Cause / Presentation
Osgood Schlatter's presents during the primary growth stages in teenagers, slightly more common in boys than girls. It is associated with a discrepancy in growth rates between the quadriceps muscle / patellar tendon and the femur (thigh bone). The drag occurring on the patellar tendon's bony attachment causes the characteristic lump on the shin and the specific pain located in the same area. This is commonly “insidious”, occurring without an apparent reason or mechanism (besides growth). Often those with this discrepancy are not symptomatic. They have no pain until they challenge the region with increased mechanical load, commonly through sport or vigour activity participation. Osgood Schlatter's presence is associated with pain directly over the Tibial Tubercle, the bony lump just below the knee cap. This is the site of attachment of the Patellar Tendon, the connective tissue extension of the quadriceps (thigh) muscles responsible for straightening the knee. These muscles are most used in force-producing activities, standing, stairs, jumping, kicking, running etc. Consequently, when the system is taut due to the discrepancy in bone vs muscle/tendon growth, the additional load of activity irritates the attachment site causing pain.
Common Treatment
The academic literature and general medical training indicate that Osgood Schlatter's is a self-resolving problem. Typically adolescents are recommended to cease all symptom provoking activities and manage symptoms with passive external modalities (ice, heat, pain killers etc.). While the medical fraternity is correct in the self-resolving issue – it will naturally improve as the individuals' growth normalises – there is no need to wait the years often recommended to participate in the activity.
The underlying problem here is typically load tolerance. The knee cannot manage the load challenges of the given activity and hence becomes painful. This is a structural problem with a functional influence.
Ideal Intervention
Anecdotally, many teenagers respond well to a mixture of improved strength, improved movement quality and control, and a targeted mobility program.
The Patellar Tendon's tolerance to load is the most critical factor. If you can train the individual to improve strength and offload the knee by learning to use the hips and ankles, a return to activity can occur quickly.
Below are some excellent examples of potential interventions. However, these should be prescribed appropriately by a physiotherapist who can assess the impairments that will give the individual the best “bang for their buck”.
Mobility
In the early days, stretching the Quadricep muscle is not recommended. Pulling more on the point of bony irritation will likely only stir symptoms with a bit of ongoing benefit.
Foam Rolling is a much better approach, as we can improve the length and tissue quality in the muscle without pulling on the site of the complaint. Try Rolling the quadriceps, gluteals and calves as a starting point.
Strength
This should be targeted to the quadriceps, gluteals and calves, Three of the most significant force-producing muscles in the lower limb. These can both offload and improve the tolerance of the knee to activity.
Leg Extension (Isometric Holds) (40sec x 3)
Control
Squat control (valgus and hip dominant). Aim to keep weight in heels while sticking bottom back. Knees should stay in line with toes (not caving inwards).
Load Management
Understanding the appropriate level of load to allow and the best way to progress it avoids a flareup is especially important. This is such a big topic it will have its own blog, “Load Management”, check the website for more details.
Summary
Osgood Schlatter's is a common and frequently poorly managed condition in adolescents. Symptoms can be managed so young athletes can participate in sport and activity while the body slowly growths and prepares for adulthood. Specific strength and mobility work is recommended to improve tolerance to activity.
If you are suffering from Osgood Schlatters, book in with your Physio for a thorough assessment by clicking here. Once the cause has been identified, a plan can be designed specifically for you and get you back to doing what you love.
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