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Understanding Osgood-Schlatters Disease: Causes, Symptoms and Treatment
by Ed Mateus Hebo, Physiotherapist
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Osgood-Schlatter disease is a common condition that affects adolescents, particularly those who are physically active. It can cause discomfort and interfere with daily activities, but with the right approach, our clinicians can help manage it effectively (Corbi et al., 2022).
In this blog post, we'll explore what Osgood-Schlatter disease is, its causes, symptoms, and various treatment options supported by research, and ultimately how we can help you.
What is Osgood-Schlatters?
​Osgood-Schlatter disease is characterised by inflammation of the patella tendon, which connects the kneecap (patella) to the shinbone (tibia). This inflammation typically occurs at the point where the tendon attaches to the shinbone. This can cause pain, swelling, and tenderness on touch just below the kneecap (Corbi et al., 2022).
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Osgood Schlatter disease usually develops at a stage of bone maturation known as ossification (process of bone formation). The condition occurs due to repetitive strain and microtrauma from activities like jumping and sprinting, particularly during periods of rapid growth. This overuse injury results from the patella tendon pulling on the bony projection below the knee, leading to irritation and inflammation (Smith and Varacallo, 2020).
Predisposing factors include poor flexibility and/or misalignment of the quadriceps and hamstrings. In severe cases, the pulling from the patella tendon can lead to partial or full fractures. Other risk factors include male gender, adolescence, sudden growth spurts, and repetitive activities (Smith and Varacallo, 2020).
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Who does it affect and symptoms
Osgood-Schlatter disease typically affects adolescents between the ages of 12-15 for males and 8-12 for females, with boys being more commonly affected than girls. Research suggests that this condition is common and approximately affects 10% of adolescents and up to 20% of adolescents involved in high impact activities (NICE, 2020).
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Symptoms
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Knee pain just below the kneecap
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Tenderness on touch
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Swelling
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Tightness and stiffness in the knee
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Painful bump below the kneecap
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Pain during and after physical activity
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Pain eases with rest
How can we help?
The first protocol of action is an initial assessment with one of our Physiotherapists or Sports Rehabilitators. This will allow your therapist to conduct a comprehensive evaluation about your current condition, functional limitations, medical history and goals. Based on the information gathered your therapist will formulate an individualised treatment plan taking into consideration your symptoms, lifestyle, time availability and goals.
Treatment Strategies
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Exercise
Evidence suggests that targeted exercises focusing on quadriceps and hamstring strengthening, along with stretching routines, can alleviate symptoms and reduce how much the condition affects you on a daily basis (Reinking et al., 1992) (Smith and Varacallo, 2020).
Following from your initial assessment your therapist will make a bespoke exercise programme based on what they saw during the assessment and send you the programme via our virtual rehab platform, showing how and when to do set exercises.
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Shockwave Therapy
Shockwave therapy, also known as extracorporeal shockwave therapy (ESWT), is a non-invasive medical treatment that uses sound waves to promote healing and reduce pain in injured or damaged tissues. There are 2 types of ESWT available in our clinic, focused shockwave therapy (FSWT) and radial shockwave therapy (RSWT). Based on the nature and location of Osgood Schlatter disease, FSWT is more appropriate to use.
FSWT utilises high-energy sound waves with increased treatment depth, precision and better patient comfort in comparison to RSWT.
A study investigated the effectiveness of FSWT on apophyseal injuries such as Osgood Schlatter disease in youth athletes and found that FSWT enhanced an early return to play by improving the healing process and helping pain reduction, in 2-4 weeks (Shafshak et al., 2023).
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Mechanism of Action
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Microtrauma Induction: The high-energy waves create controlled microtrauma in the tissue, enhancing cartilage and bone repair by stimulating bone matrix production (Corbi et al., 2022).
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Enhanced Blood Flow: Increases blood circulation to the affected area, aiding in tissue regeneration.
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Pain Reduction: Helps in reducing pain through various mechanisms, including peripheral nerve desensitisation and reduction of inflammation (Lee et al., 2013).
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Procedure ​​​
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Initial Assessment: A thorough evaluation by one of our therapists to determine the suitability of FSWT.
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Preparation: A gel is applied to the skin to enhance the transmission of shockwaves.
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Application: A handheld device is used to deliver focused shockwaves to the targeted area. The intensity and frequency of the waves are adjusted based on your pain tolerance
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Duration: Each session typically lasts 15 minutes, depending on the area being treated.
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Number of sessions: The recommended number of sessions is 4-6, this is dependent on how long you may have suffered with it, levels of pain and how well you react to the FSWT. Your therapist will determine the number of sessions that is best for you based on clinical assessment and its effect on consecutive sessions.
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Frequency: For the best outcome, session should be spread out between 7-10 days. Effectiveness of the FSWT starts decreasing after 10 days between sessions.
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Side Effects
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Discomfort: Some patients may experience mild discomfort during or after the procedure, occasionally can last between 24-48hrs.
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Redness and Swelling: Temporary redness or swelling in the treated area.
Lifestyle Modifications
If you are struggling to tolerate your daily activities and/or usual exercise regime, it is advisable to implement activity modification strategies aiming at minimising stress on the knee for a limited period of time. This could be in the form of:
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Reducing exercise duration, frequency, or intensity.
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Incorporating low-impact exercises such as swimming (NICE, 2020)
During the Initial consultation your therapist will go through different strategies based on your activity levels throughout the day and lifestyle to best manage your symptoms.
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Pain Relief
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, paracetamol can offer pain relief.
Ice application for 10-15 minutes 3 times per day over the site of pain can help with reducing the swelling, particularly after physical activity.
Utilising knee braces or straps can also help relieve pain on kneeling (NICE, 2020).
Osgood-Schlatter disease can be a source of discomfort but with the right approach, it can be managed effectively. By understanding the causes, symptoms, and treatment options available, we can help you take proactive steps to alleviate pain and improve your quality of life.
If you or someone you know is experiencing symptoms of Osgood-Schlatter disease, book an initial assessment with one of our Physiotherapists or Sports Rehabilitators for an assessment and personalised treatment recommendations.
References
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Shafshak, T., Amer, M.A. Focused extracorporeal shockwave therapy for youth sports-related apophyseal injuries: case series. J Orthop Surg Res 18, 616 (2023). https://doi.org/10.1186/s13018-023-04065-0
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Corbi, F., Matas, S., Álvarez-Herms, J., Sitko, S., Baiget, E., Reverter-Masia, J. and López-Laval, I. (2022). Osgood-Schlatter Disease: Appearance, Diagnosis and Treatment: A Narrative Review. Healthcare, [online] 10(6), p.1011. doi:https://doi.org/10.3390/healthcare10061011.
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Lee JH, Cho SH. Effect of extracorporeal shock wave therapy on denervation atrophy and function caused by sciatic nerve injury. J Phys Ther Sci. 2013 Sep;25(9):1067-9. doi: 10.1589/jpts.25.1067. Epub 2013 Oct 20. PMID: 24259917; PMCID: PMC3818770.
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Smith, J.M. and Varacallo, M. (2020). Osgood Schlatter’s Disease (Tibial Tubercle Apophysitis). [online] PubMed. Available at: https://www.ncbi.nlm.nih.gov/books/NBK441995/.
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NICE (2020). Osgood-Schlatter disease. [online] NICE. Available at: https://cks.nice.org.uk/topics/osgood-schlatter-disease/background-information/prevalence/ [Accessed 6 May 2024].
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Vaishya, R., Azizi, A.T., Agarwal, A.K. and Vijay, V. (2016). Apophysitis of the Tibial Tuberosity (Osgood-Schlatter Disease): A Review. Cureus, [online] 8(9). doi:https://doi.org/10.7759/cureus.780.
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Reinking, M. F. (1992). Exercise in the Treatment of Osgood-Schlatter Disease. Physical Therapy, 72(12), 893–900. [doi:10.1093/ptj/72.12.893]
