the kneecap and into the insertion of the patellar tendon at the tibial tuberosity. In adolescents the tibial tuberosity is located on the open tibial growth plate which makes this area susceptible to inflammation and damage from the repetitive pull of the tendon on this attachment.
Causes
Some of the factors that can contribute to the development of Osgood Schlatter’s include external factors:
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Inappropriate increases in training (eg adding too much activity in a short space of time)
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Hard training surfaces
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Improper equipment (eg footwear)
And internal factors including
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Decreased muscle flexibility
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Decreased muscle strength
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Altered biomechanics (eg excessively flat feet)
Symptoms vary depending on severity but can include
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Pain in one or both knees that gradually worsens over time
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Aggravated by squatting, running, going up and down stairs
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Pain that eases with rest
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Swelling or redness at the tibial tuberosity (bony prominence at top of shin bone)
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Tenderness to touch the tibial tuberosity
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Inability to kneel on the affected knee
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Quads weakness.
Treatment
We understand that compliance with rest and rehab exercises is often an issue in the group of people that this condition affects and strive to ensure the patient and their parents fully understand the condition and some of the more serious long term problems that can come from leaving this untreated (possible growth plate fractures, patella tendinopathy, lasting bump deformity).
Generally, Osgood Schlatter’s disease has a very good prognosis, settling well with rest and over time as the growth plates mature. Unfortunately, in the early course of treatment, relative rest is essential. This means reducing the load until activity becomes pain free. This is often difficult as the last thing the active teenager wants to do is stop playing the sports they love. This may not always be required as a reduction in activity levels may be enough, however rest for a short period is usually beneficial in reducing the rehab timeframes dramatically.
Other ways of reducing the stress on the affected area can include addressing weaknesses through strengthening exercises, improving flexibility through a stretching program or correction of biomechanics through footwear advice or prescription of orthotics. Other techniques such as soft tissue release, manual mobilisations and bracing or taping have also been shown to be effective in the management of Osgood Schlatter’s and your physiotherapist will implement all appropriate treatments into your individualized program.