Adolescent Knee Pain - Osgood Schlatter Disease
What is Osgood Schlatter Disease?
Osgood-Schlatter Disease is a condition, described by Robert Bayley Osgood and Carl Schlatter in 1903, whereby pain is felt at the tibial tuberosity. This is the bony elevation at the bottom of the knee/top of the shin. This is known as the apophysis, a growth plate located at site where a tendon (in this case, the patellar tendon) attaches to the bone. The condition is most commonly found in males between 12 and 15 and females between 8 and 12. During the significant growth experienced during adolescence, greater load and stress can take place at this site. This, in combination to repetitive stress from the pulling of the quadriceps muscle during physical activity, can lead to inflammation (apophysitis), particularly in active populations. This contributes to the experience of a painful ‘lump’, swelling and tenderness at the top of the shin. This pain is commonly brought on by mechanisms that can cause traction at the site of attachment including running, jumping and climbing stairs, and may at times progress to a constant pain.
The long-term outcome of Osgood Schlatter Disease is generally quite good with most symptoms alleviating after the closure of the growth plate at skeletal maturity. During this time, pain can vary depending on levels of activity, and can last from months to years (Circi, Atalay & Beyzadeoglu, 2017). Although, in more rare cases (approximately 10%) chronic symptoms may persist into adulthood, in which case other management options including surgery may be considered.
Although there is a lack of high-quality research outlining the most effective management, available literature suggests conservative management in order to control symptoms (pain and swelling) and to maintain physical activity and sport participation.
1 - Activity Modification
An important component of managing Osgood Schlatter Syndrome is to modify activity levels in accordance to an individual’s pain levels. This can include decreasing training sessions, game time or limiting specific dynamic activities including jumping. Altering participation, in conjunction with the other components of management, alleviates symptoms before gradually returning to full participation levels. Incorporating low-impact exercises including swimming and cycling can be used as an alternative to maintain fitness and lower limb strength while symptoms alleviate. Some studies have suggested the benefits of complete immobilisation of the knee, however considering the self-limiting nature of the condition, and the risk of muscle wasting, this technique has generally fallen out of favour.
2 - Exercises
Exercises generally involve a combination of stretching and strengthening. Strengthening generally commences at a low intensity isometric exercises aiming for improved quadriceps activation, as well as addressing other potential biomechanical or strength deficits such as gluteal weakness or quadriceps tightness. Studies have found an association between quadriceps tightness and the presence of Osgood Schlatter Disease, suggesting stretching the quadriceps muscles may reduce the pulling forces from the patellar tendon, and assist in reducing the tensile stress at the attachment site.
Quad Stretch example - should be performed pain-free and held for 20-30 seconds, and repeated 3-4 times a day
Isometric Exercise examples - should be performed relatively pain-free and held for 10 seconds and repeated for 8-10 repetitions, 3 sets a day.
3 - Adjuncts:
Oral Anti-inflammatories such as ibuprofen may be advised to assist in symptom management due to their anti-inflammatory and analgesic properties.
Ice is another alternative aimed to control inflammation and assist with pain relief. Use of ice can be particularly effective after physical activity
Protective equipment: Use of tape or knee padding to protect the area can also assist with symptoms relief and avoiding aggravation during activities with potential direct knee contact.
Osgood Schlatter Disease is a self-limiting condition with around 90% of patients experiencing full symptom relief after conservative management involving activity modification, symptom-relief techniques as well as physiotherapy and exercise.
Gholve, P., Scher, D., Khakharia, S., Widmann, R., & Green, D. (2007). Osgood Schlatter syndrome. Current Opinion In Pediatrics, 19(1), 44-50. doi: 10.1097/mop.0b013e328013dbea
Circi, E., Atalay, Y., & Beyzadeoglu, T. (2017). Treatment of Osgood–Schlatter disease: review of the literature. MUSCULOSKELETAL SURGERY, 101(3), 195-200. doi: 10.1007/s12306-017-0479-7
Tzalach, A., Lifshitz, L., Yaniv, M., Kurz, I., & Kalichman, L. (2016). The Correlation between Knee Flexion Lower Range of Motion and Osgood-Schlatter's Syndrome among Adolescent Soccer Players. British Journal Of Medicine And Medical Research, 11(2), 1-10. doi: 10.9734/bjmmr/2016/20753