Osgood-Schlatter Disease is not a disease but rather a group of symptoms involving the tibial tubercle epiphysis. The tibial tubercle is a small bump on the tibia (shin bone) where the patellar tendon of the quadriceps muscle attaches.
This condition is a result of traction. The tibial tubercle is a growth center (apophysis or epiphysis) located just below the knee joint on the front of the tibia. This conditions will most likely affect males of 12 to 16 and females of 10 to 14 years of age.
The layer under the hard bone of the tibial tubercle is fibrocartilage and is different than any other of the body?s physes. The tibial tubercle physis looks like a layered pastry. During the active growth years these layers are loosely held together. The traction of the quad muscle causes a disruption and inflammation in the layers of the pastry.
In other words, the femur is growing faster than the quad muscle. This causes the quads to place undue pressure on the growth center of the tibia (where the patellar tendon attaches), causing pain. As the X-Ray shows, the traction of the tight quad mechanism is pulling the tibial tubercle away from the body of the tibia.
The symptoms include:
Pain over the tibial tubercle,
Swelling over the tibial tubercle,
Weakness in quad muscle group,
Increased pain & swelling with activity,
Visible lump, and
Pain to the touch over the affected area.
Athletes who suffer from this growth related problem are susceptible, though not likely, to an avulsion fracture of the tibial tubercle. If the growth center has too much traction on it for too long a period of time the bone fails and a fracture results.
Since the quad muscle is elastic, much like an extended spring, if the fracture occurs, the bone fragment will be displaced. Repairing this injury usually results in surgery. The surgical repair usually involves fixing the displaced bone with one or two screws. Surgery is then followed by four to six months of rehabilitation.
Preventing this problem from progressing to a season ending injury is fairly easy. The three symptoms to address are pain, swelling, and flexibility. If these problems are addressed, the athlete should be able to participate at a competitive level.
During competition the athlete should wear a protective pad. The most effective is a standard volleyball knee pad. The knee pad will protect the sensitive tibial tuberosity from impact. Impact to the swollen tuberosity is the most common cause of increased pain during competition.
Some athletes will see pain reduction when a neoprene sleeve is combined with the knee pad. The neoprene sleeve places subtle pressure on the swollen area and retains heat. The light pressure seems to relieve pain by compressing the separating physis. Combining this with the protection afforded by the pad will help to alleviate the most common symptoms during competition.
To control inflammation after activities, ice should be applied to the affected knees daily. This should be done every day, even those without pain. The ice will control the swelling associated with activities and control pain on a daily basis. Non-steroidal anti-inflammatory medications will also help to control these symptoms.
Effective medications are Advil® and Aleve®. These medications should be taken in accordance with package or personal physician?s instructions.
If these medications are taken only when the knee(s) hurt, they will function as pain relievers. If taken daily for two or more weeks they will assist in controlling inflammation. Do not take these medications daily for more than four weeks continuously. Doing so can lead to the stomach upset.
Addressing flexibility is one of the most important treatments for controlling symptoms for the duration of the growth spurt. On the surface, one would expect to stretch the quad muscles. In reality, stretching the hamstrings are more important.
The hamstrings are also undergoing the same stress as the quad mechanism. They are not growing as fast as the femur is. The hamstring insertions are usually not affected the same way as the quad attachments. The hamstring tightness does, however, affect the quad mechanism.
Increased hamstring tightness causes the quad to pull harder during athletic activities, consequently placing more traction force on the tibial tubercle. Increasing hamstring flexibility will help to alleviate the pain. Examples of hamstring stretching are shown on these pages.
Quad stretching will increase the traction forces on the quad attachment, possibly increasing pain and swelling. Quad stretching should be performed with caution so as not to cause increasing pain. Gentle stretching should be performed. Quad stretching is shown above.
Stretching should be performed at least four times daily. Ideally the suffering athlete should stretch 6 times daily. At the minimum, every athlete should stretch after waking, before athletic activities, after athletic activities, and prior to bedtime.
These stretching sessions should attack all major muscle groups with added time emphasizing tight spots. Each stretch should be held for 10 to 30 seconds and repeated three to five times. Do not bounce while stretching, and ease into and out of each stretch.
If the athlete continues to have increasing pain and can not participate on a daily basis, a physician should be consulted. Removal from athletics for a short period of time may help to relieve the pain enough to allow the athlete to return to competition.
If the athlete has to be removed from competition, rehabilitation exercises should be performed to maintain aerobic fitness and strength. These exercises should not exacerbate the symptoms.
Examples of exercises that may worsen symptoms are knee extensions, heavy squats, power cleans, and plyometrics. Any exercise that involves explosive use of the quad mechanism may aggravate symptoms. Appropriate exercises for improving aerobic fitness are cycling (utilize a high seat post), slide board, and swimming. Stair climbing activities may or may not aggravate symptoms, utilize only if appropriate.
For maintaining muscular strength, perform exercises such as straight leg raises, body weight squats, hamstring curls, and calf raises. These should be performed to minimize strength loss rather than increasing strength.
Allowing an athlete with Osgood-Schlatter Disease to continue to lift weights and compete at a high level is appropriate if participation in these activities does not increase pain. Decreasing the intensity of training may be all the adjustment needed to control the pain and swelling associated with this condition.
Most adolescent athletes will experience this problem during their athletic career, it does not mean disqualification from participation.