When I was about 11 years old, I developed sore heels, which would be diagnosed as Sever’s Disease. I recently wrote a post all about Sever’s Disease, which outlined common signs and symptoms of the condition, along with conservative management techniques. What I did not mention in that piece was that about 12 months after my Sever’s diagnosis, I began to experience discomfort in my knees also, which would be quickly diagnosed as Osgood-Schlatter’s Disease. It was just as debilitating as frustrating, however was able to be managed well with the help of a dance physiotherapist.
What is Osgood-Schlatter’s Disease (OSD)?
Similar to Sever’s, OSD is not a ‘disease’ – it is not communicable from one person to the next, but is a condition of adolescence which affects the patella tendon’s attachment to the top of the shin bone. The attachment site is directly over the superior tibial growth plate, the apophysis. In a young person at risk, the area can become irritated and inflamed, resulting in inflammation of the growth plate. Technically called tibial apophysitis, this is Osgood-Schlatter’s Disease.
The growing part of the bone is the weakest part of the osseous-musculo-tendinous unit, until it fuses in late childhood or early adulthood. It can be irritated by direct trauma to the site, or through traction and mechanical stress via the tendon attachment to the bone.
What are the signs and symptoms?
Signs and symptoms that someone might have OSD are:
- pain at the front of the knee, just below the knee cap
- swelling around the front of the knee
- soreness during activity and ache afterwards
- may be sore or ok upon waking in the morning
- a painful gait, possibly causing a limp
- reduced strength and power in jumping activities
- the development of a bony lump on the front of the top of the shin bone
- discomfort with or inability to kneel down
How do we diagnose Osgood-Schlatter’s Disease?
A sports doctor or physiotherapist will generally be able to diagnose OSD from the patient’s history and explanation of symptoms in conjunction with their physical examination. XRay’s are typically not required, but may be necessary to rule out something more sinister. Radiological findings, such as a fragmented growth plate, are often visible in healthy, normal knees, as illustrated below.
Who does it affect?
Apophysitis can occur at any growth plate site. OSD affects active, young people; girls aged 8 to 13 and boys aged 10 to 15.
What can contribute to developing Osgood-Schlatter’s?
- Activities involving running, jumping, and repeated rising movements require repeated and forceful contraction of the quadriceps muscle which connects to the patella and continues as the patella tendon, in turn placing repeated stress on the tendon’s attachment to the tibia
- Sports like soccer, football, basketball, gymnastics and dancing
- During periods of high velocity growth, there may be a discrepancy between the length/size of the bone and strength/length of the surrounding muscles and tendons, placing increased tensile strain on the soft tissues and their bony attachments. In line with growth is expected and normal weight gain, which will add additional load.
- Tightness and/or weakness in the big muscles of the lower limbs (mainly calves and quadriceps), or stiffness in the ankle and foot, decreases the dorsiflexion (plié) range of movement and reduces shock absorption ability when landing from jumps
- Sub-optimal biomechanics of the lower limb kinetic chain
- Poor intrinsic foot muscle coordination and strength further reduces the ability to absorb shock when landing from aerial movements, forcing the tendon and it’s attachment to take on more load
- A sudden increase in training load can strain the tissues beyond their capacity
- Addition of new skills to a training regime can overload the tissues
- Time of the year – in Australia, kids tend to grow most in September and January, so growth-related and overuse injuries during these periods are more common
How can physiotherapy help to manage the symptoms?
I wrote a blog recently detailing strategies to help with managing acute injuries, which outlines the POLICE acronym – protect, optimal loading, ice compress, elevate. All of these methods are applicable to the management OSD symptoms.
Physiotherapists can be pretty clever people! We are body detectives, engineers and mechanics, and have a huge bag of tricks up our sleeve to help guide you or your child through OSD. In addition to those outlined in previous articles:
- Taping techniques to offload the inflamed area and facilitate correct activation of the stabilising quadriceps muscle
- Massage to release tight quadriceps and calves
- Mobilising to improve ankle and foot range of motion
- Assessing biomechanics and addressing contributing factors
- Retraining optimal movement patterns
- Strengthening leg muscles
- Loading the patella tendon appropriately so as to maintain strength without overloading it
A physiotherapist will be able to advise the client on ways to modify their activities and adjust their loading, such as cross training, to allow activity to continue during periods of pain and incapacity. At times when symptoms are severe, the client may require rest from all activities to allow inflammation and pain to settle. Whereas when symptoms are mild or stable, the client may be able to participate in full training. For example, in a ballet class, a dancer may be able to take barre and adage in the centre, but no allegro. Finding balance and working with what the body can tolerate on any given day is key to successful continuation of class or training.
Emotional and Motivational Recovery
See my previous blog about recovery for additional tips to address the non-physical aspects of rehabilitation.
What is the prognosis?
For the majority of sufferers, the prognosis is excellent. Some people are left with a more prominent bony tubercle at the top of the shin bone, which may be uncomfortable to kneel on. Symptoms will come and go, often for up to a couple of years, and will naturally resolve once growing slows.
Need some personalised advice on Osgood-Schlatter’s? Get in touch!
The information and methods outlined above are intended as a guide only and are provided on the basis the reader will be responsible for assessing the relevance and accuracy of the content in reference to their specific situation.