Another of the Traction Apophysitis conditions (stress and inflammation where tendons connect to bone from repetitive pulling forces), this one was first described in 1903 by Osgood and Schlatter in America and Switzerland simultaneously. This condition is one that affects the bony thickening at the top and centre of the shin bone called the tibial tuberosity. A great deal of effort and research has gone into investigating what happens to cause pain around the insertion of the thigh muscle tendon onto the shin.
Its important to note here that pain is normally only felt around the bony lump itself. If the pain on palpation refers down into the shin the patient should be seen by a GP or Primary Care Physician as soon as possible.
For the most part it is accepted that the pull of the tendon onto the bone causes irritation on the bone which can lead to some weakening of the bone structure and its ability to absorb load eventually leading to inflammation and pain at the tibial tuberosity. This makes sense given the way the thigh muscle uses the kneecap like a pulley system to straighten the knee exerting lots of force on the bone.
There are 3 main presentations:
Girls who physically mature earlier than boys tend to present between the ages of 10-13 and boys between 12-15 years old, although this can vary slightly depending on the individuals timing and tempo of maturation.
This injury is much more common during the accelerated growth spurt between 8-12 for girls and 12-15 for boys. This is called Peak Height Velocity where up to 5-10% of overall height can be gained in 6-12 months. The bones often gain length faster than the muscles and tendons around them, which then have to adapt their length during a period where lots of pressure is placed on the tibial tuberosity.
At Pure, your Physio will take a detailed history of your symptoms followed by a thorough clinical examination. This will help produce a fast and definitive diagnosis, allowing the most effective treatment and management plan to begin straight away, helping to achieve optimal outcomes. Your Physiotherapist will want to know how your condition is effecting you day to day so that your treatment can be tailored to your needs and will mean personalised goals can be established. Regular re-assessment will track your progress towards your goals and will allow treatment modifications to be made in line with symptoms.
Traditionally, OS has been thought of as a self-limiting condition and symptoms will stop once full maturity is reached. More recent research suggests this condition is more of a spectrum than previously thought, however, as with all traction apophysitis conditions, the frontline treatment is activity modification – sports may need to be stopped for a period of time.
At one end are patients who have acute OS pain in the knee in adolescence. They take a period of time of activity modification to reduce load on tibial tuberosity and patella tendon and the symptoms settle. This is followed by a phased return to sports anywhere from 2-6 months and largely have no further issues.
At the other of the spectrum, there are those who have more than just the bone involved with the surrounding tendon and other structures irritated. These patients tend to have significant strength deficits of certain muscles or the inability to perform one-legged activity such as jumping. These patients need activity modification and a good strengthening programme to restore normal movement and the ability to perform one-legged tasks to the same level as the other side. This can be even more problematic if affecting both sides at once. Despite good rehabilitation, symptoms can sometimes re-occur or persist in tasks such as kneeling into adulthood, although this can be due to the change in shape of the tibial tuberosity.
At Pure Physiotherapy a specialist paediatric Physio will guide you through a personalised rehabilitation programme. As symptoms improve following a suitable period of rest, you will start to re-introduce load back into the muscles and tendons around the leg and progressively return to sporting activities. Progressions will be lead by symptoms.
For patients whose symptoms don’t settle or those who experience relapses, targeted strengthening to reduce deficits in strength and power may need to be addressed first. Really problematic cases may require imaging such as an ultrasound to determine the involvement of other structures or blood tests to check the level of Vitamin D – an indirect measure of bone health.
For the greater majority this condition will only last a few months for others they may have to engage in a longer term strengthening programme to lessen their chances of symptoms continuing into adulthood. Our expert team at Pure can help guide your recovery working with you to get the best results.
NICE Evidence – click here
Cairns, G., Owen, T., Kluzek, S., Thurley, N., Holden, S., Rathleff, M. S., & Dean, B. J. F. (2018). Therapeutic interventions in children and adolescents with patellar tendon related pain: a systematic review. BMJ open sport & exercise medicine, 4(1).
Rathleff, M.S., Winiarski, L., Krommes, K., Graven-Nielsen, T., Hölmich, P., Olesen, J.L., Holden, S. and Thorborg, K. (2020). Activity Modification and Knee Strengthening for Osgood-Schlatter Disease: A Prospective Cohort Study. Orthopaedic Journal of Sports Medicine, 8(4), 2325967120911106.