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Growing Pains Part 2 – Knee Pain – Osgood-Schlatter Disease

By: | Tags: | Comments: 0 | August 18th, 2021

What is it and how does it present?

Osgood-Schlatter disease is an inflammation of the knee cap tendon’s attachment to the shin bone that causes pain at the front of the knee during adolescent growth.

This area of bone can become inflamed and painful due to strain on the growth plate in this area from repeated contraction of the thigh muscle (quadriceps). This issue is particularly prevalent during or after significant growth spurts. It tends to develop earlier in girls than in boys, corresponding with their growth spurts. Typical onset can occur between the ages of 8–12 for girls and 12–15 for boys. Most often symptoms present in only 1 knee, but in 30% of people with this issue, it affects both knees. As it is caused by repeated forces at the tendon attachment site, regular high impact activities such as repetitive running, jumping, and sports can exacerbate Osgood-Schlatter’s disease.

Typically, Osgood-Schlatter’s disease presents with a gradual onset, symptoms are usually intermittently painful after sporting activities, particularly heavy impact sports. This pain is often mild but can become severe and more constant in nature if loading increases or continues at high volumes for long periods of time. There is commonly tenderness when you press over the tibial tuberosity (the slightly knobbly bony point around 1 inch below the kneecap) at the front of the knee and there may be localised swelling in this region or an increase in the size of this bony prominence. This tenderness may be provoked by knee extension against resistance or compression of this region such as kneeling.

In most cases symptoms may come and go but tend to be exacerbated when taking part in high impact activities or going through a growth spurt. Typically, the condition settles over weeks or months, but occasionally may persist for 1–2 years before resolving completely in 90% of people. Symptoms occasionally persist into adulthood in only approximately 10% of people and may lead to chronic pain, reduced ability to participate in sports, and decreased lower body strength.

Additional Risk factors

Biomechanical factors in individuals during growth might have an influence on the amount of pull occurring through the quadriceps tendon including quadriceps muscle tightness and reduced flexibility or comparative strength of the hamstring muscles. These will be thoroughly reviewed by your physiotherapist.

How is it diagnosed?

A diagnosis of Osgood-Schlatter’s disease can be made based on clinical presentation and history of onset. There is usually no indication for a knee X-ray to help diagnose Osgood-Schlatter’s disease.

Other conditions can cause also knee pain, and assessment by a medical professional should be sought if your knee pain:

  • Starts suddenly after trauma to the knee;
  • Is associated with more systemic symptoms, including a high temperature or generally feeling unwell;
  • Is associated with bone pain or joint pain at other sites;
  • Persists at night or after rest;
  • Is associated with an abnormal examination of the hip or knee joint

How do I Manage my Symptoms?

  • Analgesia such as paracetamol and/or a nonsteroidal anti-inflammatory drug (NSAID) might be beneficial, you should speak to your GP prior to commencing this medication;
  • Applying ice packs intermittently over the tibial tuberosity area can be helpful, particularly if the area is inflamed;
  • Using protective knee pads to relieve pain on kneeling during times of significant flare up might also be helpful;
  • Your physiotherapist might also teach you taping techniques to help offload the pain;
  • They will be also able to fully assess and offer advice about exercise modification and muscle stretching exercises to help offload the area being strained;
  • Once the exacerbating features have been addressed, activity modification may be required. Sports such as swimming will be fine, but activities such as football and high impact sports are likely to flare up symptoms. You might be able to play sports but with an acknowledgment and understanding that certain activities will be painful.

The condition should eventually resolve, but lifestyle changes will need to be made until this time to limit symptoms. If symptoms fail to improve, the cause of knee pain should be reassessed and where there is diagnostic uncertainty, you may be referred to a paediatrician or orthopaedic consultant should be considered. People whose symptoms persist into adulthood should be referred for specialist assessment to an orthopaedic surgeon if symptoms are significantly affecting their functioning.

Closing thoughts

If you or your child are experiencing symptoms caused by Osgood Schlatter’s disease, please book an appointment to receive a thorough examination and recommendation the best plan to help you moving forwards!