Do you suffer from Osgood Schlatter Disease? It doesn’t have to be the end of your sporting career. With proper treatment and adapting your training it can be managed successfully.
Osgood Schlatter disease symptoms
Osgood Schlatter disease or Osgood Schlatter lesion is a very common cause of knee pain in children between the ages of 10 and 15 years old.
- Knee pain which is localised to a specific point on the front your shin bone, just below your knee. This bony protrusion is called the tibial tuberosity.
- Pain becomes worse with exercise, particularly weight bearing exercise such as running, football and sports involving jumping.
- You will likely have pain when contracting (tensing) the quadriceps muscles with your leg straight.
- Squatting is also likely to be painful, particularly a single leg squat.
Assessment & diagnosis
Osgood Schlatter disease is usually easy to diagnose because of the specific location of symptoms and the age of the patient. A professional therapist will also look for the following signs:
- Your tibial tuberosity may become swollen or inflamed and over time a lump may occur.
- If you have suffered for some time then your quadriceps muscles may have begun to atrohpy (waste away).
- In extremely severe cases they may do an X-ray to see exactly how much damage has occurred.
It is possible for Osgood Schlatter disease symptoms to come and go, becoming more or less severe. Often this happens for no apparent reason.
Keep a training diary! You can monitor activity levels and symptoms to identify if any particular training methods worsen your injury.
Causes & anatomy of Osgood Schlatter disease
The patella tendon (or patella ligament as it is sometimes called) connects the bottom of the kneecap (patella) to the shin bone. It attaches at a bony protrusion called the tibial tuberosity. Osgood Schlatters Disease is a painful reaction at the point where the patella tendon inserts into the tibia.
Osgood Schlatter disease was named after two physicians in 1903, Dr. Robert Osgood and Dr. Carl Schlatter.
Over time it becomes progressively worse as tendon pulls at the growth plate at the top of the tibia. With repeated trauma, new bone grows back as part of the healing process. The causes an obvious prominent bony lump felt at the tibial tuberosity.
As the young athlete’s bones grow quickly, it can take some time for the muscles and tendons to catch up.
If the muscles have not yet adapted to the length of the bones, this can result in additional strain. The additional strain pulls at point the tendon inserts into the bone. This is frequent in younger athletes because their bones are still soft and are not yet fully grown.
What causes Osgood Schlatter disease?
Osgood Schlatter syndrome is primarily an overuse injury although certain factors can increase the likelihood of sustaining this condition.
It is more likely to affect boys aged around 13 to 15 years old than girls. However, girls can be affected. If they are though, 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. Osgood Schlatter can occur in adults, however it is rare. It is more likely if it was not been treated properly during your teenage years.
Children who do lots of weight bearing sports, running, jumping and football are most at risk. Managing training loads and symptoms is important.
Overpronation is where the foots rolls in or flattens too much when you walk or run. This in turn causes the lower leg to rotate in and as a result, the knee. This twisting increases the forces through the patella tendon.
Osgood Schlatter Treatment
Treatment for Osgood Schlatters disease consists of reducing pain and inflammation, along with longer term management of training. Education is important, not just for the young athlete but also parents as well.
What can the athlete do?
Apply the PRICE principles
Immediate first aid and the best way of relieving symptoms is to apply the PRICE principles. This consists of protection, rest, ice, compression, and elevation.
- Protect of the knee from further injury. This can be done by wearing a patella knee strap or patella tendon taping technique. A patella strap or taping works by compressing the tendon which therefore changes the direction of forces through it. 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.
- 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 lower impacts rather than training every day. Switch high impact exercise to swimming or cycling if pain allows. A plaster cast can be applied for three weeks if the pain is severe.
- Ice – Apply ice or a cold therapy wrap to the knee regularly. Ice can be applied for 10 minutes every hour if your knee is particularly painful. As your symptoms improve this can be reduced to three times a day. It is a good idea to apply ice after training as part of your routine. Ice massage with an ice cube is a convenient way to apply cold therapy to the patella tendon. Keep the ice moving as applying directly to the skin can cause ice burns.
- Compression in the form of an elastic support or wrap can help support the area and reduce swelling.
Read more on PRICE principles.
Patella tendon taping & bracing
- Taping the patella tendon can help reduce symptoms by changing the way forces are applied to the injured tendon.
What can a professional do?
- A Doctor may prescribe NSAID’s or anti-inflammatory medication such as Ibuprofen to help reduce pain and inflammation.
- However, it is not good to rely on medicatoin long-term as it will mask how bad your knee actually is. Athletes with asthma or other contraindications should not take Ibuprofen, always take your Doctors advice before taking medication.
- Once normal daily activities are pain-free, gentle stretching exercises may be beneficial.
- Sports massage/myofascial techniques for the quadriceps muscles can help ensure they are strong enough to cope with the loads placed on them, as well as not being too tight.
- Massage should not be applied directly to the tibial tuberosity where the patella tendon inserts as this are likely to make symptoms worse.
Osgood Schlatter disease exercises
Gentle stretching exercises, particularly for the quadriceps muscles can be done as soon as pain allows. If the bones of the young athlete have grown quickly during a growth spurt and the thigh muscles have not yet caught up then lengthening them through stretching exercises can help reduce the strain on tendon insertion into the bone.
If stretching is painful, it should not be performed. Too much stretching when it is not necessary could make the condition worse.
The quadriceps muscles at the front of the thigh attach via the knee cap or patella and patella tendon to the tibia or shin bone at the tibial tuberosity. Gently stretching the quad muscles may help in the treatment of Osgood Schlatters disease although it must be done slowly and gradually.
Standing quad stretch
Stand next to a wall or something you can hold on to. Bend the knee of the leg you wish to stretch and pull the foot towards your buttock. When you can feel a slight stretch, hold this position for 20-30 seconds. If the stretch feeling fades, pull the foot further in, or tilt the hips backwards.
Training management of Osgood Schlatter disease
The most important thing is the management of the athletes training program so they can do as much exercise as pain will allow. This may mean focusing on quality rather than quantity.
Read more on training with Osgood Schlatter disease.