Osgood-Schlatters Disease
An Osgood-Schlatter lesion is a condition that affects where the patella tendon inserts into the tibial tuberosity. This condition is very common in adolescents especially at the time of a growth spurt and an increase in sporting activities. As the young athlete’s bones grow at an accelerated rate the quadriceps muscles fail to lengthen at the same rate and are put on stretch. This may add tension, traction and sometimes compression to the attachment of the tendon which has a pulling effect on the underlying growth plate.
The growth plate is at the tibial tubercle (which can be felt as a knob of bone on the shin just below the knee). Pain will usually radiate from this area and can be tender to touch. It is usually associated with tight quadriceps. In highly active children this can cause a considerable amount of swelling and pain in this area, especially in sports involving running, jumping and explosive leg movements.
WHAT IS A GROWTH PLATE?
Growth plates are the areas of new bone growth in children and teens. They’re made up of cartilage, a rubbery, flexible material that remains ‘open’ for bones to grow from. The growth plates usually ‘close’ and form solid bone once adolescents in completed. Most growth plates are near the ends of the bones and are typical attachment points for other ligaments and tendons. Due to the make up of the growth plate, it has a higher tendency to get injured as opposed to other parts of the bone. Such injuries are umbrella termed ‘growth related injuries’ exactly like Osgoods and other types affecting different parts of the body like the Heel (Severs). Typically we find that growth plate related pain starts distally (at the feet) and then starts to travel proximally (up the body). There is a high likelihood that if your child is suffering from Osgoods growing pain, they would of likely had some level of Heel / Severs related pain in the past too. More sinister growth related injuries that are more acute and traumatic in nature are growth plate fractures or avulsion fractures.
HOW TO IDENTIFY OSGOODS?
A thorough history and examination is needed to exclude other injuries that may be present, such as an Osteochondral Lesion (OCD). Once excluded, location of pain gives us best accuracy to determine diagnosis. The following information will then be collected and analysed to provide your child with gold standard methods to monitor and control pain, and improve athletic performance:
- Training schedule
- Training load
- Previous injury
- Movement capability
- Rate of growth
- Sport specific demands
HOW DO WE TREAT OSGOODS?
Once Osgood’s Disease is identified, treatment is focused on conservative management. Pain on activity can last anywhere from 6 months to 2yrs. Management of these conditions centres around activity modification and load management. Although rest will not speed up the healing process, a reduction in explosive and impact related activity will result in reduction of pain.
Stretching of the affected muscles in the acute stage will likely increase pain levels and is NOT recommended. Stretching will further stretch and compress the already aggravated growth plate, causing more pain long term. A biomechanical assessment is essential and may reveal an asymmetry or dysfunction which when corrected can dramatically reduce the stress on tendons. Load management is important to minimize high levels of pain. Reducing activity/sport time by 10%-20% can be sufficient to manage pain levels in active children.
Strength training in adolescent years is crucial for improving long term athletic development and minimizing injury. Research shows that the stronger the athlete is relative to their body weight, the less likely they are to sustain an injury compared to a weaker athlete of the same sex and age. Developing ‘eccentric strength’ is imperative to not only minimize injury and improve performance, but also allow the muscles to remain strong over length particularly whilst the bones of the body are growing at a faster rate than the muscle system. Developing a specific strength & conditioning program tailored to your child is best practice to ensuring minimal modifiable injuries are sustained throughout their playing season.
General Acute Treatment:
- Ice 15 min (especially when inflammed and acute) – 2/3 x p/day
- Use of anti-inflammatory medication/gels during the acute stages
- Physiotherapy ‘hands on’ treatment
- Activity modification – reduction in load and weight-bearing activity for 2 – 8 weeks
- Appropriately prescribed strength and stability exercises of the hips and lower legs
At Point Health & Performance, we pride ourselves on being one of the foremost providers that has extensive experience with the adolescent population. Our experience over the years working with different youth teams makes us first choice for adolescent injuries. Experience the difference in quality care with us. Book online today
