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Nov 5

Osgood Schlatter Disease – knee pain in active kids

By Vital Core Physio Olivia Bredenkamp

Is your healthy active child complaining of pain in the front if the knee?

Osgood-Schlatter disease (OSD) is a common knee condition that affects active growing children and is characterised by pain in the front of the knee, however it is not a disease as the name suggests. It’s correct name is Tibial Tubercle apophysitis.

 

The patella tendon attaches the thigh muscle (Quadricep) and knee cap (Patella) to the the bumpy bit at the top of the shin (Tibial tubercle). This tibial tubercle in kids has a “growth plate” beneath it which is a thin layer of cartilage between it and the underlying bone (tibia).  It is this sensitive ‘growth plate’ area which which becomes irritated and painful with OSD.

How does it happen?

Active kids love to run and jump and squat and lunge, kick….often all at the same time – right?! All those movements require the quadricep muscle to contract. That contraction then pulls on the patella tendon which in turn pulls on the tibial tubercle. Add in to this an adolescent who is rapidly growing. Their thigh bones and shin bones are getting longer. The forces required to run, jump, kick result in even greater forces on the thigh muscles and tendons and the growth plate which causes more inflammation and pain. Over time this results in the body laying down extra bone to try and alleviate the stress on the cartilage. It can also cause the tibial tubercle to seperate from the underlying tibia.

OSD is caused by too much load on the patella tendon. That is usually from excessive physical activity such running and jumping during growth spurts, but can also be due to stiff quadriceps muscles. There may be an imbalance between the growth of the thigh bone and thigh muscles which means the thigh muscles may be shorter and stiffer in relation to the bone length, or your child does not stretch well after training sessions.

It affects 1 in 10 adolescents, boys (11-15 years old) more than girls (8-13 years old) and growing children of all activity levels. However, children participating in running and jumping sports are at an increased risk of developing OSD.

What are the signs and symptoms of OSD?

  • Pain and swelling in the lower aspect of the knee where the tendon attaches to the tibial tubercle (top bony aspect of the shin). It may affect one or both knees.
  • “Bump” in the front of knee (see picture) due to bone formation at weakened growth plate.
  • Constant dull ache due to inflammation which is made worse by physical activity especially jumping, running and stair climbing.
  • Inability to straighten the knee when resistance is applied.
  • Pain when kneeling if symptoms have been prolonged.

How will Physiotherapists at Vital Core assess your child’s knee?

As always at Vital Core we start with what are the goals of treatment? Does the child have an important game/ match coming up that they want to play? What are they doing currently? What sports (school and out of school)? What other activity do they like to do (trampoline, bike riding, scooter). How often do they have a full day off exercise?

Assessing the general body posture can give us a lot of information. We will not just look at the knees, but also at hip and foot posture and may need to see your child’s active footwear.

We will assess your child’s leg function and joint alignment using functional tests e.g. hopping and running, squatting. We will test leg muscles strength and check flexibility especially of the Quadriceps (thigh) muscle.

A thorough knee assessment needs to be done to exclude ligament or meniscal damage and other injuries that may present similar. The patella tendon will be palpated for tenderness and the knee range of movement measured.

There may be other tests that we need to do as well. In the end we will have a very clear picture of exactly what stage your childs’ OSD is at and therefore what needs to be done to get it 100% better and your child achieving their goals.

Vital Core Physiotherapy management for OSD.

Once we have provided the education to you and your child of what is going on and why we can set about settling it down and getting your child back to their activities pain free and confident in their abilities.

There will be three main phases of treatment

Phase 1

Initially we will focus on settling the symptoms of pain and inflammation. We will provide advice on activity and load modifications, advice on the use of anti-inflammatory and pain medications, ice application and compression of the knee. Gentle exercises will be given during this time.

Phase 2
After the initial pain and inflammation has settled, the child will be provided with an individualised and progressive home exercise program to address any dysfunction we may have identified during the assessment. There is no “one size fits all” approach when it comes to exercise prescription for OSD, but it is important to appropriately load the patella tendon to aid recovery and as it recovers, especially if it was caused by excessive training and load on the tendon.

If we have identified muscle stiffness as a contributing factor to the condition, soft tissue release techniques will be used to help improve muscle flexibility and we will teach the child how to use a roller and stretches to release the muscles.

If we’ve identified any foot posture abnormalities, we may refer you to a well trusted Podiatrist with expertise in OSD co-management.

Phase 3

Management and prevention.

Your child may continue to grow. We want them to remain as active as possible as we all know how important life-long health exercise is to our general well-being. So once your child’s pain has settled and they are correcting the dysfunctions that we had identified we will teach them some preventative and management protocols to keep them performing at their best.

Importantly, we will provide the child (and parent) with a treatment plan based on his/ her individual goals and normal healing time frames. Our goal will be to get the patient back to the things he/ she loves doing and again it may look different for every individual. Full recovery and resumption of previous activity levels may take 3 months or longer to achieve, but this does not mean complete rest from all activities during that time. At Vital Core we are not about the quick fix.

Additional equipment that may be needed to help recovery:
• Foam roller or spikey ball
• Exercise ball
• Light weights and or an elastic band
• Knee brace/ sleeve to wear during treatment phases and when returning to activity
• Tape to help settle acute symptoms
• Ice pack
• Appropriate footwear/ orthotics

Who else may be involved in the management of OSD:
• Podiatrist
• GP for referral for further investigations should symptoms persist beyond normal healing time frames to exclude a fracture or other conditions that may present similar. Plain X-rays may confirm OSD diagnosis.
• Your GP may also refer you to an orthopaedic surgeon should symptoms persist. It is important to note that a recent systematic review found no evidence to support surgery for the management of OSD.

So if your active, healthy child is struggling because of knee pain please come and see us at Vital Core Physiotherapy so we can help get them back to the sports and activities that they love. Remember you can make and appointment online or call and speak to one of our admin team.