Osgood-Schlatter Disease is a condition of the knee that affects young boys more often than girls. However, it does not discriminate between the sexes.  It occurs when any youth undergoes a rapid growth spurt and the femur grows faster than the quad muscles. This places significant stress on the tibial tuberosity which is the insertion site for the patellar tendon of the quadriceps. You can feel the tibial tuberosity which is the bony prominence on the tibia about 1-2 inches below the knee cap.

The rapid growth spurt results in the quadriceps being too short in relationship to the length of the femur, so it pulls on its tendonous insertion into the tibial tuberosity which begins to avulse or tear the bone away from the rest of the bone/tibia resulting in the painful bump below the knee. This is called an avulsion fracture. Naturally, this is very painful and will cause pain with walking, kneeling, and significant pain with sports and activities such as hiking, running (especially deceleration),  kicking a ball, jumping, etc.

In the old days, the patient would live with the pain or the  patient would be placed on crutches and the natural process would be allowed to play itself out. This is unnecessary and can cause permanent limitations such as pain with kneeling and physical limitations, as well as chronic low back and knee pain. So, what can be done? Go see your physician and get a prescription for physical therapy as soon as possible. This is a very easy diagnosis to treat and results will be seen very quickly. Not treating this diagnosis places huge stress on the youth secondary to the constant, and at times, very significant pain they will have to endure. In addition, the avulsion fracture can become rather significant, prominent, and permanent. Imagine having so much stress placed upon a bone that some of it begins to tear away from the rest of the bone on a daily basis for months. The resulting trauma can result in new bone formation that can result in a bony prominence as much as a quarter inch. Perhaps that can place into perspective the amount of pain the youth experiences on a daily basis. That type of pain can result in increased cortisol (stress hormone) levels, decreased energy levels, depression, irritability, decreased immune system, and muscle atrophy secondary to inactivity.

Treatment: Physical Therapy has a very high success rate treating this diagnosis and teaching the patient to handle this diagnosis at home during this treatment episode as well as any future growth spurts that happen. The physical therapist would first focus on calming down the inflammation at the patellar tendon and the tibial tuberosity with frequent icings, either ice massages, which is preferred, or ice packs. In severe cases they can also use a modality called Iontophoresis, which is a non-invasive delivery system for a steroid (no needles). Next, gentle quadriceps, hip flexor, and hamstring stretching will be done multiple times per day. A special type of massage called transverse friction massage would be performed to the patellar tendon.  Aggressive soft tissue mobilizations and massage would be performed on the quadriceps muscles to loosen it up making it more receptive to stretches.  In addition, for those physical therapy facilities that have a certified Kinesio Tape Practitioner, Kinesio Tape can be used day one to inhibit the quad, inhibit the patellar tendon to take pressure off the tibial tuberosity, and assist with any patellar tracking problems as well.

As the patient progresses, the exercise program they are put on will focus on endurance and flexibility of the quads, hamstrings, and gluteal muscles. Once the symptoms have improved moderately, a more aggressive exercise program will be instituted preparing the youth to return to sports.

I have treated very competitive high school athletes with this condition. I personally experienced this condition when I was in 8^th grade. One of my runners had had a 6/10 constant pain that went up to 10/10 during competitive running for over 5 months prior to coming to PT.  It was so painful and constant, she would be crying by the end of the day. The patient’s mother finally took her to an orthopedic surgeon who immediately sent her to physical therapy. Within two weeks of beginning her physical therapy, her constant pain resolved and she was back to running within 4 weeks and back into competitive competition within 6-8 weeks.

Left untreated, this diagnosis can plague an individual for months or years and in some case (like myself) forever.  If treated, the speed of recovery will be dependent upon how quickly the youth is placed into therapy and where they are in their growth spurt. If the growth spurt is over, recovery will be very rapid. If they are in the beginning or middle of a growth spurt, their constant pain can be alleviated completely but there may have to be temporary sport restrictions until the growth spurt is over.

For those who do not have access to physical therapy, take home points are frequent icing and stretches and avoidance of activities that increase pain.