"Osgood-Schlatter Disease or OSD". Let us travel the road to recovery together!!!
Osgood Schlatter disease, also known as osteochondrosis, tibial tubercle apophysitis, or traction apophysitis of the tibial tubercle(1)
Osgood-Schlatter disease is a condition that causes pain and swelling below the knee joint, where the patellar tendon attaches to the top of the shinbone (tibia), a spot called the tibial tuberosity.(2)
it is an overuse injury that occurs in active adolescent patients(1)
Osgood-Schlatter disease is caused by irritation of the bone growth plate. (2)
The condition is self-limited and occurs secondary to repetitive extensor mechanism stress activities such as jumping and sprinting.(1)
Let us understand a little more about OSD
Bones do not grow in the middle, but at the ends near the joint, in an area called the growth plate.
While a child is still growing, these areas of growth are made of cartilage instead of bone.
The cartilage is never as strong as the bone, so high levels of stress can cause the growth plate to begin to hurt and swell.
The tendon from the kneecap (patella) attaches down to the growth plate in the front of the leg bone (tibia), the tibial tubercle.(2)
Ossification of the tibial tubercle happens at ages 10-12 in girls and at ages 12-14 in boys.
It is during this stage of bone maturation when Osgood Schlatter disease develops.
The tibial tubercle develops as a secondary ossification center that provides attachment for the patellar tendon.
Bone growth exceeds the ability of the muscle-tendon unit to stretch sufficiently to maintain previous flexibility leading to increased tension across the apophysis. (1)
The thigh muscles or quadriceps is attached to the patella. When they pull on the patella, this puts tension on the patellar tendon. The patellar tendon then pulls on the tibia, in the area of the growth plate.
Any movements that cause repeated extension of the leg can lead to tenderness at this particular area.(2)
Stress at this musculotendinous junction can cause pain and swelling. The pain felt by the patient is mostly unilateral, but often it is bilateral(3)
Repeated traction over the tubercle leads to microvascular tears, fractures, and inflammation.
Force is increased with higher levels of activity and especially after periods of rapid growth.
The physis is the weakest point in the muscle-tendon-bone-attachment (as opposed to the tendon in an adult) and therefore, at risk of injury from repetitive stress and with repeated contraction of the quadriceps muscle mass, especially with repeated forced knee extension as seen in sports requiring running and jumping (basketball, football, gymnastics), softening and partial avulsion of the apophyseal ossification center may occur with a resulting osteochondritis.
Predisposing factors include poor flexibility of quadriceps and hamstrings or other evidence of extensor mechanism misalignment(1)
Pain at the tibial tuberosity that worsens with physical activity or sport.
Increased pain at the tibial tuberosity with sports activity.
In some cases increased bony protuberance at the tibial tuberosity.
Secondary to pain there will be tightness of Quadriceps.
Resisted isometrics of the Quadricep muscle is painful.
1. Conservative treatment: Treatment should begin with rest, icing, activity modification, knee pads and sometimes non-steroidal anti-inflammatory drugs.
2. Surgical treatment: Surgical procedures should be avoided until the child has grown up and the bone growth has been completed to avoid growth-plate arrest and the development of recurvatum and or valgus of the knee. There are different surgical procedures like
drilling of the tibial tubercle, excision of the tibial tubercle (decreasing the size), longitudinal incision in the patellar tendon, tibial sequestrectomy, insertion of bone pegs and/or a combination of any of these procedures.(3)
Physical Therapy management
The goal of physical therapy is to speed up your recovery for a return to pain-free activity. Many physical therapy treatments are effective in treating OS. Our treatment plan may include: Patient education, Pain management, Range of motion, strength and flexibility training and functional training.(4)
The pain usually subsides with the cessation of growth at the tibial tubercle.
Ice application after activity reduces the anterior knee pain.
Limiting the sports activity, for 6-8 weeks is advisable.
Patellar loading is decreased by patellar tapping/ McConnel tapping, and by the use of brace.
Low-intensity Quadriceps-strengthening exercises, such as isometric multiple- angle quadriceps exercises, are instituted earlier in the conditioning program. High-intensity Quadriceps exercises and Hamstring stretching are introduced gradually and have been proven effective with high evidence rating. Incorporation of high-intensity Quadricep exercise can intensify pain.
swimming, as a secondary athletic activity, is very good during this disease (no discomfort). Also knee-braces, tapes, slip-on knee support with an infrapatellar strap or pad are recommended and may help during physical activities and can reduce pain.(3)
Are there ways to help prevent OSD?
Physical therapists can help prevent OSD by adopting the following measures:
Educate coaches, parents, and athletes on guidelines for participating in sports.
Explain the common cause of overuse injuries. They provide strategies for prevention.
Inform athletes about the risks of playing through pain and the benefits of scheduling enough rest time to recover between events.
Track a young athlete's growth curves (height, weight, body-mass index). This helps to identify periods of increased injury risk.
Develop athlete-specific flexibility and strengthening routines for athletes to follow throughout the season.(4)
Today, there is no need for total immobilization, or for totally refraining from athletic activities.
The child should continue his normal physical activities, to the limit that the pain allows it, so lower intensity of frequency of exercising (activity modification) will help. Also
Research by Gerulis et al has shown that limitation of physical activity, physical load restriction, and conservative treatment are more effective than physical load restriction and activity limitation alone.(3)
At Valley Healing Hands, Brownsville, Texas we provide the best Physical Therapy treatment for OSD or Osgood Schlatter Disease. We provide an atmosphere developed for teen athletes with a one on one ratio for the best quality of care needed for maximum outcomes and return to play. Our physical therapist are highly qualified and will plan an individualized treatment routine, customized to your specific needs. Our patients are highly satisfied with our services. You can learn about what they have to say about us here and get connected to us here. Our patients love us and you too will! We can get you back in the game!!!