Osgood-Schlatter’s disease (OSD) is a few things (on top of being a bit of a mouthful); it’s a growth plate injury in children, notoriously difficult to diagnose and commonly mismanaged. Osgood-Schlatter’s is characterised by swelling and irritation of the growth plate at the top of the shinbone. The growth plate is a layer of cartilage located toward the end of a bone where the bone’s growth occurs. This is why adults cannot suffer this “disease”.
When it comes to kids, two things are pretty much certainties; they’re going to grow and at some point they’re going to hurt themselves. When these two certainties occur simultaneously, children can end up with painful growth-plate injuries that can be difficult to treat and manage effectively. Growth plate injuries are quite a common cause of pain in children and adolescents and Osgood-Schlatter’s causes pain in the front of the knee. Boys are more likely to suffer the condition than girls, and playing in sports that involve lots of running, jumping and kicking increases the chances of it popping up too. Musculoskeletal physiotherapists classify Osgood-Schlatter’s disease as an overuse injury, not a disease!
HOW IS OSGOOD-SCHLATTER’S DIAGNOSED?
Because children’s bodies are physiologically different than adults, it is not uncommon for the Emergency Department or a GP to misdiagnose a child’s pain as another injury. Your child’s physiotherapist will conduct a thorough assessment which will include checking movement patterns of the hip, knee, ankle and foot, assessing muscle strength and muscle length in order to pinpoint the cause of pain. X-rays and other medical imaging are usually not required.
If your child has Osgood-Schlatter’s, they will normally have pain close to where the patellar tendon connects to the shin bone slightly below the knee cap. It can also cause a painful lump to form in that area. For your child, their pain will probably be heightened during physical activity and the pain commonly gets worse with running, jumping and walking up hills. The pain and swelling tends to improve relatively quickly (in the short term) with a bit of rest.
WHAT CAUSES OSGOOD-SCHLATTER’S?
Osgood-Schlatter’s is an overuse injury, which is exactly like it sounds. During a child’s growth spurt, the bones, muscles, and tendons all grow at different rates. In OSD, the tendon connecting the shinbone to the kneecap pulls on the growth plate at the top of the shinbone. Activities and sports such as AFL, soccer and athletics can cause this movement to happen over and over, causing injury to the growth plate. When undergoing physical activity with strong, repetitive muscle contractions in the thigh, micro-fractures can occur due to the immature nature of the joint and bones. Another possible cause of Osgood Schlatter’s in adolescents is the lack of growth of the quadriceps in comparison to the femur bone. During a child’s growth spurt, the slow lengthening of the muscle is unable to keep up with the rapidly lengthening femur, which causes increased tensile force on the tibial tuberosity and more pain.
HOW IS OSGOOD-SCHLATTER’S TREATED?
I’ve seen mild cases of Osgood Schlatter’s Disease resolve themselves within a few weeks, but severe cases must be professionally managed to avoid permanent growth plate damage. Fortunately for the unfortunate child, Osgood Schlatter’s disease is very successfully managed via physiotherapy. Osgood Schlatter’s disease is a self-limiting syndrome which means that with time, complete recovery can be expected with the closure of the tibial growth plate. If OSD hasn’t been treated effectively during childhood, it is not uncommon for there to be recurring discomfort in the knee while kneeling due to enlarged lumps as a result of the distorted growth plate. Although symptoms of Osgood Schlatter’s disease can hang around for months at a time, surgical intervention is hardly necessary.
The goal of the treatment is to control your child’s knee pain and prevent the condition from worsening. Treatment usually includes:
- The tried and true RICE method (rest, ice, compression, and elevation)
- Medications such as anti-inflammatories for discomfort and swelling
- Wrapping or compression of the knee
- Limit on activity
- Physiotherapy to help lengthen and strengthen the thigh and leg muscles
What not to do:
- Stretching! Multiple sources online speak about stretching out the quadriceps, to help lengthen the muscle and alleviate tension on the growth plate. With additional tensile force pulling on a growth plate that is constantly being pulled, no child will thank you for stretching out their quadriceps!
Your child’s physio will also prescribe specific exercises for your child to complete depending on their assessment findings. One of the common reasons adolescents develop Osgood Schlatter’s syndrome is tight quads, hamstrings and calf muscles. In that case, manual therapy and soft tissue release will assist pain and quicker recovery.
If your child has been complaining of a sore knee or has been limping or showing signs of discomfort, don’t let the issue linger for too long. Call one of our musculoskeletal physiotherapy experts on (02) 8964 4086 and get a diagnosis and treatment plan before any long term damage occurs.