When children come to the stage of puberty, drastic mental and physical changes usually give lots of challenges to the parents. Growth spurts are generally the leading cause of several musculoskeletal problems. During the body’s rapid growth, the bones’ increased length usually develops faster than the muscles. As a result, the muscles are being pulled and induced strong tension.
Osgood–Schlatter disease is one of the most common adolescent knee pains associated with growth spurts. A part of the shin bone named tibial tuberosity is located just under the knee cap. It is attached to the powerful front part of the thigh muscle (quadriceps). During puberty, the growth spur already tightens up the tension of the quadriceps. Sports like soccer or basketball further increase muscle tension due to repetitive forceful jumping and kicking. Consequently, the excessive pulling tension of the quadriceps muscle can damage the tibial tuberosity, cause inflammation, and even deformity in this bone.
The featured symptoms of this condition are pain just below the knees cap exaggerated by jumping and squatting activities, enlarged tibial tuberosity (require a copyrighted picture) and localized pain when pressing on it. Besides jumping and squatting activities, patients will also suffer from pain when kneeling, climbing stairs, and running. The most common age of this condition is around 12-15 years old, and the prevalence ranges from 6.8-33%. Adolescents participating in sports including soccer, basketball, gymnastics, volleyball, karate, taekwondo, baseball, and running have higher risks of developing Osgood–Schlatter disease because of repetitive jumping and kicking. Traditionally, it is much more common in males, but the gender discrepancy is getting less since more females also take part in high-impact sports nowadays.
Diagnosis is always the first and most crucial part of management. If boys or girls are in puberty and suffer from prolonged knee pain, parents should arrange for them to consult doctors or specialists for a proper diagnosis. X-ray is usually required to check for Osgood–Schlatter disease and estimate the severity. Conservative management and physiotherapy treatment will be recommended if the condition is not severe.
Physiotherapy treatments for Osgood–Schlatter disease usually include soft tissue mobilization, passive stretching to the quadriceps, and electrotherapy to relieve pain and inflammation. Specific treatments such as extracorporeal shockwave therapy or magnetic field therapy are sometimes required for complicated cases. Extracorporeal shockwave has been proven to be effective in promoting tendon remodeling and repair.
Magnetic field therapy is useful for cartilage and bone repair. However, education is far more important than hands-on treatment at the clinic. Physiotherapists will also educate the patients and parents to do simple and safe massages to the thigh muscles at home. In the early stage, it is important to avoid or minimize painful activities in daily life. For patients who are students and required to climb stairs at school every day, we would communicate with the school to allow the patients to use a lift and avoid stairs for 2-4 weeks if necessary. For athletes who need to continue sports activities, special self-taping skills or the use of a knee guard would be recommended. Adequate warm-up and cool-down stretching are essential to improve flexibility and reduce the tension of the quadriceps muscles. Icing on the knees for about 10-15 mins after sports activities is also advisable to reduce inflammation.
Early diagnosis and intervention are the keys to handling Osgood–Schlatter disease. Most of the cases of Osgood–Schlatter disease can be managed well by conservative treatment and physiotherapy so that patients can resume a pain-free normal life. As mentioned, the muscle tension can sometimes be strong enough to pull and deform the shin bone. Once the bone is deformed, the change in bone shape may be irreversible, and even the pain and inflammation subsides. In addition, a small portion of severe cases may even have pain after long-term follow-up, such cases may require surgical treatments by orthopaedics.
In summary, Osgood–Schlatter disease is a typical adolescent knee pain related to growth spurts. Muscle tension is a crucial factor contributing to this condition. Regular muscle stretching exercise is simple and helpful to maintain flexibility during puberty, parents, and teachers should encourage students to do so.
