Knee pain in younger athletes

Osgood Schlatter Disease

Knee pain is a common phenomenon we see here.  When it is present in a 9-14 year old, one of the things we need to consider is, "Is its Osgood Schlatter Disease?"

Osgood Schlatter Disease (OSD) is one of the most common painful knee conditions in adolescent athletes. OSD is a type of osteochondritis, defined as tibial tubercle apophysitis which is caused by repetitive strain on the patella tendon insertion (Brukner & Khan 2012 & Kabiri et al, 2014).

As shown from the above pictures, the quadriceps muscle attaches to the knee cap and to the tibial tubercle through patella tendon. When the amount of traction force exceed the bone strength, there will be inflammation at the insertion and if left untreated, it could potentially turn in to avulsion fracture (check out the x ray).

 

Causes of OSD (Osgood Schlatter Syndrome, 2015)

During a growth spurt, the patella tendon might become tighter. When the patella tendon is under excessive load (e.g. contracting quadriceps) the attachment of the tendon on the bone becomes inflamed and if this continues it will lead to a micro-fracture of the bone. As this condition progresses, it could become an avulsion fracture – partial separation of the bone. The appearance of the tibial tuberosity might become bigger (like a lump) as the fracture is naturally repaired by building up extra bone tissue.   

 

Incidence rate

OSD was reported to be affecting 21% of the adolescent athletes and 10% of the general adolescent population (Kabiri et al, 2014). Amongst different sports in adolescent athletes, OSD has a stronger correlation to specific sports types, contributing 30% of the soccer injuries, 17% of football injuries and 14.2% of male figure skating injuries. Basically sports that involves repeated forced knee extension such as basketball and gymnastic will pose higher risk of developing OSD.  It is also more common in boys than girls.

 

Diagnosis of OSD

Diagnosis of OSD weights more on clinical evidence than imaging findings (Brukner & Khan, 2012, Kabiri et al 2014 & Whitmore 2013).

Here are some common signs and symptoms:

  • Localised pain at tibial tubercle

  • Enlarged tibial tubercle

  • Tender and swollen tibial tuberosity

  • Discomfort or pain in running, kneeling or climbing up or downstairs

  • Weak and tight quadriceps muscles

  • Painful in single leg squatting

 

Treatment and management options

Typically OSD resolves by itself within one year with appropriate activity modification, however symptoms might persist up to two years (Brukner and Khan, 2012 & Osgood Schlatter Syndrome 2015). There is strong evidence that the following physiotherapy management options should help the recovery of OSD (Kabiri et al, 2014):

  • Stretches of hamstring and quadriceps muscles

  • Reducing or modifying aggravating activities

  • Strengthening quadriceps muscles

There are also weaker evidences suggesting the use of

  • Ice

  • Infra-patella strap

  • Kinesio taping

 

Take home message

The lump at the knee is not as scary as what it looks like. With proper activity modification, exercises and symptoms management, OSD usually resolves by itself with bone maturity.

 

If you are wondering if you or someone you know has OSD, come in to see a highly skilled physiotherapist well versed on knee pain.  Here at Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment,  We have an expertise in musculoskeletal physiotherapy and we are near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Wahroonga, Westleigh, West Pennant Hills, West Pymble amongst others.

 

References

  1. Akbas, E., Atay, A. O., & Yuksel, I. (2011). The effects of additional kinesio taping over exercise in the treatment of patellofemoral pain syndrome. Acta orthopaedica et traumatologica turcica, 45(5), 335-341.

  2. Brukner, P. & Khan, K (2012) Clinical Sports Medicine. Australia: McGraw-Hill Australia.

  3. Janikowska, K., & Chomiuk, K. (2014). The taping applications in Osgood-Schlatter Disease. New Approaches in Joints Pain Patellofemoral Syndrome, 94.

  4. Kabiri, L., Tapley, H., & Tapley, S. (2014). Evaluation and conservative treatment for Osgood-Schlatter disease: A critical review of the literature.International Journal of Therapy and Rehabilitation, 21(2), 91-96.

  5. Kase, K., High-profile athletes including Lance, D. C., Armstrong, S. W., Garcia, S., & Garnett, K. (2011). Applications of taping: lymphatic to pediatric.Dynamic Chiropractic, 29.

  6. Osgood Schlatter Syndrome (2015) http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Osgood_Schlatter_syndrome

  7. Whitmore, A. (2013). Osgood-Schlatter disease. Journal of the American Academy of Physician Assistants, 26(10), 51-52.

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