Osgood-Schlatter disease (OSD) is a prevalent musculoskeletal condition that primarily affects pediatric and adolescent populations experiencing growth spurts, particularly between the ages of 10 and 15. The incidence of OSD is higher in males as compared to females. This condition is predominantly observed in young athletes participating in sports or activities necessitating repetitive knee flexion and extension movements, such as soccer, basketball, or ballet.
Article Index:
Introduction
Treatment & Exercise
Conclusion & References
Introduction
OSD is characterized by inflammation and irritation of the patellar tendon at its insertion point on the tibial tuberosity, a bony protuberance on the anterior aspect of the tibia. Consequently, this leads to pain, swelling, and tenderness localized inferior to the patella.
Prolonged stress on the region can result in the formation of a palpable and tender bony prominence. It is crucial for healthcare professionals to recognize these specific clinical manifestations, especially within the pediatric and adolescent athlete population.
Typically, Osgood-Schlatter disease demonstrates a self-limiting course and resolves over time. Nevertheless, therapeutic intervention is often required to alleviate pain and discomfort. Conservative management strategies, including rest, cryotherapy, non-steroidal anti-inflammatory drugs (NSAIDs), and modification of physical activities, have proven effective. Additionally, stretching exercises and manual therapy are significant in symptom management.
Clinical Features of Osgood-Schlatter Disease:
Anterior knee pain predominantly localized inferior to the patella at the tibial tuberosity
Swelling or tenderness surrounding the knee, particularly at the tibial tuberosity
A palpable bony prominence or lump inferior to the knee, sensitive upon palpation
Muscular stiffness or tightness encircling the knee joint, exacerbated after periods of inactivity
Pain aggravated by physical activity involving running, jumping, or squatting movements
Pain alleviation with rest
Predominantly observed in pediatric and adolescent athletes participating in sports or activities involving repetitive knee flexion and extension.
Symptoms may be unilateral or bilateral.
Infrequently, the affected region may exhibit erythema, warmth, or signs of infection.
Manual Therapy
Hands-on manual therapy is a valuable treatment option for Osgood-Schlatter disease (OSD), offering several benefits to patients suffering from this common musculoskeletal condition affecting children and adolescents. Manual therapy techniques can help alleviate pain, improve flexibility, and enhance overall function in individuals with OSD. Some of the key benefits of hands-on manual therapy include the following:
Pain reduction: Manual therapy techniques, such as soft tissue mobilization, can help alleviate pain in individuals with OSD by releasing muscle tension and breaking up adhesions around the affected area. These techniques can be particularly effective in reducing pain associated with tight muscles and tendons, such as the quadriceps and patellar tendon.
Improved flexibility: Manual therapy can help enhance flexibility in the muscles and tendons surrounding the knee joint by targeting areas of tightness and restriction. By promoting increased flexibility, manual therapy can help reduce stress on the patellar tendon and tibial tuberosity, which are primarily affected in OSD.
Enhanced joint mobility: Manual therapy techniques, such as joint mobilization, can help improve knee joint mobility by addressing joint restrictions and enhancing the range of motion. Improved joint mobility can reduce pain and improve function in individuals with OSD.
Reduced inflammation: Manual therapy can help decrease inflammation around the affected area by promoting increased blood flow and lymphatic drainage. This can help reduce swelling and tenderness at the tibial tuberosity and promote healing.
Muscle balance: Manual therapy can help correct muscle imbalances around the knee joint by targeting weak or tight muscles that may contribute to the development or progression of OSD. By addressing these imbalances, manual therapy can help reduce the load on the affected area and alleviate symptoms.
Biomechanical correction: Manual therapy can help address biomechanical issues that may contribute to OSD by improving the alignment and function of the lower extremity. Correcting biomechanical factors can help reduce the stress on the patellar tendon and tibial tuberosity, leading to symptom relief and prevention of further injury.
Individualized treatment: Hands-on manual therapy allows healthcare professionals to tailor treatment plans to the specific needs of each individual with OSD. By addressing the unique factors contributing to a patient's condition, manual therapy can provide more targeted and effective relief from symptoms.
Exercise
Though not curative for Osgood-Schlatter disease, exercise interventions can aid in symptom relief and damage prevention. Beneficial exercises include:
Stretching exercises: Muscular tightness exacerbating OSD can be mitigated through stretching exercises, reducing pain. Quadriceps, hamstring, and calf stretches are particularly advantageous.
Strengthening exercises: Enhancing muscle balance around the knee joint through strengthening exercises can reduce the load on the affected area. Leg presses, squats, and step-ups are examples of beneficial exercises.
Low-impact exercises: High-impact activities such as running and jumping can exacerbate Osgood-Schlatter's disease. Low-impact exercises, including cycling, swimming, and yoga, can help maintain cardiovascular fitness and improve flexibility without worsening symptoms.
Rest and cryotherapy: Rest and ice application can help alleviate pain and inflammation in the affected area. It is crucial to abstain from activities that induce pain and allow adequate time for the body to heal.
Treatment and Exercise Demonstration
Osgood-Schlatter Disease Uncovered
In this video, Dr. Brian Abelson, the Developer of Motion Specific Release (MSR), and Miki Burton RMT present you with effective treatment procedures and functional exercises for this common condition.
Note:
The treatment demonstration starts at 01:50
Mobility exercises start at 05:56
Strengthening exercises start at 11:42
Treatment Frequency Recommendations
When providing manual therapy for OSD, the goal is to alleviate pain, reduce inflammation, and improve function. Each individual's response to therapy can vary. Regular assessment and feedback will determine the optimal frequency and duration for the patient.
Acute Phase:
If the pain and inflammation are severe, it's advisable to start with 2-3 sessions per week for one to two weeks.
This helps to manage the acute symptoms effectively.
Subacute/Chronic Phase:
Once the acute symptoms subside, the frequency can be reduced to once a week or once every two weeks, based on the individual's progress and response to therapy.
Duration
Each session typically lasts between 15 and 30 minutes. The exact duration would be determined by the severity of the condition and the specific manual therapy procedures being used.
Remember, while manual therapy can offer relief, it's essential to address the root cause of OSD, which is often related to overuse or specific activities that place repetitive stress on the growth plate in the knee.
Conclusion
In conclusion, Osgood-Schlatter disease is a prevalent musculoskeletal condition that affects children and adolescents during their growth spurts. It is essential for healthcare professionals and the general public to be aware of the signs and symptoms of OSD, particularly among young athletes. While the condition is typically self-limiting, a combination of conservative management strategies, including rest, ice, NSAIDs, activity modification, exercise interventions, and hands-on manual therapy, can effectively alleviate pain and discomfort. Manual therapy, in particular, offers numerous benefits, such as pain reduction, improved flexibility, enhanced joint mobility, and biomechanical correction. By incorporating manual therapy into a comprehensive treatment plan and staying informed about the latest findings in the field, healthcare professionals can optimize patient care and outcomes for individuals with Osgood-Schlatter disease.
DR. BRIAN ABELSON DC. - The Author
Dr. Abelson's approach in musculoskeletal health care reflects a deep commitment to evidence-based practices and continuous learning. In his work at Kinetic Health in Calgary, Alberta, he focuses on integrating the latest research with a compassionate understanding of each patient's unique needs. As the developer of the Motion Specific Release (MSR) Treatment Systems, he views his role as both a practitioner and an educator, dedicated to sharing knowledge and techniques that can benefit the wider healthcare community. His ongoing efforts in teaching and practice aim to contribute positively to the field of musculoskeletal health, with a constant emphasis on patient-centered care and the collective advancement of treatment methods.
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References
Gholve, P. A., Scher, D. M., Khakharia, S., Widmann, R. F., & Green, D. W. (2007). Osgood Schlatter syndrome. Current Opinion in Pediatrics, 19(1), 44-50.
Kaya, D. O., Toprak, U., Baltaci, G., Yosmaoglu, B., & Ozer, H. (2013). Long-term functional and sonographic outcomes in Osgood-Schlatter disease. Knee Surgery, Sports Traumatology, Arthroscopy, 21(5), 1131-1139.
Demirag, B., Ozturk, C., Yazici, Z., & Sarisozen, B. (2004). The pathophysiology of Osgood-Schlatter disease: a magnetic resonance investigation. Journal of Pediatric Orthopaedics B, 13(6), 379-382.
Circi, E., & Atalay, Y. (2017). Conservative treatment of Osgood-Schlatter disease: a systematic review and meta-analysis. European Journal of Orthopaedic Surgery & Traumatology, 27(6), 729-736.
Sousa, T., & Castro, M. (2019). Osgood-Schlatter Disease: A comprehensive review. EFORT Open Reviews, 4(11), 633-639.
Vaishya, R., Azizi, A. T., Agarwal, A. K., & Vijay, V. (2016). Apophysitis of the Tibial Tuberosity (Osgood-Schlatter Disease): A Review. Cureus, 8(9), e780.
Weiss, J. M., Jordan, S. S., Andersen, J. S., & Lee, B. M. (2007). The use of a pneumatic leg brace in Osgood-Schlatter disease: a prospective, randomized study. The American Journal of Sports Medicine, 35(3), 316-320.
Nakase, J., Goshima, K., Numata, H., Oshima, T., Takata, Y., & Tsuchiya, H. (2015). Precise risk factors for Osgood-Schlatter disease. Archives of Orthopaedic and Trauma Surgery, 135(9), 1277-1281.
Emery, C. A., Whittaker, J. L., Mahmoudian, A., Lohmander, L. S., Roos, E. M., Bennell, K. L., & Toomey, C. M. (2019). Establishing outcome measures in early knee osteoarthritis. Nature Reviews Rheumatology, 15(7), 438-448.
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