Osgood-Schlatter Disease: Causes, Symptoms & Management

Osgood-Schlatter Disease

Osgood-Schlatter Disease is a common condition that affects the knees, primarily in adolescents, particularly during growth spurts. It is characterised by pain, swelling and tenderness just below the kneecap, where the patella tendon attaches to the top of the shin bone (tibia). This condition is most commonly seen in physically active children and adolescents, especially those involved in activities that stress the knee, such as running or jumping.

Causes

Osgood Schlatter disease is much more common amongst boys (approximately 13-15 years of age) than girls (about 10-12 years of age). During growth spurts at this time, symptoms will often develop as a result of exposure to repeated forced knee extension.

The causes can, therefore be broken into three categories;

Growth

During rapid growth phases repeated knee extension via the quadricep muscle may cause softening and partial avulsion of the developing secondary ossification centre (where bones develop).

Physical activity

Osgood-Schlatter is associated with activities involving substantial knee extension such as running and jumping. Unaccustomed peaks in frequency or intensity may also contribute to developing symptoms.

Biomechanics

Specific biomechanics such as bony alignment, gait abnormalities, tight muscles or flat feet can cause additional stress on the patella tendon and its junction with the tibial tuberosity.

Symptoms

The main features of Osgood-Schlatter disease include;

Pain

The primary symptom is pain and discomfort at the site of the tibial tuberosity, which is a bony bump just below the kneecap. The pain typically worsens during physical activities and may subside with rest.

Swelling and Tenderness

Swelling and tenderness are often present over the tibial tuberosity, and this area may be sensitive to touch.

Bony Bump

Over time, a bony bump may develop at the site of the tibial tuberosity due to the repetitive stress on the growth plate in this area.

Diagnosis

Physiotherapy examination of an adolescent with knee pain involves a thorough history to determine the location and nature of the knee pain, determining the onset of the pain, past history and any other potential contributing factors.

Physical examination aims to exclude other common, and less common, causes of knee pain. In the case of Osgood-Schlatter disease examination reveals tenderness and sometimes a bump over the tibial tuberosity. There may be associated muscle tightness in the quadriceps or in adjacent muscle groups. Excessive subtalar pronation (flat feet) or other biomechanical factors may predispose to the development of Osgood-Schlatter disease.

Typically, the diagnosis of Osgood-Schlatter disease is clinical and will not require radiographs.

Treatment

Several treatment strategies may be applied;

Activity/Load modification

Critically, when an adolescent presents with Osgood-Schlatter disease, they are likely to be required to modify their exercise levels. Young athletes will often play several sports at one time. By reducing the number of sessions that are completed, adolescents will often be able to manage their pain levels. Pain is typically the leading guide to the limitation of activity.

Education

As a condition that affects adolescents, Osgood-Schlatter disease is often the first experience that children have with an injury. It is therefore important that they are brought ‘on the journey’ to understand the nature of the injury, the management plan and expected recovery. Importantly understanding that Osgood Schlatter disease is largely self-limiting helps to ease concerns around long-term prognosis.

Pain management

Icing, medication and bracing can be used to reduce pain levels for those suffering from Osgood Schlatter disease.
Biomechanical modifications: Following a physical assessment, physiotherapists will often suggest treatment strategies aimed at reducing the traction on the tibial tuberosity. This may involve stretching of the quadricep muscles, correction of excessive subtalar pronation (flat feet) or strengthening adjacent muscle groups and improving general fitness.

This blog was written by Peter Growse, Senior Physiotherapist/Musculoskeletal Physiotherapist. If your child is experiencing pain or discomfort, book an appointment with Peter by clicking here.

Published November 10, 2023