Osgood-Schlatter's disease, OSD, apophysitis, osteochondrosis, tibial tuberosity pain, anterior knee pain, children and adolescent knee pain, knee overuse injury, overuse injury, tendon pain, growth pain, growth plate pain.
Osgood-Schlatter's disease, also known as apophysitis or osteochondrosis of the tibial tubercle, is a common cause of knee pain in growing children. It typically presents as anterior knee pain and tenderness at the insertion of the patellar tendon on the tibial tubercle, without a history of injury.
This condition is often caused by repetitive stress, such as running and jumping, which are common in sports such as soccer, basketball, and gymnastics. The increasing prevalence of artificial turf fields, with their high traction and rapid changes in direction, may contribute to the increased incidence of this condition. In the past, sand fields were more common and provided less stress on the growth plates, but now, artificial fields are causing more stress on the knee.
Apophysitis and osteochondrosis
Apophysitis refers to a situation in which the bone's growth area, apophysis, is subjected to repeated traction stress without adequate recovery. This leads to microscopic damage to the growth area, which over time can become more extensive and cause pain, swelling, and pressure sensitivity.
Apophysitis is a general term for pain at the attachment site of the growth area and the skeleton muscle and does not necessarily indicate an inflammatory condition, although the suffix "-itis" suggests this. Apophysitis can occur on any growth area, depending on the load generated by the sport in question. The most typical apophysitis is found in the knee and heel areas. Advanced apophysitis can lead to osteochondrosis.
Osteochondrosis is a more severe skeletal growth disorder than apophysitis, which may involve inflammation, a hardening or widening of the growth area, and bone necrosis. The cause is often a circulatory disorder in the bone or growth plate, resulting in local necrosis, although bone regeneration often follows.
The root cause of osteochondrosis is not known, but the same factors that cause apophysitis are often involved. Genetic factors and anatomical anomalies also contribute to the development of osteochondrosis. The most typical apophysitis and osteochondrosis are Osgood-Schlatter's disease, Sever's disease, and Sinding-Larsen-Johansson disease.
Etiology
Osgood-Schlatter's disease typically develops during bone growth, around 8-12 years of age for girls and 10-14 years of age for boys. The condition is more common in boys than girls and occurs due to overloading of the tibial tuberosity, the bony bump below the kneecap, through the quadriceps and patellar tendons. Repetitive stress on the tibial tuberosity from these tendons causes microfractures and inflammation, resulting in swelling, pain, and tenderness in the area.
Contributing factors may include weak quadriceps, biomechanical challenges, overuse, under-recovery, poor nutrition, and lack of sleep. Thus, it is important to consider all factors while assessing the condition to provide effective and personalized treatment.
Risk factors
Gender; more common in girls than in boys
Age; boys aged 10-14, girls aged 8-12
Sudden growth spurt
Repeated stress to the knee, such as jumping and running
Inadequate recovery
Repetitive or early specialization in one sport
Weakened flexibility or strength in the quadriceps
Biomechanical factors and lower limb alignment issues
Symptoms
The initial symptoms of Osgood-Schlatter's disease are often pain and a burning sensation felt on the front of the knee after physical activity. As the condition progresses, pain may also be felt during exercise and at rest. The prominence of the shinbone's front protuberance increases due to the greater traction force, making kneeling uncomfortable. The knee is often swollen and sensitive to touch, leading to changes in gait and movement. Walking and running may become difficult, and the child may begin to avoid activities that strain the knee.
Treatment
The treatment for Osgood-Schlatter's disease primarily involves resting and avoiding activities that exacerbate pain. It's important to find alternative physical activities during this time and focus on improving technique in a way that doesn't cause knee pain.
Stretching exercises and manual therapy can improve thigh flexibility and reduce load on the knee joint. Biomechanical functions of the lower extremities should be improved along with power output, especially for the hip, thigh and gluteal muscles. Using knee braces or taping can reduce the strain on the patellar tendon. Cold therapy can also be used to reduce pain during acute flare-ups, and careful selection of shoes and equipment is recommended.
In severe cases, the knee may need to be immobilized with a cast. In rare cases where there is an isolated bone fragment under the patellar tendon causing pain, surgery may be necessary after growth has stopped. However, the prognosis for full recovery from Osgood-Schlatter's disease is generally very good.
Physiotherapy
Physiotherapy always begins with a thorough assessment of background factors, based on which an individualized rehabilitation program can be developed. It is necessary to distinguish between the underlying factors and determine which factors have contributed to the development of the pain.
The aim of the background factor assessment is to identify the reasons for the onset of the condition. Typically, these can be roughly divided into three categories:
Excessive load or inadequate recovery
Rapid growth
Biomechanical factors that cause excessive strain on the patellar tendon
Rehabilitation is carefully planned according to the background factors, so what works for one person may not be the best treatment for another. Therefore, it is recommended to contact a physiotherapist who specializes in lower limb or pediatric and adolescent overuse injuries as soon as possible when dealing with this condition.
Self care
Here are some specific exercises and tips that may be helpful for someone with Osgood-Schlatter's disease:
Week 1-4
Activity modification (avoid activities that aggrevate your knee pain)
Static holds against the wall for thigh activation (10 repetitions, 30 seconds each, once daily)
Pelvic lifts, preferably with excess load (3 sets of 10 repetitions, every other day)
From week 5 onwards
Excercise with body load (squats, pelvic lifts, wall holds etc.)
Gradually increase knee loading activities using the activity ladder:
Light walking/cycling
Faster walking/medium to hard cycling
Slow running
Stairs
Running in medium pace
Skipping
Jumping
High speed running, turning and jumping
Warm-up and 50% training
Warm-up and full training
Match/competition
Avoid doing exercises that aggrevate your pain intensity over a 5/10 on the visual analogue scale (VAS) or activities that maintain an increased pain sensation in the knee for over 24 hours after stopping with that exercise.
Cold therapy: Apply cold to the sore area for 15-20 minutes several times a day until the daily knee pain has stopped. After this, the use of cold is still advisable when the knee becomes sore.
Consult a physical therapist: If your pain persists despite self-care measures or is interfering with your daily activities, consult a physical therapist. They may recommend additional treatments such as manual therapy, individualized exercise program or custom orthotics.
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