Most if not all growing children get aches and pains. Some are directly related to exercise or activity levels, and sometimes they happen with no definitive cause. Unfortunatey sometimes the problems will not pass with a day or two of rest, due to either inflammation or an underlying condition. One of the most common growing ailments seen in children and teenagers affects the knee and is called Osgood-Schlatters Disease. Fortunately, unlike some more sinister diseases, this condition will fully resolve, and with appropriate management will not cause too much disruption to your child’s (or your ) lifestyle.
Osgood Schlatters Disease (or syndrome) is an inflammation of the bone at the top of the tibia (shin bone) , just below the knee, where the tendon from the patella (kneecap) attaches to the tibial tuberosity. It often occurs during a growth spurt and is associated with physical activity. It is thought the tendon attaching the quadricep muscles to the shin bone becomes tight due to the bones growing at a faster rate than the muscle. This can cause inflammation and micro-fractures at the bony attachment.
What causes Osgood Schlatters:
Growth spurt: the condition tends to affect adolescent children, when the bones are still forming and hardening. The growth plates (apophyses) are unable to withstand high tensile forces. When presented with strong, repetitive muscle contractions, micro-fractures occur at the immature area. The separation results in symptoms typical of Osgood Schlatter disease, as well as irregular bone growth that explains an enlarged tibial tuberosity afterwards.
Age : Affected boys are often aged about 12 to 14 years, while affected girls are often aged 10 to 13 years
Exercise : active children, particularly those engaged in higher intensity sports are at increased risk
Gender: boys are more susceptible than girls, but perhaps this is because boys typically play more vigorous sports. This discrepancy seems to be lessening as girls undertake more regular and more intensive sporting endeavours
Symptoms include:
- Localised pain, swelling, and tenderness over the tibial tuberosity at the attachment of the patellar tendon
- Pain during exercise (especially running and jumping) or walking up or down stairs
- Pain with direct contact, such as in kneeling
- Quadriceps weakness can be present in chronic cases
- Bilateral symptoms ie. pain in both knees, occur in 20-30% of cases
- The tibial tuberosity may be enlarged in later stages, which looks and feels like a bony lump
What to do about it:
Physiotherapy assessment and treatment is a proven benefit for Osgood Schlatter disease sufferers. Most patients respond well to non-operative physiotherapy treatment, but symptoms may come and go for 12-24 months before complete resolution.
Treatment options include:
- Activity modification or relative rest – completely avoiding activities that are painful for at least a couple of weeks followed by gradual return to activity guided by symptom levels
- Soft tissue release such as massage to the affected muscles can offer symptomatic releif and help to return them to optimal lengths
- Frequent use of icepacks to reduce the local pain and swelling
- Stretching and strengthening exercises for the quadriceps, hamstrings and calf muscles – a suitable program can be developed based on specific needs and deficiencies
- Medications, including painkillers and anti-inflammatory drugs