Knee pain. - Osgood-Schlatter disease

Osgood-Schlatter disease is a very common cause of knee pain in children and adolescent athletes, usually between the ages of 10 and 15 years.  It occurs due to a period of rapid growth, combined with a high level of sporting activity, which results in the growth centre of the tibial tuberosity (the bony lump just below the knee) becoming irritated or detached from the main bone of the tibia.  

Patients suffer pain at the tibial tuberosity and it may become swollen or inflamed and certainly more prominent than that on the other side.  The area is often tender and painful to touch or pressure and is generally worse during and after activity.  Pain will often be made worse by contracting the quadricep muscle at the front of the thigh against resistance.  

The problem is nearly always caused by keen young athletes and generally the types of activities that involve load bearing activity.  Periods of increased training or changes in footwear can precipitate the problem.  

Self help measures for patients include rest so that the inflammation in the area can settle down and when returning to activity only do as much exercise as you can without causing pain.  It may be helpful to progress from non load weight bearing activity, such as swimming, to a graded increase in load bearing activity.  Ice for regular periods of up to 15 minutes, particularly after activity can be helpful as well as stretching the quadriceps muscles if it is comfortable to do so and the use of a knee support.

  From a clinical point of view it is important for us to make sure that the problem is indeed an Osgood-Schlatter disease and that there is not anything else causing the pain.  Soft tissue release techniques and therapeutic ultrasound for the quadriceps and the patellar tendon can be useful as well as a review of running, posture and gait.  Mark Endacott, physiotherapist here at Andrew Gilmour and Associates can undertake a clinical review and offer treatment and advice.

An appropriate exercise programme that will allow patients to do as much exercise as possible and return to training at the earliest stage feasible is important.  

In extreme cases further imaging such as X-ray or MRI scan an be helpful to see exactly how much damage has occurred.  

In the most severe of cases a plaster cast or surgical review from a lower limb surgeon may be necessary, but this is unusual.