If you have pain just below the knee and are either in your early to mid-teens or have recently had a growth spurt, you may have a growth pain called Osgood Schlatters Disease.
What causes Osgood Schlatters Disease?
It is a condition (not a disease) that occurs where the quadriceps tendon inserts below the knee. The quadriceps are the large muscles in the front of the thigh. They are responsible for straightening and limiting the amount of bending at the knee.
The quadriceps tendon crosses the knee and attaches to the shin bone just below the knee joint. Contraction of the quadriceps increases tension at the insertion site of the tendon and in some cases repeated contraction may cause pain and the tendon to pull away from the knee and some swelling at this point. That is Osgood Schlatters disease.
Why does it happen?
Osgood Schlatters Disease is common at the time of growth spurts when the bones grow but the muscles do not. Therefore, the muscles effectively become tighter which puts increased stress through the quadriceps tendon. It may also be related to unusual mechanics of the leg due to muscle weakness or tightness, or poor foot posture. Over training or incorrect training can also play a part.
What will a physiotherapist do?
Initially, an X-ray may be performed to rule other causes of the pain. From there the physiotherapist will examine the biomechanics of the patient to see if any other areas are contributing to the knee pain. Treatment may focus on relative rest, ice, massage, stretches, electrotherapy and use of a patella tendon strap.
Once the pain has settled, quadriceps strengthening will commence. If the physiotherapist notes any contributing problems in the patient’s biomechanics, appropriate strengthening and stretching exercises will be given and the patient may be referred to a podiatrist to have their feet thoroughly assessed.
What about sport?
Activity without pain is a crucial element to recovery. This may mean decreasing the number of sports played or the frequency of training sessions. Complete rest is rarely required. The physiotherapist will be able to advise on appropriate amounts of activity and progressions.
Outcome
Osgood Schlatters Disease will settle, usually within six weeks to 12 months but it can last as long as two years. It settles when the bones fuse, in the mid to late teenage years. Patients may end up with a slightly enlarged bump below the knee, where the quadriceps tendon attaches (especially if you do not manage the condition properly).
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