Osgood-Schlatters disease is a growth disorder that causes a lump called an anterior tibial tubercle; it sits just below the knee cap and above the shin. (See Figure 1) It is directly above the fragile growth plates and occurs in adolescents aged ten to fifteen years old. The lump tends to be very painful and happens to children who are involved in athletics during growth spurts and then tends to resolve itself as soon as growing stops.
 Figure 1: Side of Osgood-Schlatter Disease
Courtesy of sites.google.com
It received its name from the doctors that discovered the disease, Dr. Robert Osgood and Dr. Carl Schlatter. These doctors noticed similarity in symptoms between patients during growth spurts. Back in 1903 when it was discovered, adolescent boys worked alongside their fathers on the farm and were prone to growth type injuries. It is now considered a “sports-related†injury. Osgood-Schlatters now equally affects girls, because more girls are involved in sports nowadays.
What causes Osgood-Schlatters Disease?
Stress on the cartilage that covers the growth plates in adolescents can cause it to knot up and turn into a bump. Repeated stress injuries in this spot can actually cause a bony growth. It begins in the quadriceps muscle and the over the shin, as these muscles are overworked it puts stress on the cartilage that protects the growth plate. It most often only affects one side, but can affect both in some cases. Some kids even experience actual stress fractures of the long bone. The condition does not happen overnight, but rather after repeated impact over time. The harder and longer the sports impact on the legs, the more severe the disease. Some kids have to leave their sport permanently due to these injuries.
Activities like figure skating that cause landing impact on the lower leg, basketball that requires jumping and landing and gymnastics are all some of the higher risk sports that contribute to this disease. Other sports that contribute to the condition are; soccer, tennis, running in track and ballet. Because of the risk factor; sports should be rotated throughout the year and kids in competitive sports need to practice good muscle warm-up and stretching prior to the activity.
What are the symptoms of Osgood-Schlatters Disease?
The most prominent symptom of this disease is pain to the upper shin, just below the kneecap. The pain comes on after strenuous physical activity and tends to decrease with rest. Some parents may think these are just growing pains, but if a child experiences repeated complaints of pain to this area then evaluate for these other symptoms:
- Swelling and Inflammation just below the knee cap
- Muscle tightness and tension in the shin and quadriceps muscles
- A bump that can be felt on the upper shin below the knee
- Redness to the area
- Pain in the affected leg and the actual knee
- Noticeable limp
Symptoms may also cause insomnia, irritability and even depression in some kids. When they are very involved in sports, this disease can be a setback. Most cases clear up quickly without treatment and there are medical treatments available that can help to alleviate the discomfort.
Treatment for Osgood-Schlatters Disease
Treatments for this disease are aimed at providing comfort, increasing activity levels and reducing the healing time. Most often, the child will have to take a break from sports and rest the affected area. The doctor can prescribe pain relievers and anti-inflammatories for pain and swelling. If necessary, a referral can be made for physical therapy. Surgery is needed to remove the excess bony prominence in some cases, but this is very rare. Usually, this condition clears up without any help at all.
Here are some helpful tips for a quick recovery:
- Rest, Rest, Rest – Stay off the affected leg until the pain is gone and the inflammation is gone.
- Do some mild gentle stretching exercises that focus on the quadriceps and shin muscles.
- Elevate the affected body part.
- Wrap the affected knee in an elastic style wrap or use a sports brace.
- Keep it cold. Use ice for 15 minutes on and 15 minutes off a few times a day.
- Try a different sport. If the sport you are doing is too much, try something new even if for a few months out of the year. For instance, ice skate during winter and swim during the summer months.
- Always warm up muscles prior to exercise or sports. This helps reduce the incidence of injury.
- Talk about the feelings that surface due to the injury. Many kids will suffer mild depression loss of self-esteem if removed from a sport that they love.
- Get involved in non-impact sports and hobbies. Try reading, art and music.
*These tips include R.I.C.E. which is the mnemonic for Rest, Ice, Compression and Elevation. This is the most common orthopedic treatment for orthopedic injuries. (See Figure 2)
Figure 2: R.I.C.E. Mnemonic
Courtesy of Atlantisorthopedics.com
What is most important to keep sports player in the game, is to stay out of the game for as long as the doctor recommends. It is important for kids to not return to sports before the doctor releases them to do so.
Conclusion
If you have a child that is suffering from chronic pain in one or both knees, it is important to seek proper diagnosis from a physician to prevent permanent damage. The physician will then decide how to treat the patient. The most popular treatment is R.I.C.E. (Rice, Ice, Compression and Elevation) and this most often puts the child back out on the playing field in no time.
The outlook for patients with Osgood-Schlatters disease is generally very good and most kids return to their favorite sport after 3 days to 3 weeks of rest. Even in more severe cases requiring intervention from a physician or surgeon tend to recover quickly and do very well. It is very seldom and rare that a child has to leave a competitive sport due to this disease.