The big overview

Definition

Definition of Osgood Schlatter

Let's understand what Osgood Schlatter is so that we can make sense of the best available treatments to get it better.  

Osgood Schlatter Disease (OSD) is an overuse condition of the knee that affects children and adolescents mostly between the ages of 8 to 15. The problem zone is usually a small painful area or bump below the kneecap on your shinbone. You can usually put your finger precisely onto it.^[4]

The mechanism of the disease is not yet fully understood. But, a combination of high-impact sporting activities, during a period of a growth spurt, is likely to be the cause of the symptoms.Irritation in this area occurs, as this area of bone is softer during growth and has not yet fully hardened to take on the frequent pull of your strong thigh muscles. In some occasions, the tendon part itself and the underlying structures may even become the source of pain. 

History of the disease

The surgeons Robert Bayley Osgood and Carl Schlatter, who gave the disease its name, first described the painful overuse condition of the knee in children as early as 1903. Nowadays, Osgood Schlatter is seen as one of the most common knee conditions in children. ^[5]

Understanding the signs and symptoms

Running, jumping, and kicking cause particularly high forces around the area of your knee where the thigh muscle attaches to the shin bone.During a period of growth, this repeated pulling on the bony attachment on your shin leads to inflammation and pain. At first, symptoms may only occur occasionally, but get better quickly after sport or the next day. If however the knee continues to be stressed when it's irritable, then the pain takes much longer to disappear. Patients often experience pain during daily activities such as walking, stair climbing and standing up from a chair. 

Am I the only one that has Osgood Schlatter?

No, not by a long shot. Osgood Schlatter is the most common knee pathology in children. Up to one in 10 children suffer from it.  Boys are affected slightly more often than girls. Very active children who play single sports are four times more likely to suffer from it than kids who play multiple sports.

‍Who gets the disease the most?

Boys are slightly more affected and tend to suffer from it between the ages of 10-15 years of age. Girls, on the other hand, suffer from it more often a little earlier on, at an age of 8-12 years.   It is noticeable that most children are usually very active and often do more than 2 hours of sports per day. ^[11,12,13]

‍What makes my knee hurt?

The scientific community is still unsure what causes Osgood Schlatter pain in the first place. In the growing child, it's believed that the pain is caused by the frequent pulling on the bony tendon attachment by the thigh musculature. As a result of frequent and intense sporting activities, this bony attachment can become highly inflamed and painful. In many cases, this leads to the formation of extra bone on the front of your shin. This visible bump is typically highly sensitized and provoked by kneeling and squatting down. ^[8]

What makes my knee pain worse? 

Pulling on the growing thigh bone may not explain the whole pain story. Many aspects of your life can affect how intensely your pain is perceived and how it affects your movement. For instance, your pain may cause you to limp and avoid movements, which over time may create other types of problems that overlap with the disease. More often than not, stress, fear, and worrying may turn up the pain dial and increase your pain sensation. Some kids can’t even touch the bump because they perceive it as being „disgusting“ and avoid looking at it. 

Diagnosis of Osgood Schlatter

‍How is Osgood Schlatter diagnosed by a doctor?

Actually, Osgood Schlatter is very easy to diagnose. You can usually point a finger onto the painful spot on the top of your shin bone. This spot hurts especially when kneeling. Only very rarely do you need X-ray imaging or an MRI. A clinical diagnosis is easily made and should leave no hesitation. Unfortunately, far too many healthcare resources are spent on exhaustive diagnostic imaging, several specialist visits, and expensive healthcare professionals to come to the same conclusion: You have got Osgood Schlatter.

‍What other knee pain conditions are there apart from Osgood Schlatter disease?

There are many causes of knee pain in young children. There are growing pains, overuse injuries and traumatic injuries. 

Growing pains are not serious and their origin is unknown. They are usually located in the muscles and surprisingly, not always related to growing itself. They can be felt as a throbbing pain or aching pain in both legs. Growing pains often occur in active children and are often felt in the evening or night-time. The pain disappears by the next morning. 

Osgood Schlatter is a form of growing pain and an overuse injury. These forms of knee pain may occur after the athlete has overdone it in training, practiced a new activity repeatedly or changed surface or shoes. It is important to stress that in overuse injuries, we talk about structures being sensitized, not broken. Lots of overuse injuries hurt, but you cannot always see a reaction from the body, such as swelling (a sign of inflammation). Lots of overuse injuries around the knee affect the kneecap. This condition is called anterior knee pain or Patellofemoral Pain. Another condition is called Jumpers Knee or Patella Tendinopathy and this condition affects the tendon itself. Not sure if you have Osgood Schlatter? Then click here!

Traumatic injuries differ from overuse injuries as there is usually a strong impact to the knee or a forceful twist that precipitated the injury. Traumatic injuries usually have a specific event that caused the problem. For example, a fall onto the kneecap may cause it to fracture. Big twists of the leg may cause injuries to the internal structures of the knee such as Anterior Cruciate Ligament injuries (ACL). These are often accompanied by deep pain in the joint, immediate swelling, reduced range of motion, an inability to weight bear and a feeling of „giving way“ when attempting to. 

Please seek medical advice if you feel that your knee pain may come from other sources apart from Osgood Schlatter. 

Do I need an X-ray or an MRI to diagnose the disease?

X-ray or MRI imaging is not usually necessary to diagnose Osgood Schlatter. However, if there was a traumatic onset or there are other symptoms around the knee that do not correlate with a point of tenderness on the shin bone, then seek medical advice to get an appropriate diagnosis. ^[15]

‍Can I have Osgood Schlatter on both knees?

Yes, unfortunately. In 20-30% of cases, children are affected on both knees.^[5]

‍Treatment of Osgood Schlatter

‍What is the most promising treatment option?

Any treatment strategy should focus on a long-term strategy. An immediate cure is not possible. Every Osgood Schlatter patient is different, thus needing a milestone-based treatment approach that is done proactively and consistently for many weeks: 

This approach should be focused on the three pillars of success that are the cornerstone of our App: ^[16]

• Education and a treatment plan based on milestone progressions. 
• Regular stretching, strengthening and coordination exercises to reduce the pull on the shin bump. 
• Managing the pain through activity modification. 

‍What is good physiotherapy / physical therapy?

A good physical therapist will become your new coach. He or she will help you understand the condition, provide you with treatment solutions and modify painful activities so that you can still do sports without suffering from knee pain. It is your therapist's job to guide you through flare ups and provide a treatment plan to get you back to your goal. Remember that you are part of the rehab team. Let your therapist know when you are feeling low, struggle with the program or hurt after a treatment session. The more you can work together with your therapist, the better the outcome. Teamwork makes the dream work. 

Are there exercises that I can do right now?

Yes, you can start with our “Top 5 exercises for Osgood Schlatter”. They provide a good starting point for most kids. So click here to read more about it!

‍How to know when you are doing too much?

Since others cannot feel your pain, it is important that we use a scale that helps us communicate our knee issues with parents and coaches.  

Using a 10 point pain scale, we can identify three zones of discomfort. There is the Green Zone. This is the Zone from 0-2 and where we want you to be during, after, and 24h after your exercise. The goal is to find as many sporting activities as you can that you can do in this range.  

If you are in the orange Zone during, after and 24 h your sport, you have overdone it and need to take a rest day or modify your activities until your back in the Green Zone.

Everything in the red Zone we do not want. Here, your knee is unable to handle the stress and reacts with pain. Be honest with yourself and don`t push through it. The longer you stay here, the harder it is going to get to be to get things to calm down.  

Let's give you an example of modifying your activities:  

Let's say you are playing Basketball and jumping and cutting cause you to be in the Orange - Red Zone. Talk to your coach and see if he can find you some drills to work on that keep you in practice and "in the Green". Then, while the others are doing other work, you can do the exercises that we show you in the APP.

‍What about straps for the Knee?

You may have seen some of your peers walking around with these. They can help to reduce pain, but from our point of view, they should be seen more like a band-aid. They relieve some symptoms but won't tackle the underlying problem.

‍How about Injections, will they help?

Injections, in the form of dextrose (prolotherapy), into the area of symptoms cannot be recommended based on the scientific literature. In fact, these injections did not offer any significant benefit when compared to a placebo injection.

Does surgery speed up my recovery?

According to the scientific literature, surgery is only very rarely the right choice for children with Osgood Schlatter disease as less than 2% are actually operated on. Surgery can be indicated if symptoms persist, the skeletal bone has matured (approximately at the age of 17-18 years of age) and conservative treatment has failed. A study showed that after surgery, individuals were able to get satisfactory outcomes and get back to sports. But, it took nearly half a year to a year of rehabilitation to get there. Since this topic is complexe click here to read more about it.

‍Can I treat myself?

The first step is to see a doctor to confirm the diagnosis of Osgood Schlatter. There are many problems around the knee that can mask Osgood Schlatter Symptoms, which require an alternative course of action. Once the diagnosis has been made, you can either see a physiotherapist who can provide you with an individual treatment plan. Or, you can download the Osgood Schlatter Treatment App and get guidance from experienced physiotherapists online! If you want the best of both worlds, show our App to your therapist and let’s work on it together. You want to learn more about the most common treatment options? Click here!

Why is Osgood Schlatter managed so poorly?

There continues to be a lack of helpful advice on Osgood Schlatter. Compared to many other knee conditions such as ACL injuries for example, Osgood Schlatter is a neglected topic by the medical community and scientific evidence is lacking. ^[20]

In addition to poor evidence, many health professionals haven’t caught up to the most effective treatments either. And you can’t blame them. Evidence shows that it takes 17 years for research to make it into clinical practice. ^[21]

Yet, recent scientific studies for Osgood Schlatter Treatment show, that following a specific exercise program:

• 68% were back doing playing sport after 3 months,
• 79% after 6 months
• 81% after 12 months
• 86% after 16 months.^[16]