Osgood Schlatter Disease

Osgood Schlatter disease is the most common cause of knee pain in adolescents. It is caused by tension and inflammation just below the kneecap which can result in a painful bony lump.

It usually occurs in active people, most commonly aged 9-16, often following a growth spurt and affects approximately 1 in 5 adolescents. 

It is most common in boys, particularly those playing lots of sport involving running, kicking and jumping.

Here we will look at what causes Osgood Schlatter Disease, how it presents, and what you can do to treat it and prevent it from coming back again in the future.

What Causes It?

Osgood Schlatter disease usually develops after a sudden growth spurt when the leg bones (femur and tibia) grow quicker than the quadriceps muscle (quads). 

As a result, the muscles get very tight which creates a lot of tension where they attach to shin bone at the tibial tuberosity. This damage the bone, known as Traction Apophysitis, which results in inflammation and swelling.

The body tries to heal itself by laying down new layers of bone.  When the quadriceps muscles are used heavily and frequently such as in running and kicking, this goes into overdrive causing a bony lump to form on the shin.

Sometimes, the tension in the muscles pulls so hard on the bone that small cracks develop, pulling the tibial tuberosity away from the tibia itself. This is known as an avulsion fracture.

Occasionally, the condition occurs following a direct blow to the tibial tuberosity, such as a forceful kick, but this is much less common.

Symptoms of Osgood Schlatters

The main symptom of Osgood Schlatters is pain just below the knee. It is tender to touch and will hurt with any sporting activity. The pain comes and goes, increasing with activity and decreasing with rest. You may also be able to feel a bump on the front of the shin bone just below the knee (the tibial tuberosity).

It tends to only affect one knee, though in 20-30% of cases people get symptoms in both knees.

Treatment Options

1) PRICE (Protect, Rest, Ice, Compress, Elevate) - the first line of treatment. Rest from any aggravating activities is extremely important, else the condition just gets worse. Once you return to sport, ice on the knee before and after can also help. Visit the Ice to find out how to use ice safely and effectively and the ice wrap section for the best ways to apply ice

2) Knee Brace Straps: Wearing a knee strap directly on the patellar tendon (below the kneecap but above the tibial tuberosity) works really well to reduce pain and facilitate returning to sport as it directs the tension away from the bone. They are simple to use, extremely effective and cost about $6/£9

3) Painkillers: generally paracetamol. NSAIDS (non-steroidal anti-inflammatories) such as ibuprofen are not always recommended for children

4) Exercises: after a period of rest, you can start some gentle exercises. You want to do a combination of stretches and strengthening exercises. These must be progressed slowly so as not to cause a flare up. Click the links for some simple exercises that will help.

5) Gel Knee Pads: reduce the forces going through the knee when kneeling and eliminate friction on the bone.

6) Plaster cast: Very occasionally when the symptoms are severe, the doctor will recommend immobilising the knee in a plaster cast to ensure complete rest for 3 weeks

Recovery

It generally takes somewhere between a few weeks and a few months for Osgood Schlatter Disease to settle down completely. Usually, the knee needs total rest from any aggravating activity for about a week. Then training can recommence but with reduced frequency, duration and intensity, ensuring symptoms don't return. If they do, activity levels should be reduced.

People usually return to normal sporting activities after about a month, but may benefit from wearing a knee strap. However, sometimes it can take a long time to fully recover from Osgood Schlatters, up to 2 years.

Things usually settle down when the bone reaches maturity at around 16 years of age with approximately 9 out of 10 cases resolving completely. Occasionally however, people continue to get problems as adults.

Preventing Osgood Schlatters

Osgood Schlatter Disease can be difficult to resolve and therefore it is definitely worth trying to prevent it.

Things to Do

1) Knee Stretching exercises: Osgood Schlatters is caused by muscle length not keeping up with bone growth during growth spurts. Stretching the thigh muscles will combat this and reduce the tension on the tibial tuberosity. Click the link to find out the quickest, most effective ways to stretch the knee muscles.

2) Strengthening exercises: ensuring there is no muscle weakness around the knee can help to reduce the chance of developing Osgood Schlatter disease. Click the link for simple exercises that will help.

Things to Avoid

1) Resistance training: ie leg weights under the age of 16 – it puts too much strain on soft, young bone
2) Over training: avoid long training sessions (over a couple of hours) or training too often (try to have a day off in between training sessions)
3) Repetitive activities: eg hopping and jumping

What Next?

Visit the Osgood Exercises section for exercises that will help you recover quickly from the condition.

There are a number of other causes of front knee pain. If this doesn’t sound quite like your knee pain, visit the Knee Pain Diagnosis section for help working out what is causing your knee pain.

Go to Common Knee Conditions or Homepage

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Updated 30th April 2013
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