Osgood-Schlatter Disease

The knee is the meeting place of two very important bones in the leg, the femur, and the tibia. The patella (also known as the kneecap) is the moveable bone that sits in front of the knee. This bone is wrapped inside a tendon that connects the large muscles on the front of the thigh, the quadriceps muscles, to the lower leg bone.

The patellar tendon is a connective band of tissue in the knee. This tendon holds the kneecap and the shinbone together. It attaches right below the kneecap and then stretches to the part of the shinbone where new bone grows. Because of this connection point, there can be a pain when a child goes through a growth spurt.

Osgood-Schlatter disease (jumper’s knee) is a condition that happens when a tendon in the knee pulls against the top of the shinbone. This causes pain in the knee and the upper shin. Tendons are bands of tissue that connect muscles to bones. The patellar tendon pulls on an area of the shinbone where new bone is forming, called the growth plate. The pulling causes pain and inflammation (swelling and irritation). A hard bump may also grow right below the knee as the growth plate hardens. Patients with Osgood-Schlatter disease typically get better with rest, over-the-counter pain medication, and time.

Osgood-Schlatter disease is also referred to as osteochondrosis, which is a group of disorders of the growth plates that occur when a child is growing rapidly. Doctors aren’t sure as to what causes osteochondrosis, however, the disorders do seem to run in families. Some of these osteochondrosis diseases also include Kohler bone disease, Legg-Calve-Perthes disease, and Scheuermann’s disease.

Causes & Symptoms

Children and adolescents may get Osgood-Schlatter disease when they play contact sports that put repeated stress on the patellar tendon. There are certain activities (such as running and jumping) that cause your leg muscles to pull the patellar tendon, which then pulls on the growth plate. Sometimes called growing pains, Osgood-Schlatter disease often occurs when children are going through a growth spurt. During periods of rapid growth, the bones, muscles, and tendons shift and grow abnormally larger. These changes can put more stress on the patellar tendon and the growth plate.

If you’re an adolescent and you have pain right below your kneecap, you may be at risk of developing Osgood-Schlatter disease. Your chance of having this condition is higher if you play sports that involve constant jumping or bending your knees. A hard bump on the front of your knee above your shin is also a sign of Osgood-Schlatter disease.

Overall, any of the following factors can contribute to Osgood-Schlatter disease:

OSD (Osgood-Schlatter Disease) is most often caused by inflammation of the patellar tendon where it attaches to the tibia or shin bone, just below the kneecap. There may also be inflammation of the tibia bone or cartilage.
Repetitive strain on the thigh muscles during physical activity pulls on the patellar tendon, which pulls on the attachment at the tibial tubercle apophysis. This causes inflammation and pain.
Growing bones are different from mature bones. They have growth plates from which bones grow longer and separate bony areas, called apophyses, where tendons attach. Apophyses are open areas in the bone and are a weak link making these areas more prone to injury. As the child matures these areas fuse together and become a solid bone.

Each younger patient may experience symptoms of Osgood-Schlatter disease differently. They may include:

Tenderness below the knee.
Limping.
Swelling around the knee.
A bony lump at the top of the shin bone.
Tightness in thighs and muscles near the knee.

The symptoms of Osgood-Schlatter disease may resemble other conditions or medical problems of the knee. Therefore, it is important to seek a diagnosis.

Who gets Osgood-Schlatter Disease?

Some of the main risk factors associated with Osgood-Schlatter disease are:

Age – Osgood-Schlatter disease occurs during puberty growth spurts. Age ranges differ by gender because girls enter puberty earlier than boys. Osgood-Schlatter disease typically occurs in boys ages 12 to 14 and girls ages 10 to 13.
Gender – Osgood-Schlatter disease is more common in boys, but the gender gap is narrowing as more girls become involved with sports.
Sports – The condition occurs more often in sports that involve running, jumping, and swift changes in direction (basketball, soccer, skiing, and football).
Flexibility – Tightness in the quadriceps muscles can increase the pull of the kneecap’s tendon on the growth plate at the top of the shin bone.

How Does it Affect You? How Serious is it?

Osgood-Schlatter disease normally does not cause any long-term complications. In most rare cases, however, children with the disease may experience chronic pain or ongoing swelling. In severe cases, some children may need to undergo surgery if the bone and tendons in their knee does not heal properly.

Recommended Treatment & Rehabilitation

In addition to a complete medical history and physical examination, diagnostic procedures for Osgood-Schlatter disease may include:

Bone scan – A nuclear imaging method to evaluate any degenerative and / or arthritic changes in the joints; to detect bone diseases and tumors; to determine the cause of bone pain or inflammation.
Magnetic Resonance Imaging (MRI) – This is a test that uses a combination of large magnets, radio waves, and a computer to produce detailed images of structures within the body.
X-ray – This uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs for clear results of the disease.

If there are symptoms related to inflammation due to Osgood-Schlatter disease, treatment may be pursued to try to calm the inflammation of the knee. Some of these treatments include:

Rest – Allowing the knee to rest is the first step in treatment, and often the only step necessary to resolve the symptoms of this condition. Rest may also include immobilization of the knee in a slightly bent position to take the pressure off the condition.

Anti-inflammatory medications – Oral medications can be used to help relieve pain and reduce inflammations. Typically, non-steroidal anti-inflammatory drugs (NSAIDs) are used to help calm the irritated kneecap. In more severe cases, a cortisone injection, also a powerful anti-inflammatory medication, can both be administered to help address the problem.

Compression knee braces – Knee braces can help limit mobility and support the kneecap. A simple patellar compression knee brace is often the most helpful type of brace for this condition.

Ice and heat therapy – Decreasing inflammation and relieving pain is often accomplished with the application of ice packs directly to the front of the kneecap. keep the ice pack applied for 20-30 minutes every 3-4 hours for a rapid short-term relief. You can also add a heat pack to increase blood circulation in the affected area.

If you have been immobilized, then you can begin a physiotherapy session with a physiotherapist once your immobilization has been removed. During physiotherapy for Osgood-Schlatter disease, your physiotherapist will begin by educating you on activity modification and implementing a period of active rest so that your symptoms can improve. Taking an active rest means decreasing your activity intensity or duration such that you are not aggravating your knee. Some activities, however, may need to be completely avoided or replaced by less stressful ones. Avoiding excessive use of the stairs, as well as resisted weight training can help reduce further kneecap pain.

Your physiotherapist may also use electrical modalities such as ultrasound or interferential current to help ease your pain or decrease any swelling that may exist.

He or she will use an additional tape or flexible brace to assist with your symptoms. The aim of this type of treatment is to help guide the kneecap through its proper range of motion while you move the knee during your rehabilitation exercises and during everyday activity.

Once your symptoms begin to subside, your physiotherapist will design a specific exercise plan in order to ensure you maintain your full knee range of motion. The following exercise examples include:

Squats

Stand straight with your feet hip-width apart. Next, lower your bottom down and backward, as if you were going to sit in a chair. Stop when your knees reach about a 90-degree angle. Try not to lean your upper body forward more than a few inches. You may want to move your arms forward for balance or stand next to a wall, counter, or other support. Straighten your legs to return to standing straight, then repeat 2-3 times a day.

Side leg raises

Lie on your side with your injured leg on top. Slowly raise your injured leg toward the ceiling. Hold this position for 10 seconds, then repeat this method 3-4 times a day.

Leg presses

Laying on the floor with the ends of a resistance band or tubing in each hand, bring your knees to your chest. Put the tubing across the bottoms of your feet and take up any slack in the resistance band. Afterward, while keeping your elbows on the floor and your hands by your chest, slowly press on both legs outward, leading with your heels until your legs are straight. Gently return to a bent-knee position before repeating this exercise 3-4 times a day.

Knee extensions

While sitting on a chair with both feet on the floor hip-width apart, slowly raise one leg out in front of you until it’s level with the floor. Then, slowly lower the same leg back to the floor and repeat 2-3 times a day.

Step-ups

Stand tall with feet shoulder-distance apart at the base of a set of stairs. Next, shift your weight onto one foot. Place your right foot entirely on the stop and press yourself up so that your body is up onto the step, placing the left foot next to the right foot on the stair. Slowly lower your left foot back to the floor and steady yourself. Continue this process with your right foot on the step as you repeat this method 2-3 times a day.

Alternative & Homeopathic Treatment

If you have mild to moderate symptoms linked to Osgood-Schlatter disease, you can often treat it at home. Here are some homeopathic treatments that can help you reduce and improve symptoms linked to this condition:

Herbal ointment – Some studies have shown that there are pain-relieving effects of a salve made of cinnamon, mastic, sesame oil, and ginger – they found the salve was just as effective as over-the-counter arthritis creams containing salicylate, a topical pain-relieving treatment.

Tai chi – This is an ancient Chinese form of mind-body exercise that improves balance and flexibility. Tai chi can help reduce pain and increase the range of motion. It also involves deep breathing and relaxation. These aspects may also help reduce stress and help you manage chronic patellar pain.

Willow bark extract – Some patients sometimes use willow bark extract for joint pain, as it may help relieve pain and inflammation. However, it is recommended to check in with your doctor before the usage of this extract.

Ginger extract – Ginger extracts are available as supplements and ginger tea. These are used to help reduce arthritic pain.