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Osgood-Schlatter’s

What is Osgood-Schlatter’s?

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 an irritation of the kneecap tendon at the point where it attaches to the leg bone.

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 and 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 with jumping and running

What are the symptoms?

The signs and symptoms include:

  • Pain with activities such as running, jumping and descending stairs
  • Swelling, 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 occurs in one knee but both knees may be affected.

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 temporarily limit the number of events or games they take part in.

Are there any long-term problems?

There may be a lump your child feels pain. 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 when your child is around 16 years old.

How is it treated?

Treatment involves temporarily 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. Limit 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

Lie flat on your stomach and bend one knee. Hold onto your ankle or use a towel around the ankle to pull your foot towards your bottom, until you feel a stretch at the front on your thigh. Squeeze your bottom muscles throughout the stretch to help push your hips into the bed or floor.

Illustration of person laid down on their front with one leg bent with a towel around their ankle pulling to their bottom

Hold for 30 seconds. Repeat 3 times on both sides.

Hamstring stretch

Lie flat on your back. Tighten your lower stomach muscles (to keep your back in the correct position). Bend your hip to 90 degrees and hold onto your leg. Then straighten your leg as much as possible until you feel a stretch at the back of your thigh.

Illustration of person laid down on the floor with one leg raised with their hands behind their knee

Hold for 30 seconds. Repeat 3 times on both sides.

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.

Illustration of person down on one knee, with their other foot on the floor so their knee is at a right angle to their hip

Hold for 30 seconds. Repeat 3 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 until you feel the stretching in the calf of the straight leg.

Hold for 30 seconds. Repeat 3 times. Repeat on the other side. 
Person stood with hands flat on a wall with one leg behind them, straight, and the other in front bent at the knee

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.

Hold for 30 seconds, and repeat 3 times. Repeat on the other side.

Person stood with hands flat on a wall with one leg behind them, bent a little, and the other in front bent at the knee

Management

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

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Disclaimer

Please note: this is a generic information sheet relating to care at Sheffield Children’s NHS FT. These details may not reflect treatment at other hospitals. This information is not intended as a substitute for professional medical care. Always follow your healthcare professionals’ instructions. If this resource relates to medicines, please read it alongside the medicine manufacturer’s patient information leaflet. If this information has been translated into another language from English, efforts have been made to maintain accuracy, but there may still be some translation errors. If you are unsure about any of the guidance in this resource or have specific questions about how it relates to your child, always ask your healthcare professional for further advice.

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S10 2TH

United Kingdom

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