Osgood Schlatter Disease

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Osgood Schlatter Disease isn’t actually a “disease” at all. It’s actually a painful reaction in a growth plate at the top of the tibia (shin bone). It occurs when the quads muscle pulls on the growth plate during rapid growth spurts.

It occurs during a growth spurt between the ages of 11-14 years. The growth spurt, and the symptoms, typically last around 6 months. It most commonly affects both knees, although one may be worse than the other.

The key point with Osgood Schlatter Disease is that it’s a growth-related issue, not related to lower limb biomechanics. This means that you don’t need to buy special shoes, orthotics or similar to fix the problem.

The other point is that there are no detrimental effects from pushing on. No matter how much sport you play, you can’t make it last longer. And there aren’t any ongoing issues once growth slows, no matter how much you played throughout the episode.

Osgood Schlatter Disease isn’t to be confused with other conditions and injuries that can occur around the same age. Patellar tendon injuries generate pain and tenderness to touch in the tendon slightly above the bony prominence. Moving further up again, another growing pain can affect the lowest point of the Patella. Called Sinding Larsen Johansson Disease, it gets sore in the same patterns as OSD but won’t respond to many of the treatment approaches.

TIPS

  • The most critical factor for pain management is adjusting overall load – you don’t need to stop all activity. If you can tolerate the pain, you can play as much as they want
    1. Start by making a list of all the activities in a regular week, including games and training
    2. Then order them based on importance and enjoyment – remember that there’s a psychological component to sport that needs to be considered. Participation, social involvement and contributing to a team goal are huge in a child’s development
    3. Begin to reduce or remove the least important/enjoyable sports first, reducing by one session per week, until the pain levels are tolerable
    4. Over time and as the condition eases, you can begin to add these sessions back in with one extra session per week, provided that it doesn’t worsen symptoms
  • There are a number of ways that you can reduce pain after activity
    • Ice packs or ice massage – used immediately after exercise, it’ll reduce the intensity and duration of residual soreness
    • Paracetamol or anti inflammatory medication, although the latter does carry some risk worth prolonged use
  • Using a brace to directly offload the tendon attachment is a very effective and quite cheap method of relieving pain during exercise
    • Here’s an example of a Patellar Tendon Strap, only costs a few dollars and can be used during any activity that causes pain
  • The most effective way to speed up the resolution of symptoms is with gentle strength exercises
    • Exercise can help the muscle length adapt to the growth change
    • Select exercises with the muscle in a lengthened position, such as a walking lunge or a step down
    • Keep them gentle, don’t add to the overload

MYTHS

  • You don’t need to avoid pain!
    • There is no issue with pushing through the pain – if you can tolerate the soreness, you can continue with that activity
    • Just be cautious with pain-induced gait changes. If pain causes you to limp, you may be overloading other areas, which can lead to other injuries
  • Orthotics are not required
    • Along with growing bones, you’ll have a sudden decline in muscle control and posture – basically you’ll begin to move like a newborn giraffe. This will affect the way the foot stabilizes, but it returns to its previous function soon after the growth rate slows
  • Don’t stretch the muscle
    • It doesn’t affect its length or the rate it adapts to the growth spurt
    • Vigorous stretching will add more load to the area and potentially irritate the bone further
  • There are no long term consequences of playing through the pain
    • The growth plate will thicken slightly as a result to the condition, leaving you with a bump at the top of your shin. The bump doesn’t affect your function at all, so there’s no concern about ongoing issues
    • You can’t make it worse by playing with pain
    • Rest doesn’t help it resolve sooner – the duration is linked to your growth spurt, not your activity levels

WHAT ELSE COULD IT BE?

  • Patellar tendon tear – a tear in the tendon just above the bony attachment
  • Patellar tendinopathy – irritation of the tendon
  • Shin splints – usually felt slightly lower and towards the inside of the shin
  • Bone stress injury due to direct impact (eg. Falling and landing on knees)
  • Patellofemoral pain syndrome
  • Sinding Larsen Johansson Disease – growing pains but in a different location