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Sports Injury Prevention & Rehabilitation

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Osgood Schlatters Disease

(Also known as Tibial Apophysitis)
What is Osgood Schlatters disease?
Osgood Schlatters disease is a relatively common condition of the knee affecting adolescents. It refers to an injury to the growth plate at the top of the shin bone (tibia) just below the knee cap.
The muscle group at the front of your thigh is called the quadriceps. The quadriceps attaches to the knee cap (patella) which in turn attaches to the top of the shin bone (tibia) via the patella tendon.
In people who have not reached skeletal maturity, a growth plate exists where the patella tendon inserts into the shin bone. This growth plate is primarily comprised of cartilage. Every time the quadriceps contracts, it pulls on the patella tendon which in turn pulls on the tibia's growth plate. When this tension is too forceful or repetitive, irritation to the growth plate may occur resulting in pain and sometimes an increased bony prominence at the front of the shin. This condition is called Osgood Schlatters disease.

Cause of Osgood Schlatters disease
Osgood Schlatters disease is typically seen in children or adolescents during periods of rapid growth. This is because muscles and tendons become tighter as bones grow longer. As a result, more tension is placed on the tibia's growth plate. Osgood Schlatters disease is more commonly seen in active children or adolescents who participate in activities requiring strong or repetitive quadriceps contractions such as running or jumping sports.

Signs and symptoms of Osgood Schlatters disease

Patients with this condition typically experience pain at the front of the knee just beneath the knee cap (i.e. the tibial tuberosity). The pain associated with this condition may increase during activities requiring strong quadriceps contractions such as squatting, going up and down stairs, running (especially uphill), jumping or hopping. Patient's may also experience pain when kneeling or placing firm pressure to the top of the shin bone (just beneath the knee cap). An increased or swollen bony prominence may also be detected at the top of the shin bone, coinciding with the source of pain in patients with this condition.

Diagnosis of Osgood Schlatters disease
 A thorough subjective and objective examination from a physician is usually sufficient to diagnose Osgood Schlatters disease. Investigations such as an X-ray, MRI scan or CT scan may be required occasionally to confirm diagnosis.

Treatment for Osgood Schlatters disease
Most patients with this condition heal well with appropriate physical therapy. The success rate of treatment is largely dictated by patient compliance. A vital aspect of treatment is that the patient rests from any activity that increases their pain. Activities placing large amounts of stress on the tibial tuberosity should also be minimized, particularly squatting, sprinting, jumping and hopping. Resting from aggravating activities ensures the body can begin the healing process in the absence of further damage. Once the patient can perform these activities pain free a gradual return to these activities is indicated provided there is no increase in symptoms.
Ignoring symptoms or adopting a 'no pain, no gain' attitude is likely to cause further damage and prolong recovery in patients with Osgood Schlatters disease. Immediate, appropriate treatment in patients with this condition is essential to ensure a speedy recovery.
Whether or not a patient should continue playing sport is dependent on symptoms. Patients with mild symptoms may wish to continue to play some or all sport, others may choose to modify their program. Generally it is recommended that patients with Osgood Schlatters disease keep active provided their symptoms are mild or absent.
Patients with this condition should follow RICE in the initial phase of injury. RICE is beneficial in the first 72 hours following symptom onset or when inflammatory signs are present (i.e. morning pain or pain with rest). RICE involves resting from aggravating activities (this may includeregular icing, the use of a compression bandage and keeping the leg elevated. Anti-inflammatory medication may also hasten the healing process by reducing the pain and swelling associated with inflammation.
Patients should also perform pain-free flexibility and strengthening exercises as part of their rehabilitation to ensure an optimal outcome. Particular emphasis is often placed on stretching the quadriceps muscles to restore flexibility. The treating physical therapist can advise which exercises are most appropriate for the patient and when they should be commenced.

Prognosis of Osgood Schlatters disease
Osgood Schlatters disease is a self limiting condition that gradually resolves as the patient moves towards skeletal maturity. This usually takes between 6 to 12 months but may persist for as long as 2 years. With appropriate management, patients with this condition typically improve gradually over time and full function is restored. Osgood Schlatters disease does not interfere with growth. The only long term effect of this condition may be an increased prominence of the tibial tuberosity at the front of the shin.

Contributing factors to the development of Osgood Schlatters disease

There are several factors which may increase the likelihood of developing this condition. These need to be assessed and corrected where possible, with direction from a physical therapist to ensure an optimal outcome. Some of the factors which may contribute to the development of Osgood Schlatters disease include:
  • a sudden increase in training or sporting activity
  • inappropriate training
  • recent growth spurts
  • inappropriate footwear
  • muscle tightness or weakness (particularly the quadriceps)
  • joint stiffness
  • poor lower limb biomechanics
  • poor foot posture

Physical therapy for Osgood Schlatters disease

Physical therapy is extremely useful for patients with this condition as it can significantly reduce pain and allow for increased activity levels. Treatment may comprise:
  • soft tissue massage
  • stretches
  • electrotherapy
  • icing
  • taping or bracing
  • biomechanical correction
  • education
  • activity modification advice
  • exercises to address any flexibility, strength or balance issues
  • a gradual return to activity program

Other intervention for Osgood Schlatters disease
A consultation with a podiatrist may be indicated occasionally in patients with Osgood Schlatters disease to improve the condition. The treating physical therapist can advise if this is required.