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Osgood Schlatter disease (Osgoods/OSD) is a condition that causes inflammation of the bones, cartilage and tendons at the top of the shinbone or tibia where the patellar tendon is attached to the knee cap. One of the primary causes of knee pain in physically active adolescents, Osgood Schlatter syndrome is most often diagnosed in young people aged 8 to 15 years old.
Osgood Schlatter disease gets its name from the surgeons who described it in 1903 - US orthopaedic surgeon Robert Osgood (1873-1956) and Swiss surgeon Carl Schlatter (1864-1934). More of an injury than a disease, Osgoods is thought to develop as a result of overuse of the quadriceps muscles, which causes repetitive strain where the ligaments meet the growing tibia of an adolescent. As the tibia is not yet strong enough to withstand the strain, stress is placed on the area where the ligaments are attached, causing redness, soreness and - in some cases - flaking of the tibia bone. In instances of bone flaking, a hard bony bump can develop as the bone heals. This has given Osgood Schlatter disease the nickname ‘knobbly knee’.
Osgood Schlatter disease usually affects boys between the ages of 12 and 15 years old and girls between the ages of 8 and 12 years old. OSD is more common in boys than girls and tends to affect young people who play sports such as football, tennis, basketball, volleyball, gymnastics and figure skating; however, the condition has been diagnosed in less active adolescents and also in adults who had the disease when they were younger or who continue to participate in repetitive activities.
70% of the people affected by OSD only develop the condition in one knee, although it can occur in both knees. Symptoms include swelling and tenderness of the knee, tightening of the muscles surrounding the knee, and knee pain that worsens with exercise and is relieved by rest. In some cases, a small bony bump begins to develop under the kneecap.
The characteristic symptoms of Osgood Schlatter syndrome mean that it can be fairly straightforward for a doctor to give a diagnosis. A doctor will check your knee for symptoms such as tenderness, pain, redness and swelling. They will also evaluate the range of motion in the knee joint and in your hip. An x-ray can confirm the condition and show whether any bone has flaked away from the shinbone. Symptoms that are not typical of OSD and could point to another condition include pain that radiates into the thigh, persistent pain that does not stop even when at rest, and pain that is so severe that it disturbs sleep or makes a young person cry.
Rest forms the foundation of the treatment plan for Osgoods. It is often advised that young people continue their sporting activities when the pain is mild and limit them or take a break when symptoms are active. Sporting accessories such as shock-absorbent insoles can support and reduce stress on the knees, while gel pads and knee pads can protect the shins from bruising.
A physiotherapist can help with pain management by taking you through a stretching programme that targets the hamstring and quadriceps muscles. Using a physiotherapist is considered one of the best ways to minimise the reoccurrence of the condition. NSAIDS such as ibuprofen and other anti-inflammatory medicines could be prescribed for pain relief and used alongside moist heat and ice to help reduce swelling.
Adult sufferers are advised to massage their legs from the ankle to the hip and to use a patella knee strap or neoprene knee support to reduce the tension to the knees and offer extra support. The strap can be worn on the part of the knee that is painful. In severe cases of Osgood Schlatter syndrome, a plaster cast is used for pain management and surgery could be necessary if there is a considerable bone fragmentation.
In adolescents, the pain of Osgood Schlatter disease lasts until the end of their growth spurt. This means the pain can last weeks, months or up to two years. After two years, minor surgery can deal with areas of the knee from which bone has flaked and that remain unhealed. The small bony bump that develops under the kneecap in OSD is permanent but becomes painless over time.
There are few long-term consequences of OSD apart from this bump, which does not affect the joint and can be surgically removed, especially if it remains painful; however, young people and adults alike may continue to experience some pain when kneeling.
There are other problems that can develop in some adults who may have prioritised adolescent sports earlier in their lives or who did not seek a diagnosis. Orthotics may be necessary to stabilise the bones in the feet and ankles and to reduce the shock of heel strike.
If surgery is needed, there could also be the short-term effect of reduced blood supply below the knees; however, optimum circulation should return fairly quickly.
There are a few strategies that can be employed to reduce the chances of suffering from OSD. During a growth spurt, the leg muscles are quite tight and stretching can be particularly helpful during this time. Preparing for sporting activities with the proper warm-up techniques will get the muscles and tendons ready for exercise and increase their flexibility. Gradually working your way into any intense activity can be especially important for bones that are not fully developed and helps to reduce injury.
Containing intense physical activity to 90-minute slots and allowing the body to rest between sessions to recuperate from the physical stress is also believed to be a preventative measure against developing OSD. Deferring weight lifting activities until at least age 16, when bones have matured and hardened, helps to ensure that young knees are not put under too much stress.