Osgood-Schlatter Disease: A cause of knee pain in active kids

Knee pain is a common complaint among active, growing kids. A common cause is Tibial Tubercle Apophysitis, more well-known as Osgood-Schlatter Disease. While the name sounds intimidating, it’s a manageable condition that affects many young athletes during peak periods of growth. Let’s dive a bit deeper…

Introducing Leo:
Leo is a passionate soccer player. At 12 years old, he’s in the middle of a busy season and has just had a major growth spurt. He starts to notice a dull ache below his kneecap after practices, especially after drills involving a lot of running, cutting and jumping. Soon, the pain becomes sharper, and he develops a tender, bony bump on his shin right below the knee. The pain gets worse when he runs, jumps or kneels, and he starts limping off the field after every game.

What’s going on inside Leo’s knee?
During a growth spurt, a child’s bones grow faster than their muscles and tendons. This results in weaker and tighter muscles for Leo for a little while until he adapts to his growth spurt and regains his flexibility, strength and control. In Leo’s case, he has not yet adapted to his growth spurt and his powerful quadriceps muscle (the big muscle on the front of the thigh) are not able to manage his training loads and are pulling on his patella tendon. This tendon connects the kneecap to a growth plate at the top of the shinbone, known as the tibial tubercle.

The repeated stress and pulling on this growth plate causes inflammation, pain, and swelling. In some cases, the body responds by laying down extra bone, which creates the characteristic bony lump associated with Osgood-Schlatter disease. It’s an overuse injury, not a traditional disease, and it’s directly related to the mechanics of a growing body.

Risk factors for Osgood-Schlatter Disease:

A combination of factors can increase a child’s likelihood of developing Osgood-Schlatter’s, including:

Intrinsic factors:

• Age and Growth Spurts: It most commonly affects children during their pubertal growth spurt (typically 10-14 for girls and 12-16 for boys).
• Muscle Tightness: Tightness and weakness in the quadriceps and hamstring muscles can increase the pull on the patellar tendon.
• Gender: It is historically more common in boys, but with more girls participating in sports, the gap is closing.

Extrinsic factors:

• High-Impact Sports: Activities that involve a lot of running, jumping, and sudden changes in direction put significant stress on the knee. Soccer, basketball, gymnastics and ballet are sports that have higher incidence of Osgood Schlatter’s.
• Overuse and Inadequate Rest: Playing on multiple teams or participating in year-round sports without sufficient recovery time can contribute to the condition. Poor quality sleep or inadequate hours and inadequate nutritional fuelling also contribute to risk of injury.
• Rapid Increase in Activity: A sudden jump in the intensity or duration of training can overload the tendon and growth plate.

Early Management of Knee Pain:
Leo’s parents notice he’s not playing like himself and is complaining about his knee with soccer. Their first steps are to manage the pain at home. After a game, they have Leo rest and apply an ice pack to the sore spot for 15-20 minutes to reduce inflammation. They also encourage him to avoid activities that cause the pain to flare up, like kneeling or jumping around in the backyard. In some cases, this is enough to get a child’s symptoms under control. Leo, however, is still struggling on the field, so his parents decide it’s time to see a professional.

What will a Physiotherapist do?
A physiotherapist can be a key partner in managing Osgood-Schlatter’s. A diagnosis typically involves a history of the symptoms and a physical examination. The physiotherapist will check for tenderness, swelling, and pain at the tibial tubercle and assess the child’s flexibility and muscle strength. It will be important for the Physiotherapist to rule out other potential causes for knee pain, as there can be quite a few. Imaging like an X-ray is not usually necessary but may be recommended to rule out other potential issues.

Treatment is focused on reducing pain and managing the condition until the child’s growth plates close. A physiotherapist will create a personalised rehabilitation program that may include:

• Activity Modification: Advising on how to reduce the intensity or duration of sport, rather than stopping completely. Finding the right amount of load for each individual is extremely important in the management of Osgood Schlatter’s.
• Pain and Swelling Management: Guidance on the proper use of ice and recovery.
• Flexibility Program: A targeted program to improve flexibility in the quadriceps, hamstrings, and calf muscles to reduce tension on the knee. Care should be taken when stretching the quads, as this can exacerbate symptoms in some cases and alternatives will be provided by your Physiotherapist.
• Strengthening Exercises: Building strength in the muscles around the knee and hip to provide better support for the joint.
• Neuromuscular training: A contributing factor for knee pain is poor alignment or control when running, jumping, cutting or landing. Your Physiotherapist will assess for this and provide activities to improve neuromuscular control.
• Taping or bracing: Depending on the child’s presentation, the Physiotherapist may recommend taping or bracing to assist with pain relief and improve the child’s ability to participate in their activities.

So, what does the future hold for Leo?
The great news is that Osgood-Schlatter’s disease is very manageable with the right treatment and almost always resolves on its own once the child’s bones have finished growing, around age 14-16. With the guidance of his physiotherapist, Leo learned how to manage his symptoms. Leo is able to continue playing soccer long term, keeping him fit and healthy!

We are passionate about helping kids thrive and keep moving—and enjoying movement! If your child is experiencing knee pain or needs support for an injury like Osgood-Schlatters, our team is ready to help.

Resources:
OrthoInfo – AAOS. Osgood-Schlatter Disease (Knee Pain). Available from: https://orthoinfo.aaos.org/en/diseases–conditions/osgood-schlatter-disease-knee-pain/

Gholve, P. A., et al. (2007). Osgood Schlatter syndrome. Current opinion in pediatrics, 19(1), 44–50. Available from: https://doi.org/10.1097/MOP.0b013e328013dbea