Osgood-Schlatter disease What is it?

Osgood- Schlatter Disease is a condition that affects the cartilage around the top of the tibial bone when the patellar tendon (the lower end of your quadriceps muscle that goes over the front of the knee) repeatedly pulls on the tibial tubercle (the bump of bone sticking out at the top of your shin). This causes varying amounts of pain and discomfort just below the knee as it commonly leads to a slight lesion in the tendon where it connects to the bone. It is one of the most common musculoskeletal problems seen in adolescents but the diagnosis is often missed. It is most commonly seen in 10-15-year-olds but can be also seen outside of these ages, especially if a child has an early or late growth spurt. It is usually associated with high levels of physical activity, especially high-impact sports such as basketball or football.

What causes Osgood-Schlatter Disease?

Osgood-Schlatter’s occurs when the bones are growing at a faster rate than the muscles (e.g. during rapid growth spurts). High levels of activity cause the patellar tendon, which is already short in comparison to bone length, to be repeatedly pulled and stretched beyond capacity. The tendon in turn pulls on the tibial tubercle, causing increased friction and tension as well as weakness at that point.

The risk of Osgood-Schlatter Disease is greater in taller children and there also appears to be a correlation between it and hypermobility and associated flat-footedness (which can pull knees inwards and hence cause an unnecessary pull on the patella tendon).

What are the effects of Osgood-Schlatter’s?

Osgood-Schlatter Disease causes pain and increased muscle tension where the patella tendon attaches onto the tibia (shin bone). This can cause a lesion at the junction between the tendon and the tubercle to which it attaches. This results in pain and often a restriction in movement, making it hard to fully bend or straighten the knee. Pain can ease with rest but tends to return when the child returns to sport.

Levels of pain vary between different children and some will only have mild pain and be happy to continue playing sport regardless of the condition. For other children, the pain can be quite debilitating and cessation of any weight-bearing sports is recommended. For some children, even walking needs to be minimised due to the level of pain that this can cause.

The pain is self-limiting; sufferers are recommended to rest from any high-impact weight-bearing activity such as running, jumping, and contact sports but activity levels depend on individual pain levels and the sufferer’s tolerance to pain.

Repeated aggravation of the patella tendon without adequate rest to allow recovery can also lead to an enlargement of the tibial tubercle at the top of the tibia.

What we can do

When you bring your child in with this condition, our physiotherapists will carry out a full assessment to determine if there are any contributing factors such as poor foot alignment or muscle imbalance. We will gain a full history and understanding of your child and develop a rapport with them to make them feel comfortable and agreeable to exercises. We will discuss a plan of treatment and the goals we are working towards with you and your child so that we are all on the same page.

Following a full assessment, physiotherapy can help your child by:

• Providing an exercise program of strengthening and stretches
• Improving their gait and running patterns
• Giving advice on appropriate footwear
• Gradually increasing exercise and fitness levels to enable a return to sport
• Managing pain and providing a plan for how to manage it at home when your child has a flare-up
• Providing alternative sports/exercise to do during flare-ups
• Giving ideas for exercises in the water

What you can do

You can assist your child at home by reminding them to complete their daily exercise program and helping to make it a fun part of their day. Try to turn exercises into a game (such as balancing on a cushion while playing balloon tennis) or make them a family activity before dinner.

You can also help your child when they are having flare-ups by reassuring them that this is normal and providing them with pain relief and ice to the knee. Taking them to a heated pool to do their exercises (and have a splash around) is also a fun and highly beneficial way to help them enjoy their physio!