Osgood-Schlatter treatment - My recipe for success

A member of our Facebook community recently asked me what my treatment approach for Osgood-Schlatter disease is. Since it includes a few ifs and buts, I thought it would be best to share it in a blog post.

The eagle eyed among you may notice that I have thrown the word “disease” out of most of this article. The reason for this is that I feel that “disease” has lots of negative connotations and is a far too serious word for this condition.

In this article:

• What is Osgood-Schlatter?

• Why do kids develop it?

• How do you know that you have Osgood-Schlatter?

• My treatment approach for Osgood-Schlatter

You can watch my discussion about Osgood Sclatter in this video.

What is Osgood-Schlatter?

Osgood-Schlatter is an overuse injury that develops where the tendon from the knee cap (patellar tendon) inserts onto the top of the shin bone (tibial tuberosity).

In adults you find that a muscle terminates in a tendon which then attaches into the bone. Children, however, still has to grow and you find that their tendons attach to soft cartilage plates on the bone.

These cartilage plates are vulnerable to excessive pulling (traction) forces and the pain a child feels when suffering with Osgood-Schlatter is due to damage and inflammation in the cartilage.

Original image from: Blausen.com staff (2014). "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436

It usually develops in children who:

• Are going or have just gone through a growth spurt

• Who does sport involving running and jumping

Original image by: D3aj86 can be found at https://commons.wikimedia.org/wiki/File:MaleWithOsgoodSchlatter.jpg

Why do kids develop it?

There are a few theories, but currently not much research to back them up. We know from research that children normally develop Osgood-Schlatter during the years when they grow quickly (experience a growth spurt).

One theory is that their bones grow quickly but their muscles and tendons lag behind. In practice this means that they become a lot less flexible and their ability to coordinate/control their movements decreases for a short period until the brain has figured out how to ‘drive’ this new body. This may cause extra tugging and strain on the bit of cartilage that connects their tendon to the bone resulting in inflammation, pain and swelling in the area.

Their odds of developing this condition goes up if they also do a lot of sport during this time. The patellar tendon normally pulls on the tibial tuberosity when you run, jump or kick a ball. This pull will be much stronger if the child has lost some of his flexibility in his quadriceps muscle due to going through a growth spurt.

This theory does seem to link in with what I see in clinic. The kids that I treat for Osgood-Schlatter are often extremely sporty - doing sport up to 6 or 7 days of the week. They are usually also very inflexible.

How do you know that you have Osgood-Schlatter?

You are likely suffering from Osgood-Schlatter if:

• You are a child between the ages of 8 and 16 years (adults cannot get this condition, but they can still experience knee pain from the damage that was caused as a child)

• It is sore to press on the raised bit at the top of the shin bone (tibial tuberosity)

• Your knee hurts during or after sport

• You do not remember injuring your knee – the pain just started during or after sport

There are, however, other conditions that can give very similar symptoms and it may be best to see a physiotherapist to get a diagnosis. If the kid is also experiencing pain that interferes with their sleep at night, they have to have further investigation done. The pain from Osgood-Schlatter does not keep children awake at night.

Osgood-Schlatter Treatment

The 2 corner stones of my treatment approach is rest and flexibility. The reasons why I think this work are:

1. Rest or relative rest decreases the inflammation and gives the cartilage in the area time to heal.

2. Stretching the muscles decreases the pulling (traction) forces that may have contributed to the child developing Osgood-Schlatter in the first place.

Rest vs. Relative rest

People used to talk about Osgood-Schlatter as a self-limiting disease, because it will normally resolve by itself over the course of 2 years. This makes it sound as if you can just happily ignore it and nothing bad can happen.

Ignoring it and playing through the pain can cause you to end up with a severely painful knee that may stop you from doing all sports for a very long time. It can also predispose kids to more serious injuries e.g. where the attachment of the tendon can pull off the bone.

Original picture by James Heilman, MD from https://commons.wikimedia.org/wiki/File:Radiograph_of_human_knee_with_Osgood%E2%80%93Schlatter_disease.png

I don’t like to tell my patients to completely rest from sport unless absolutely needed. I usually ask them to refrain from all running or jumping sports for about 2 weeks if they are experiencing pain as soon as they start sport as well as during the day. I still allow them to do any activities that do not cause pain. I then use those 2 weeks to improve their flexibility.

It is important to find out exactly how many hours of what kind of sport the child is doing. Some kids do crazy amounts of sport per week. If a child is unable or unwilling to stop their sport, see if you can get them to just do the important sessions or maybe just play half a match. I tend to allow them relative rest if they only develop symptoms after playing sports and the pain settles within an hour after they stop doing sport.

Also, remember that a kid can still practice parts of the sport that does not involve running or jumping e.g. standing still while shooting hoops or just serving balls in tennis. You can read more here about the treatment approach physiotherapists use when treating sports injuries.

I don’t allow the kids straight back into full sport after the 2 weeks. A graded return, where you slowly increase the volume of running and jumping usually works best.

Summary:

They have to refrain from all aggravating activities for at least 2 weeks, sometimes longer, depending on symptoms. Slow graded return to sport if symptoms allow

Stretches for Osgood-Schlatter

The main muscle I target with stretching is the Rectus Femorus muscle which forms part of the quadriceps. The Rec Fem runs from the pelvis over the front of the hip joint and terminates in the patellar tendon.

An easy test to see how tight a child’s muscles are, is to perform the Thomas test. Get them to lie on a table so that their thighs can dangle unsupported. Let them hug one thigh to their chest while they allow the other one to hang freely.

A normal test: In clinic I usually want their thigh to be able to fall to parallel and I should easily be able to bend their knee back to about 130 degrees knee flexion at the same time.

NB: YOU CAN MAKE THE PAIN WORSE IF YOU STRETCH IN THE WRONG WAY

Remember that I said that Osgood-Schlatter develops due to excessive pulling forces where the patellar tendon attaches in the growth plate? So, it makes sense that you do not want to cause more strain on that area when you stretch the quadriceps.

I find that the traditional way of stretching the quads, where you catch your foot behind you in standing, often either flare them up or does not produce an effective stretch. This is because it tends to put a lot of strain on the structures around the knee.

I prefer to use a combined hip flexor and knee extensor stretch. You can use the fact that the Rectus Femoris muscle crosses both the hip and the knee joint to stretch the muscle without putting strain on the patellar tendon. You can target the top bit of the muscle more by getting them to extend the hip first and then adding in knee flexion.

Check out the video below for a step by step explanation.

I get them to perform this stretch 3 times a day (yes, mom, you will likely have to get up 15 minutes earlier). They have to hold it for at least 30 seconds and repeat it 3 times (90 seconds in total) in one go.

My compliant patients who stick to this religiously usually gets full range within about 2 weeks.

Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan.

About the Author

Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Masters Degree in Sports Injury Management. Follow her on LinkedIn, ResearchGate.

References:

• Junge, T., Runge, L., Juul-Kristensen, B., & Wedderkopp, N. (2015). Risk Factors for Knee Injuries in Children 8-15 Years: The CHAMPS-Study DK. Med Sci Sports Exerc, 10, 10.