Has your child ever come to you complaining about knee pain? In particular, is it difficult for them to walk, squat and go up stairs?
Have you noticed a tiny bump underneath the kneecap? And as you put some pressure on the bump, is it tender?
Does your child walk with a limp especially after physical activities or sports?
These could be some of the signs and symptoms of Osgood-Schlatter Disease.
As scary as it sounds, Osgood-Schlatter Disease is not a disease in the sense that most people think.
Medically known as Tibial Tuberosity Apophysitis, it’s actually a condition caused by overuse or injury. This causes inflammation and swelling just below the knee area over the shin bone. It’s also one of the common causes of knee pain in growing teenagers.
Osgood-Schlatter Disease occurs most often in children who are active in sports that involve running, jumping and swift changes of direction — such as soccer, basketball, volleyball, gymnastics and ballet. The condition usually occurs in just one knee, but it can also affect both knees.
Boys are more likely to be affected as compared to girls and it normally occurs when they are experiencing growth spurts during puberty. This means that most cases are typically 10 to 15 years in boys and eight to twelve years in girls.
In the early stages of OSD, patients have pain on the Tibial Tuberosity (the bump at the top of the Shin Bone). This pain occurs after physical activities, but over time, the pain becomes permanent and steady regardless of activity.
In order to understand better what’s causing your child’s knee pain, we first need to understand how the knee works.
The knee is one of the largest and most complex joints in the body. The knee connects the two longest mechanical levers in the human body: the thigh and lower leg. As a result, the forces on this joint are much higher than in most other joints.
Additionally, the knee joint is vital for movement, bears the weight of the upper body and absorbs the shock carried upward through the feet as we walk and run. With that much stress being placed on the knee joint, it’s more vulnerable to a variety of injuries.
A normal knee joint consists of the Thigh Bone (Femur), the Shin Bone (Tibia), the Kneecap (Patella), tendons and ligaments as well as cartilage.
To make matters more complicated, the lower leg is actually made of two bones: The Shin Bone (Tibia), and also another smaller bone located on the outside called the Fibula.
The Kneecap is a triangular bone located in front of the knee. This bone is connected to the upper ledge (Femur) by the Quadriceps tendon.
On the other end, the Kneecap is connected to the lower leg (Tibia) by the Patellar tendon that runs from the patella bone to the Tibial Tuberosity (that small bump at the top of the Shin Bone). This is the bump that OSD is referring to.
There are four main ligaments in the knee that act like strong ropes to hold the bones together and keep the knee stable.
Last but not least, there are two C-shaped pieces of cartilage called the Medial and Lateral Menisci, that act as shock absorbers in the knee. With numerous Bursae (fluid-filled sacs), they help the knee to move smoothly and pain-free.
I hope you now have a rough idea of the structure of the knee and how it works. You don’t need to know the technical terms. What you do need to understand is that everything is connected by a series of tendons under very high stress.
Now, let’s have a look on how Osgood-Schlatter Disease occurs in your child’s knee.
During the growth spurts of teenagers, the bones, muscles and tendons grow at different rates.
Bones don’t grow from the centre: they usually grow at the ends in an area called the Growth Plates. The Growth Plates are softer, weaker and more prone to injury compared to bones. When a child is fully grown, the growth plates will harden into solid bone.
Some growth plates are the main attachment points for tendons. In the case of OSD, the Tibial Tuberosity (The bump on the Shin Bone) is one of these attachment points. As we mentioned earlier, this is where the tendon connects the Kneecap to the Shin Bone.
During sports and physical activity, the Quadriceps muscle pulls tightly on the Kneecap. The stress on the Growth Plates combined with the accelerated growth of a child’s bone caused the Patellar Tendon to become irritated at the point where it attaches (The Tibial Tuberosity). This irritation and inflammation stimulates the formation of a bony prominence. As a result, there will be a painful and swollen bump on the tibial tuberosity: the main symptom of Osgood-Schlatter Disease.
With Osgood-Schlatter Disease, your child will be experiencing some pain and swelling on the knee. This pain can also lead to tight and weak muscles if there is no proper management plan in the early stage of the condition.
Let me share with you a step by step guide on how to fix it, before the condition worsens:
The first goal of any OSD treatment is to reduce the pain and swelling first.
We do this by elevating the knee, and applying ice or a cold pack 3-4 times a day for 20 minutes – especially after any physical activity.
Put a thin towel between the ice and your child’s skin to prevent ice-burn. In some cases, rest from activity is required for several weeks or months to avoid further aggravation. However, if your child does not have a large amount of pain or a limp, participation in physical activities may be safe to continue with proper warm up and cool down routine as well as wearing a patellar tendon strap to support the knee and reduce the stress.
Once the pain and swelling has subsided, stretching exercises can be commenced.
One of the major causes for developing Osgood-Schlatter Disease is excessively tight Quadriceps muscles, Hamstrings, Hip Flexors and Calf Muscles. These tight muscles increase the pull on the Patellar Tendon and in turn: the Tibial Tuberosity.
This can affect the alignment of the lower limbs during activities which can also change the way forces travel through the bones and muscles. Stretching exercises will help to increase the range of motion and flexibility of the muscles, as well as relieving pain in the knee.
When your child has prolonged pain and poor movement for a long time, this will naturally change the alignment of their knee joints. While stretching the muscles will reduce the forces put through their joints, it is not enough to properly fix their alignment.
Thus, strengthening both the knees and hips are also very important during the active phase of Osgood-Schlatter Disease. Increased strength of the supporting elements, leads to improved knee alignment, and can allow the muscles to support and control the knee better: especially during fast paced activities. This further decreases the pressure transferred to the Tibial Tuberosity.
Unfortunately, the human body is not well-equipped for a lifetime of high-impact, high-intensity sports. Many high-level and Olympic athletes will find themselves with heavily worn joints and cartilage in later life as a result of their overuse. As we mentioned at the start of the article: OSD is primarily an ‘overuse condition’.
As a result, it’s very important that once a problem has been identified, we don’t just treat the symptoms: we also have to treat the cause. Even with the best stretching and strengthening programme, excessive high-impact sports will lead to OSD getting worse.
For children who suffer significant OSD problems, we recommend that they try lower impact exercises that don’t exert as much pressure on the knee tendons. Swimming and Pilates are a fantastic combination that allow your child to stay active, build muscle, and keep fit during the recovery process.
At our Studio (Body in Common), we focus on Clinical Pilates. It’s a very low-impact form of exercise with great rehabilitation results. One of the best things about Clinical Pilates is that when the rehabilitation is complete, switching over to Fitness Pilates is easy and can be a life-long, social sport.
The good news is that treatment for Osgood-Schlatter Disease rarely requires surgery, and the major symptoms from Osgood-Schlatter Disease will typically resolve before age 18 (or when a teenager’s growth spurt ends and the bones mature).
The condition may leave a permanent painless bump below the knee. In the years after recovery, about 60% of adults who once experienced Osgood-Schlatter Disease will have some pain with kneeling.
If your child is experiencing symptoms of the condition, there are two steps to follow.
First, I would advise you to first see an Orthopaedic Doctor (Bone Doctor) to get a proper diagnosis. The doctor will discuss your child’s symptoms and conduct a thorough physical examination of the knee to determine the cause of the pain. The doctor may also order an x-ray of your child’s knee to help confirm the diagnosis or rule out any other problems. The doctor will be able to diagnose the condition, but will not be able to provide treatment themselves.
Second, it’s time to see a Physiotherapist for further management. Over the years, Physiotherapy has been proven as effective in treating Osgood-Schlatter Disease, and is the go-to specialist for this condition. There are several sub-specialties in Physiotherapy, and you want a Physio who:
If you’re in Malaysia, we can help you at Body in Common, Bangsar.
After the Orthopedic Doctor’s diagnosis, there is still one diagnosis to do. A physiotherapist will do a full-body assessment including analysing posture, gait (walking pattern), where the pain is, range of motion tests, as well as muscle strength tests. This assessment turns the generic diagnosis into a personalised assessment that can be used for treatment.
The physiotherapist will then create a personalised exercise programme that targets the specific issues that need to be worked on. The personalised exercise programme consists of various exercises that focus on stretching, strengthening, proprioception and balance training in order to prepare your child to be stronger, better and able to return to participating in their physical activities and sports in no time.