// Common Injuries: Osgood Schlatter disease
by Paul Wright
In previous ‘Common Injuries’ features, I have discussed anterior knee pain – in particular patellofemoral pain – as a major complaint of actively exercising adults. In this issue we will move into another cause of anterior knee pain, Osgood-Schlatter disease, a common problem in the adolescent athlete and a condition that all health and fitness professionals need to understand.
Terminology and etiology
Osgood-Schlatter disease was named back in the early 1900s by physicians Dr Robert Osgood and Dr Carl Schlatter.
The condition itself is classified as an ‘osteochondritis’, meaning there is active inflammation of the cartilage and bone, with the prime inflammation site at the growth plate of the tibial tuberosity where the strong patellar tendon joins the tibia.
The condition is thought to be caused by the repeated contraction of the quadriceps pulling on the patella tendon which then exerts force on the tibial insertion, causing softening and even partial avulsion (tearing away) of the actual growth plate. With continued trauma new bone grows during the healing which can result in the increased size of the actual tuberosity.
Signs and symptoms
This condition is most commonly seen in adolescents at the time of their growth spurt, and it is believed that the rapid growth of the long bones and resulting muscle tightness of the quadriceps group may be partly responsible for the inflammation process commencing.
The most common sufferers are 10 to 16-year-old males who are involved in high impact physical activities such as football, basketball and athletics.
The typical Osgood-Schlatter patient complains of tenderness on the tibial tuberosity (the prominent bump on the top of the shin just below the patella), pain on and around the tuberosity during and after exercise, and pain when contracting the quadriceps muscle in activities such as lifting the extended leg off the ground.
Physical examination reveals marked tenderness of the tubercle on palpation as well as associated tightness of the quadriceps. It is also common for the patient to have biomechanical issues such as increased sub-talar joint pronation and restricted ankle range of motion. Thus a full biomechanical examination and running assessment is always standard procedure.
More detailed investigations are often not required, however, many experts warn that bony tumours can be found in the knee of this age group. For this reason, the medical professional may order X-rays if the extent of pain and swelling is such that it raises suspicion of an underlying pathology more sinister in nature than a simple inflammatory process.
As with all episodes of pain it is essential the client is examined by a physiotherapist or sports physician as soon as the pain commences. The medical professional will evaluate the extent of the injury, determine an accurate diagnosis and chart the most appropriate management strategy to return the client to full function.
This is especially important in the younger athlete as poor management of any injury while in growth stages can have significant impact on future development and injury risk.
The good news for Osgood-Schlatter sufferers is that the condition resolves itself at the time when the bony fusion takes place at the growth plate.
However, this can still take between one and two years to occur, so the best advice is to modify activities to reduce the extent of discomfort during and after the activity.
Some suggestions for exercise modification include reducing total raining volume, concentrating on session quality rather than quantity, not performing higher impact activities on consecutive days and swapping higher impact activities such as running for lower impact swimming or cycling.
Treatment of the actual symptom of the condition may include regular icing (especially after activity) to reduce local discomfort, stretching of the quadriceps in an attempt to reduce the level of traction force exerted on the patella tendon, soft tissue release and massage to the quadriceps group to again reduce traction and intensive calf stretching in an attempt to control biomechanical compensations caused by rapid growth of the long bones.
Many patients with Osgood-Schlatter disease have issues relating to excessive subtalar pronation (flat feet), which can act to increase internal rotation of the lower limb, contributing to alignment issues. These patients are often best treated with an individually moulded orthotic device placed in their shoes to assist in controlling foot function.
Paul Wright, BAppSc (Physio), DipEd (PE)
Paul is the owner of Get Active Physiotherapy with clinics inside Fitness First clubs at St Leonards (Sydney) and Kotara (Newcastle) as well as a head office in the CBD of St Leonards. To preview Paul’s Knee Injury Prevention and Rehabilitation for Health and Fitness Professionals and other DVDs, visit www.getactivephysio.com.au or call 02 9966 9464.
NETWORK • SUMMER 2009 • PP34-35