Osgood Schlatter’s Disease (OSD) is one of the most common causes of knee pain in young children and adolescents. It is an inflammation of the growth plate at the tibial tuberosity. This is the bony bump on your tibia (shin bone) where the patella (kneecap) tendon attaches. A growth plate is an area of cartilage near the end of a bone. They enable bones to lengthen until children reach their full height. Once a child is fully grown, the growth plates are replaced with bone.

OSD symptoms:

The typical presentation of OSD is pain at the front of the knee below the patella that has not resulted from any trauma. Pain occurs during and after physical activity that will ease with rest. The inflamed tibial tuberosity will be tender to touch. In addition to pain, adolescents may also present with swelling, and a more prominent tibial tuberosity.

OSD can happen in one or both knees and if the pain is severe, this may lead to limping.

What causes OSD?

Typically, OSD is seen in adolescents that are highly active and growing. However, those that are less active can still develop OSD. During a growth spurt, muscles can struggle to keep up with the bones lengthening and become tight. If the quadricep muscles at the front of your thigh become tight, there could be increased tension on your patella tendon which will pull at the tibial tuberosity. Activities like running and jumping that involve repeated straightening of the knee can cause irritation at the growth plate of the tibia, leading to pain.

What are the 3 main risk factors for OSD?

Age
OSD affects adolescents and children. Males are typically aged between 12-15, whilst females are typically 8-12. OSD is more common in males.
Rapid growth spurts
During puberty, there is a sharp increase in growth, with adolescents sometimes growing several inches in a short period. Bones, tendons and muscles are all growing at different rates during this time.
Sports involving repetitive jumping and running
Activities such as basketball, football, gymnastics and sprinting, are high in impact and can cause repeated strain to the growth plate.

Is OSD serious?

OSD doesn’t usually cause any long-term complications. Some people with OSD may be left with a more prominent bump below the knee that is painless.

Does OSD ever go away?

The prognosis for OSD is very good, with most people being completely free of pain when they are fully grown. Very rarely, symptoms may persist into adulthood after an adolescent has stopped growing.

What happens if you don't treat OSD?

If OSD is not treated, symptoms may persist up until an adolescent has reached full maturity and stopped growing. This could have an impact on their participation within sports. If they continue with their normal training load without making any adjustments, the pain may cause them to limp, putting additional stress on other areas of the body, which could lead to an injury or pain elsewhere.

Can you play sports with OSD?

Those with OSD can usually still take part in their normal sports, although the amount of activity they do may need to be reduced. Pain is the main guiding factor as to how much you should limit your activities. Complete rest generally isn’t needed as it will not speed up recovery, although it will reduce pain. Once the pain has settled, you can slowly increase the training load as long as it doesn’t cause any aggravation of symptoms.

Lower impact activities like cycling and swimming can be a good way to maintain fitness whilst waiting for symptoms to improve.

OSD treatment and exercises:

Activity modification is the key to managing the symptoms of OSD. A reduction in training load (frequency and/or intensity) is needed until the symptoms become manageable. If the athlete takes part in multiple sports, it may be useful to temporarily reduce the number of sports they participate in.
Icing the knee after sports can be helpful to reduce pain. Just remember to have the ice/cold pack wrapped up in something like a towel, so it is not directly in contact with your skin. Leave the ice on your knee for about 10-15 minutes.
Gentle stretches for the hamstring, calves, and particularly the quadricep muscles are beneficial. When going through growth spurts, muscles tend to get tight as they growth at a different rate than bone.
Quadricep muscle stretch – stand, holding on for support if required. Bend one knee and take hold of your ankle with the hand on the same side. Draw your heel as close as you can to your buttock. You should feel a stretch at the front of your thigh. Hold this for 20-30 seconds and repeat 2-3 times.
Soft tissue massage to the quadriceps at the front of the thigh can help relax the muscles, reducing the tension at the knee.

Strengthening the muscles of the lower legs can be introduced as the pain allows. We would initially start off with low intensity exercises before gradually progressing to higher intensity exercises.

Key messages from this blog:

OSD is a common cause of knee pain in active, growing adolescents

Temporary activity modification is key for managing symptoms
OSD is usually completely resolved by the time adolescents have stopped growing

Can Physio help?

If you are suffering with any knee pain or any discomfort we at The Physiotherapy Place are here to help. Book an appointment or FREE phone call consultation with us and let us help you get back to health!