Osgood Schlatter Disease

Osgood Schlatter Disease (OSD) is the most common cause of knee pain in adolescents. It is caused by tension and inflammation where the patella tendon attaches 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 one in five adolescents.  

It is most common in boys, particularly those playing lots of sport involving running, kicking and jumping. Recovery can take anything from a few weeks to a few months and rest from aggravating activities is vital.

Here, we will look at what causes Osgood Schlatter Disease, the classic symptoms, treatment options and the recovery process, as well as prevention strategies to stop the condition developing or returning. 

What Causes It?

In Osgood-Schlatter disease, the enlarged, inflamed tibial tubercle is nearly always tender when pressure is applied.

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 the patella tendon attaches to the shin bone at the tibial tuberosity. This damages the bone, known as Traction Apophysitis, which results in inflammation and swelling.

Osgood Schlatter Disease is caused by friction and damage just below the kneecap

The body tries to heal itself by laying down new layers of bone, but if you are doing lots of activities like 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.

Typical Symptoms

The main symptom of Osgood Schlatters disease is pain just below the kneecap. 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, where the body has laid down extra bone to try and prevent further damage.

Usually OSD 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 or 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

Knee straps can help reduce pain and friction associated with Osgood Schlatter disease

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.  Visit the knee strap section to find out more

3) Painkillers: generally paracetamol help to reduce the pain. 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

The Recovery Process

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 again.

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, 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.

Stretches can help prevent Osgood Schlatter Disease

Things to Do

1) Knee Stretching Exercises: Osgood Schlatter disease 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 Schlatters. Click the link for simple exercises that will help.

Things to Avoid

1) Resistance training: i.e. 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: e.g. hopping and jumping

What Next?

Visit the Osgood Schlatter 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 problem, visit the Knee Pain Diagnosis section for help working out what is causing your pain.

Go to Common Knee Conditions or Homepage

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