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Osgood-Schlatter Disease: Knee pain in growing tweens and teens


Knee pain in children and adolescents can have many underlying causes, which is why taking your child to a healthcare provider for an accurate diagnosis is important. Osgood-Schlatter's Disease is one such cause of knee pain, especially in sporty teenagers.


What is Osgood-Schlatter Disease?


Osgood Schlatter's Disease is characterised by a painful bump in the inferior to the patella (knee cap) and at the tibial tuberosity (attachment site of patella tendon). It's age of onset is typically between 9 and 16, during years of rapid growth. It is more common in boys than in girls, but it can be present in both demographics.





Characteristically, the painful bump is worse with activity and better with rest. It can have flares that come and go. Therefore, monitoring activity plays a crucial role in this condition.

Although it has an intimidating name and can be painful, Osgood-Schlatter Disease is self-limiting, meaning that children will grow out of it naturally as they mature. But it can be very painful with symptoms in either one or both knees.





How do you treat Osgood-Schlatter Disease?


A recent systematic review by Neuhaus et al describes the limitations of our evidence base. Current recommendations are variable, based on clinical experience and anecdotes rather than rigorous randomised controlled trials. With that caveat, there are some safe assumptions one can try.


  1. Rest: Monitor and limit activity levels: Like many tendon injuries, load management plays a crucial role. Rest will help this condition temporarily feel better, but it can also decondition the muscles. Therefore, flare ups can re-occur if there is a sudden increase in activity levels after prolonged rest.

  2. Ice: Ice seems to help this condition when it is very painful. It can help numb out the sore area.

  3. Stretching: Stretching the hamstrings and quadracept muscles is often recommended; having tight, functionally shortened rectus femoris muscles ( quadracept) may be a risk factor for this condition.

  4. Massage: Specialised soft tissue treatments can help.

  5. Strengthening exercises: Isometric knee exercises are sometimes recommended as a starting point; similarly, strengthening the gluteal muscles, calf muscles and core muscles are a sensible guide.

  6. Tapes, Braces and Straps: These can help minimise the pain in some cases

Conclusion

In conclusion, Osgood-Schlatter's disease is one of several causes of knee pain in active young people between 8 and 16. It is more common in boys than girls, but it can occur in either. It is more common in active children who participate in jumping and sprinting sports, ie soccer, basketball, athletics. Although it is painful, it is not dangerous; therefore, reassurance, education and activity modification are essential. The evidence base is limited for this condition, so interventions should begin with a correct diagnosis and simple, conservative treatments.


Sources:


Neuhaus C, Appenzeller-Herzog C, Faude O. A systematic review on conservative treatment options for OSGOOD-Schlatter disease. Phys Ther Sport. 2021 May;49:178-187. doi:

10.1016/j.ptsp.2021.03.002. Epub 2021 Mar 9. PMID: 33744766.




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