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Osgood Schlatters Disease
Osgood Schlatters disease is a very common cause of knee pain in children between the ages of 10 and 15 years old. It was named after two physicians in 1903, Dr. Robert Osgood and Dr. Carl Schlatter.
- Symptoms of Osgood Schlatters disease typically consist of pain at the tibial tuberosity or bony bit at the top of the shin.
- The tibial tuberosity may become swollen or inflamed and may even become more prominent than normal.
- Tenderness and pain is worse during and after exercise.
- The athlete is likely to experience pain when contracting the quadriceps muscles or performing squat type exercises.
The patella tendon joins the bottom of the kneecap (patella) with the shin bone. It inserts at the tibial tuberosity or bony protrusion at the front of the shin bone or tibia.
Age - It is more likely to affect boys aged around 13 to 15 years old than girls, although girls certainly can be affected and if they are it is more likely to occur earlier at about aged 10 to 12 years old. Obviously this is a general guide and ages can vary. It occurs due to a period of rapid growth, combined with a high level of sporting activity.
Activity - As the young athletes bones grow quickly, it can take some time for the muscles and tendons to catch up. These changes result in a pulling force from the patella tendon, on to the tibial tuberosity at the top of the shin. This area then becomes inflamed, painful and swollen. This is frequent in younger people because their bones are still soft and are not yet fully grown. It is seen more often in children involved with running and jumping activities which put a much greater strain on the patella tendon.
With repeated trauma new bone grows back during the healing process which causes a bony lump often felt at the tibial tuberosity.
Professional football physiotherapist Neal Reynolds explains Osgood Schlatters Disease and how they manage it in a football academy.
Osgood Schlatters disease should clear up when the young athlete stops growing and the tendons become stronger, however, it can occasionally persist into adulthood. The most important thing is management of the athletes training program so they can do as much exercise as pain will allow, which may mean focusing on quality rather than quantity. The following may help with symptoms as they flare up but it may just be a case of waiting until the athlete stops growing so fast and the tendons and bones become stronger.
Rest is the most important element of treatment. Only do as much exercise as it will allow without causing pain. Weight bearing exercise will make it worse. Keep your sessions few and high quality rather than training every day.
Apply ice or cold therapy to the knee regularly throughout the day to reduce pain and inflammation and particularly following activity or sport. Ice should be applied at least three times a day for 10 to 15 minutes. If it is particularly painful then ice can be applied for 10 minutes every hour. Ice massage with an ice cube is a convenient way to apply cold therapy to a specific area such as the patella tendon. Keep the ice moving as applying directly to the skin can cause ice burns.
Gently stretch the quadriceps muscles if comfortable to do so. Osgood Schlatters coincides with a growth spurt so if the bone has grown too quickly leaving the muscle tendon unit tight then stretching will help. Keep the knees together and gently pull up on the foot. Push the hips forwards to increase the stretch. Hold for 10 to 15 seconds and relax. Repeat 3 to 5 times.
Sports massage techniques for the quadriceps muscles and myofascial release techniques to help stretch the muscles can help ensure they are strong enough to cope with the loads placed on them as well as not being too tight.
See video on front thigh sports massage techniques.
Use a patella knee strap or patella tendon taping technique may help reduce the tension on and support the knee. A patella strap or taping can absorb some of the shock or impact and change the angle the forces are transmitted through the tendon. It can be worn all the time if the knee is painful. A full neoprene knee support can keep the tendon warm and support the whole joint. It may be trial and error to see which type works best for you.
See video on applying patella tendon taping.
A Doctor may prescribe NSAID's or anti inflammatory medication such as Ibuprofen to help reduce pain and inflammation, although this is not good to rely on long term, or mask how bad the condition actually is. Athletes with asthma should not take Ibuprofen.
A big part of managing the condition is educating the patient, parents and coaches about the condition and the importance of not over training. It is important to manage the young athletes training program so they only do what pain will allow. If this means training just once or twice a week then so be it. They will make more progress with one or two quality sessions as opposed to daily training where lack of progress and frustration is the outcome.
In extremely severe cases they may do an X-ray to see exactly how much damage has occurred. A plaster cast can be applied for three weeks if pain is severe.
Who does Osgood Schlatters Disease usually effect?
- Boys aged 13 - 15 years old and sometimes girls aged 10 - 12 years old.
What two factors increase the chance of getting this injury?
- High activity levels
- Growth spurt
What can help reduce symptoms?
- Patella tendon brace or taping
Name the painful part of the shin bone where the patella tendon insets?
Other than the athlete, who else needs educating about Osgood Schlatters?
Name the magic cure for Osgood Schlatters Disease?
So far there isn't one! Managing training and symptoms until the athlete grows out of it is the key.
What should the athlete avoid in training?
- Deep knee bends
- Explosive hopping and jumping
- High training volumes in general
The most important element of treating this injury is?