Osgood Schlatter’s Disease

Osgood Schlatter’s Disease

Osgood Schlatter’s Disease (OSD) isn’t actually a disease but an overuse injury commonly found in the knee joints of adolescents. Although it can be very painful, it usually resolves itself 1-2 years after onset of symptoms.

OSD is an inflammatory reaction of the bone, cartilage and/or patellar tendon just below the knee joint and usually only affects one knee. Symptoms usually become evident after a growth spurt in active children and the age range varies from 8-13 in girls and 10-15 in boys. As mentioned, being active increases the risk of this overuse injury and activities such as running, jumping, sports involving twisting or rotatory movements of the knee joints has been found to be the main precursors to OSD.

Specialists are yet to agree on the mechanism of injury involved in OSD but there is agreement amongst specialists that it does stem from overuse. During an adolescent’s growth spurt, the bones, muscles and tendons grow at different rates and thereby place unusual stress and load on the growth plate of the shinbone.

The pain experienced varies and could be mild pain felt only during exertion to being a severe constant pain in the knee. Other symptoms to help differentiate OSD are:

• The pain will intensify when exercise is performed. Limping could also be evident afterwards.
• Conversely, the pain will subside when rest occurs.
• There is tenderness and/or swelling under the patella and over the shinbone.
• Compensatory tightening of the quadriceps and hamstring muscles to help protect the integrity of the knee joint occurs.

OSD will usually go away once the affected skeletal bones stop growing. This is usually between the ages of 14-18. Until this happens, the main form of treatment is rest as one can only treat the symptoms (which in this case are pain).

In mild cases of OSD, one would recommend limiting activities that cause or aggravate the pain experienced. If the pain or discomfort remains mild and bearable, the adolescent can continue doing their chosen exercise but if they experience an acute flare up of symptoms, they would need to rest until the pain has returned to usual mild levels.

Other precautions one can take while performing exercise is to:

• wear cushioned insoles to absorb load going through the knee joints,
• apply a heat pack before exercise and/or cold pack after the exercise to reduce swelling,
• wearing protective gear around the knee joint and shins (gel pads or cushioned knee/ship pads) will reduce the impact of direct trauma to the area,
• perform a regular stretching routine before and after exercise to maintain length through the muscles supporting the knee joint (focusing primarily on the quadriceps and hamstring musculature)

In more severe instances of OSD, complete rest is paramount! Some adolescents struggle with this but the knee will not heal completely if it is not given a chance to recover and rest is the only solution to ensure no load/stress is being placed through the affected area. Sometimes, a brace or cast could be prescribed if the adolescent is unable to adhere to complete rest. Also, with more severe cases, it is advised that once the adolescent had had a lengthy time off and the pain symptoms have significantly subsided, they are slowly eased back into activity together with a physical therapy programme (strengthening and flexibility) to ensure correct loading and mechanical forces are being transferred through the affected knee.

The chronic long-term implications of OSD are usually minimal. Sometimes, the teen might have a permanent bump below the knee which is painless. Very rarely, the bump might develop into a bony growth which could be extremely painful and in these instances; surgery would be recommended to have it removed.

What is of importance to note, is that around 60% of adolescents who suffered from OSD, developed knee pain while in a kneeling position as an adult.