Osgood what?

Osgood-Schlatter's Disease, hard to pronounce, possibly even harder to treat. That is, without targeted physiotherapy expertise. Osgood-Schlatter's Disease or OSD, is anatomically known as traction apophysitis or osteochondrosis, referring to inflammation of the bone at the top of the tibia (shin bone) where the tendon from the patella (kneecap) attaches.

This may be responsible for your anterior (front) knee pain, especially if you are a teenager playing sports involving running and jumping.

How does OSD occur?

The cause of your pain comes from the patellar tendon, a thick fibrous band spanning from your patella to your tibial tubercle. Doing repetitive activities, especially using your quadricep muscles like straightening your knee causes strain at the junction between the tendon and tubercle. This repetitive strain causes microvascular tears, inflammation and in some cases avulsion fractures where a small piece of bone detaches with the tendon. Furthermore, this is coupled with rapid growth not only in the whole body, but particularly the shin bone, especially in males ages 10-15 years and females 8-14 years. As the tibia grows, this stretches the tendon (the junction between the quadriceps muscle and tibia), however, this growth is often excessive and overwhelming, not allowing the tendon to adapt and stretch. Therefore, as the flexibility of the tendon cannot match the growth, this increases tension across the tibial tubercle, causing more strain and pain but further leading to partial avulsion fractures (osteochondritis).

How do I know I have OSD?

Without an in-depth physiotherapy assessment, it is hard to confirm whether or not you have OSD as there are many other conditions that have similar symptoms such as Sinding-Larsen-Johanssen syndrome, fat pad syndrome and many more. However, OSD is usually characterised by pain at the tibial tubercle, a prominent bump at the top of your shin. It should be tender to touch and aggravated during physical activity such as kicking a ball or walking up and down stairs. There may or may not be inflammation as well. Tight quadriceps are also a symptom, so you can try a standing stretch to troubleshoot this. You can also try straightening your leg and holding this mid-position as this loads the quadriceps tendon which could be painful as well.

How can I 'fix' my OSD?

OSD has a favourable prognosis with most young athletes recovering within a month once allowing the tendon to settle down. However, we all know this is only in a perfect world, especially with younger athletes being keen to continue playing sport. It should be noted that this is a self-limiting condition and continuing to aggravate the tendon will prolong your recovery time up to 2 years and in the long-term hinder your performance.

However, if you are still in-season or playing sports, you can manage your symptoms with these tips:

1. PEACE & LOVE (check out our previous blog post on how to maximise your recovery)

2. Gentle quadricep and hamstring stretching pre/post activity

3. Patellar de-loading tape (ask your local sports trainer or physiotherapist)

Applying these techniques serve as pain relief and are just temporary solutions. A gradual strengthening approach to not only the quadricep muscles but the rest of the limb (hips, hamstrings and calves) has been shown by research to effectively reduce the symptoms of OSD in the long-term. However, every athlete is different and requires personalised exercises for an effective recovery. Nonetheless, you can try these exercises to start addressing your imbalances:

1. Single leg step down

• Focus on not letting your knee cave inwards. Tap the ground lightly to challenge the lowering portion. You can do this without the @Roxpro and the @tidaltank; or switch it up with some markers on the ground and holding a 5kg sandbag.

https://video.wixstatic.com/video/23ac3b_cca1c5908bd8441281d3a73274caa154/1080p/mp4/file.mp4

2. Single leg balance on Bosu ball

• Focus on drawing in your core and hinging from the hips. Again instead of the Rox, you can also use markers on the floor.

https://video.wixstatic.com/video/23ac3b_ab4897ecb37a407193757469c7a22a31/1080p/mp4/file.mp4

3 Wall squat calf raises

• Maintaining a wall squat position like the previous exercises, slowly raise your heels off the ground and gentle lower them. You can do two legs at once or one leg at a time for extra challenge. This will strengthen your calf muscles in a functional position while loading the quadriceps tendon.

4. Hamstring focused glute bridge

• These look like normal glute bridges except your legs are propped up on a chair. This eliminates the pushing component of the glutes and allows the hamstrings to be worked more. You can try these on n exercise ball for an extra core challenge and sport specificity.

5. Single leg wall squat + hip circle

• Keep your symptomatic leg in the wall squat position while the other leg is extended straight in front of you. Holding an isometric (static) contraction has been shown to reduce pain and gently load the tendon without aggravating it. The hip circle is incorporated to activate your powerful glute muscles to help support your knee from the hip.

The exercises can vary depending on multiple factors such as what stage you are at with OSD, what sports you play and what specific musculoskeletal deficits you have. Consult with your physiotherapist to determine the most appropriate treatment and exercises for your specific condition.

Got any more questions about your sports injury? Give us a call 3061 7128 or book an appointment online to see one of our physiotherapists.

#osgoodschlatter #kneepain #physiotherapy #physicaltherapy #brisbanephysio #breathephysioandpilates

References

Circi, E, Atalay, Y, & Beyzadeoglu, T. (2017). Treatment of Osgood–Schlatter disease: Review of the literature. Musculoskeletal Surgery, 101(3), 195-200.

Rathleff, Michael S, Winiarski, Lukasz, Krommes, Kasper, Graven-Nielsen, Thomas, Hölmich, Per, Olesen, Jens Lykkegard, . . . Thorborg, Kristian. (2020). Activity Modification and Knee Strengthening for Osgood-Schlatter Disease: A Prospective Cohort Study. Orthopaedic Journal of Sports Medicine, 8(4), 2325967120911106.

Vaishya, Raju, Azizi, Ahmad Tariq, Agarwal, Amit Kumar, & Vijay, Vipul. (2016). Apophysitis of the Tibial Tuberosity (Osgood-Schlatter Disease): A Review. Curēus (Palo Alto, CA), 8(9), E780.