Carnegie Sports Physiotherapy Clinic

Osgood-Schlatter’s Disease

Osgood-Schlatter’s disease is one of the most common causes of knee pain in young athletes, usually in those who are training hard, or who are undergoing or have undergone a growth spurt.
This is because of the fact that during growth, bones will tend to grow faster than muscles and tendons, which means that in a growth spurt, children and adolescents will tend to become less flexible in all of their muscles.

The quadriceps, which is the large muscle at the front of the thigh, inserts into the top of the tibia or shin bone with a tendon called the patella tendon. It is probable that when the quadriceps becomes less flexible, and then contracts, it tugs on this attachment at the tibia, and can start to pull away from the shin bone, resulting in pain, swelling and tenderness in this area. This is called Osgood- Schlatter’s disease.

Osgood-Schlatter’s disease more commonly affects boys who are having a growth spurt during their pre-teen or teenage years, but girls can also be affected. It may affect one or both knees.
Diagnosis of Osgood-Schlatter’s Disease.

Osgood Schlatter’s is generally diagnosed on symptoms, and possibly on x-ray. Even without x-ray the provisional diagnosis and treatment would generally be the same.

Signs and Symptoms of Osgood-Schlatter’s Disease

The following signs and symptoms are local to the bottom of the patella tendon, just where it attaches to the shin bone or tibia. If the adolescent has any of these symptoms they may have or be developing Osgood-Schlatter Disease.

• Swelling
• Pain
• Tenderness
• A bump of bone growing where the tendon attaches
• Limping or pain when walking

• Pain during sport or activity.

Causes of Osgood-Schlatter’s Disease

Osgood- Schlatter’s disease can be caused by the following. These are also factors that can slow down the healing process and should be addressed, even if the child has been advised to rest. Resting alone is usually not sufficient to get rid of the symptoms of Osgood Schlatters’s disease in the long term.

• Growth spurts
• Increased exercise intensity
• Leg length difference
• Pelvic and spine alignment issues
• Poor flexibility
• Poor strength
• Poor functional stability – core, balance.

• Foot biomechanics

Physiotherapy assessment of the causes of Osgood Schlatter’s Disease

The child should be assessed fully by a physiotherapist and a podiatrist if necessary.

The assessment will include:

• Postural and biomechanical alignment assessment

• Strength testing of all of the muscles of the lower limbs – quadriceps, hamstrings, calves and gluteal muscles

• Functional movements testing – balancing, squatting, lunging, running etc

• Flexibility testing of the muscles of the lower limbs

• Assessment of leg length difference

• Referral to the podiatrist if required

The child’s pelvis and back may be slightly twisted, not symmetrical or stiff. This can be caused by tight muscles, weakness in the core muscles, poor posture, slips or trips and general activity. This malalignment of the pelvis and spine can change the child’s posture and alter how the child moves, which can then alter muscle firing or place added stress on the patella tendon.

Pain will generally be greater with activities requiring running, jumping or going up or down stairs. Symptoms are usually worse the faster the growth spurt or the less flexible the athlete.

Treatment of Osgood-Schlatter Disease

The physiotherapist will take a thorough case history and will assess all of the causative factors described above.
Treatment will then begin to address these issues, aiming to increase flexibility and strength, and also looking at biomechanics and technique if required. Treatment can include

• stretching exercises

• strengthening exercises

• massage – soft tissue work

• advice – about activity levels, application of ice to the area

• re-alignment of the pelvis and spine

• mobilisation of other joints: knees, ankles, feet and hips

• podiatrist referral if required- if appropriate, an orthotic (innersole) may be prescribed to change the foot position to allow the foot to work better. A difference in leg length should also be addressed.

Although each child will vary in recovery rates, we have great success at rapidly reducing pain from Osgood-Schlatter’s disease. With massage and stretching exercises the child will become more flexible, reducing both the stress on the tendon and pull on the bone. This allows the area to heal and the pain to decrease. Improved flexibility will also mean that the child will begin to move better, which further reduces the stress on the tendon.

Our expert advice on activities, exercises and return to sport will help to rehabilitate the child safely back to their pre-injury level of activity and may decrease other related problems in the future.

Exercising with Osgood- Schlatter’s disease

Exercising with Osgood Schlatter’s disease should be guided by pain. For example if an activity is pain free, it is generally possible to continue with that exercise ie it may be painful to run, but cycling may be painfree. Painful activities should be reduced. If the child is undergoing a growth spurt and the symptoms are worse, the child should increase their stretches and stick with painfree activities only.

Stretching should be done as shown by the physiotherapist- as often as possible.

Icing for 5 minutes several times a day, always after sport and after stretching if possible

How to help prevent Osgood-Schlatter’s disease from reoccurring

Continue to:

• Stretch on a daily basis

• Warm-up and cool down before and after activity.

• Stretch the quadriceps before sport and any other muscles that are particularly tight.

• Seek treatment if stretching doesn’t relieve tight muscles around the area

• Monitor the growth rate of the child ( ie measure their height on a weekly basis) and increase the amount of stretching done when the child is in a growth spurt.

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