Osgood-Schlatter disease

What is Osgood-Schlatter disease?

Osgood-Schlatter disease is a common cause of pain in the front of the knee. It is not a disease, but a condition or disorder. This condition is also referred to as ‘traction apophysitis’, meaning pulling on the growth plate causing inflammation.

It is caused by a difference in growth rate between bone and soft tissues. It is an irritation of the kneecap tendon at the point where it attaches to the leg bone. One or both knees may be affected.

In some children, a rapid growth spurt takes place in the bone leaving the muscles in a relatively shortened position. In the lower leg, this causes the kneecap tendon to be placed under greater tension and stress, leading to pain and inflammation.

Osgood-Schlatter disease most often occurs during a growth spurt when bones, muscles, tendons are changing rapidly. The tendon from the kneecap attaches to the shin bone (tibia) at a point just below the kneecap (called the tibial tuberosity). Repeated contraction of the muscles in the thigh pull on the tendon from the kneecap. This then pulls on the tibial tuberosity. In some children, this repeated contraction can cause inflammation and lead to this part becoming painful and swollen.

Who does it affect?

It usually affects:

• teenagers aged 10 to 15 years of age
• boys more than girls
• active sportspeople who is at the beginning of the teenager growth spurt
• children who are very active, particularly in sports involving jumping and running

What are the symptoms?

The signs and symptoms include:

• Pain with activities such as running, jumping and descending stairs
• welling, tenderness and pain in the area just below the kneecap
• painful lumps just below the knee due to swelling and increased bone formation in this area

It usually happens in one knee.

The symptoms tend to have a gradual onset and as such, your child may not remember a specific injury but will often experience a dull ache that gets worse during or after sport. It tends to ease with rest.

It is a temporary condition but it can be painful intermittently for months or even years.

How is it diagnosed?

It is diagnosed by typical symptoms and by examination of your child. Usually an X-ray is unnecessary, but sometimes this will be done to check for other knee problems.

Can it be prevented?

Young sports players or athletes are advised to stretch their leg muscles regularly, allow a day or two of rest between each training session to allow the body to recover and limit the number of events or games they take part in.

Are there any long-term problems?

There may be a lump where the pain is located. Typically, this is a temporary condition that will get better once growth slows over 12 to 24 months. It should resolve by the time the bone has fully matured – around the age of 16.

How is it treated?

Treatment involves reducing the amount of exercise to a level that improves symptoms. This will vary for each child. If your child still has pain despite reducing the level of sport then they should avoid sport until the symptoms decrease, after which a gradual return to activities can be started.

If your child is suffering from pain that is not responding to the following treatments then you should seek help by contacting NHS 111 or your GP.

Rest

Limit, or, modify the amount of activity your child is doing. This means your child should stop an activity before they feel pain or reducing the time spent playing sport if they feel pain after stopping. Avoid activities which involve a lot of running or jumping, until the pain settles.

Cold therapy

Apply a cold compress or ice to the affected area for 10 to 15 minutes, especially after activity.

Pain relief

Pain relieving medication may reduce pain and swelling, such as paracetamol and ibuprofen. You may need to discuss options with a pharmacist or GP.

Physiotherapy

Your physiotherapist can provide an exercise programme and advice on return to sport. Common exercise are:

Quadriceps stretch

Ask your child to lie flat on their stomach, tighten their bottom muscles and hold throughout the stretch. Ask them to hold onto their ankle or use a towel around the ankle to pull their foot towards their bottom, until they feel a stretch at the front on their thigh.

Hold for 20 seconds, repeat 4 times. Repeat 3 to 4 times a day.

Hamstring stretch

Ask your child to lie flat on their back. Tighten their lower stomach muscles to keep their back in the correct position. Ask them to bend their hip to 90 degrees and hold onto their leg. Then straighten their leg as much as possible until they feel a stretch at the back of their thigh.

Hold for 20 seconds, repeat 4 times. Repeat 3 to 4 times a day.

Hip flexor stretch

Start in a half-kneeling position as in the picture below. Squeeze your bottom and gently and push the hip of the back leg forwards until you feel a stretch in the front of the thigh.

Hold for 20 seconds, repeat 4 times on both sides.

Calf stretches

Stand in a walking position with the leg to be stretched straight behind you and the other leg bent in front of you. Make sure you keep the arch on the inside of the back foot. Take support from a wall or chair.

Lean your body forwards and down until you feel the stretching in the calf of the straight leg.

Stand in a walking position with the leg to be stretched behind you. Make sure you have an arch in the inside of the back foot. Hold on to a support.

Bend the leg to be stretched (back leg) and let the weight of your body stretch your calf without lifting the heel off the floor.

Management

Management will be guided by your physiotherapist and most children return to their normal level of sport within 12 months. This condition is self limiting, which means when growth stops, the growth plate fuses naturally and the condition resolves with time in most children.