Osgood-Schlatter (pronounced
as: slot'-er) disease is a
painful swelling of the bump on the front of the upper tibia (lower leg bone) in
an area called the anterior tibial tubercle. This disease is probably
caused by microtrauma (small, usually unnoticed injuries
caused by repetitive overuse) which occurs before the complete
maturity of the anterior tibial tubercle attachment.
The disorder is typified by a painful swelling just below the
knee on the front (anterior) surface of the lower leg bone.
The area is tender to pressure, and swelling ranges from
minimal to very severe. Running, jumping, and climbing stairs
cause discomfort. Symptoms occur on one or both legs. The
disorder is seen most often in active, athletic adolescents,
with boys more frequently affected than girls.
This disease was named
after the two physicians who defined it in 1903, Dr. Robert
Osgood and Dr. Carl Schlatter. Recently, a Finnish study found
that 13% of the teenagers of Finland had symptoms of Osgood-Schlatter.
Today there are over 25 million children in the United States
of America, and over 350 million worldwide, who are in the
typical 8-16 year old age group which is most susceptible to
Osgood-Schlatter. The condition is caused by the powerful
thigh muscles pulling on the attachment point of the patellar
tendon on the tibial tuberosity (see below) during activities
such as soccer, basketball, track, wrestling, hockey,
baseball, gymnastics and other sports. It is also a common
problem for ballet dancers, as well as participants in
Highland, Irish and other athletic dancing styles. Originally
Osgood-Schlatter was reported as being more common in boys.
However with increasing participation in sports by many young
ladies, it is becoming almost equally as common in them. In
fact, perhaps because of the more delicate skeletal structure
in girls, they could be more susceptible. They have a smaller
tendon attachment point, with greater tension per square mm.
It can even appear spontaneously during a child’s “growth
spurt”, and has often been called “growing pains."
Causes
Bones generally grow
from the ends, versus in the middle. New bone forms from a
cartilage growth plate (epiphysis), located at either end of
the bone. Cartilage isn't as strong as bone, and stress on the
growth plate can cause it to become swollen and painful. This
may be especially so if your child is very active during his
or her growth spurt.
The cause of Osgood-Schlatter
disease is activities that place repeated stress on the top of
the tibia, the big bone in the lower leg, where the tendon of
the kneecap inserts. During activities that involve a lot of
running, jumping and bending — such as football, soccer,
basketball, volleyball, gymnastics and ballet — the pull of
the quadriceps can place tension on the band of tissue that
connects the knee to the tibia (patellar tendon). Symptoms are
clearly exacerbated by exercise - jumping and pivoting sports
are the worst; repetitive trauma the most likely source
In Osgood-Schlatter
disease, a small growth center on one of the leg bones (the
tibia) degenerates, causing pain. The pain is on the
front of the leg, just below the kneecap, where a small bony
bump is located on the tibia. This bump is there because
it is a point of attachment for a muscle and is called the
tibial tuberosity. Everyone has this bump, but it is not
painful normally. The patellar tendon may
begin to pull away from the raised area on the tibia where it
attaches , resulting in pain and swelling.
In severe cases, the tendon stretches to the point where it
comes away from the tibia, and may take a bone fragment with
it.
Symptoms
-
Pain,
swelling and tenderness at the bony prominence (tibial
tuberosity) on the shinbone (tibia), just below the
kneecap
-
Knee
pain that worsens with activity, especially running and
jumping, and improves with rest
-
Tightness
of the surrounding muscles, especially the thigh muscles
(quadriceps)
The pain varies from
person to person. Some have only mild pain while performing
certain activities. For others, the pain is nearly constant
and debilitating. Osgood-Schlatter disease usually occurs in
just one knee, but sometimes it develops in both knees. The
discomfort can last from weeks to months and may recur until
your child has stopped growing.
Diagnosis
Your doctor will conduct
a physical examination of your child's knee — looking for
tenderness, swelling, pain, redness and range of motion.
X-rays may be taken to look at the bones of the knee and leg
and to more closely examine the area where the patellar tendon
inserts into the tibia. Ultrasound is often more valuable than
radiography for demonstrating the features of Osgood –
Schlatter disease and may be useful in the assessment of
clinically atypical cases.
Treatment
Osgood-Schlatter
disease usually gets better without formal treatment.
However, you and your child can take a number of steps to
relieve the inflammation and pain. The main form of
treatment involves resting the area so that it can heal.
This may mean that your child needs to limit the time spent
doing activities that aggravate the condition, such as
kneeling, jumping and running, or must stop them completely
for a period of time. These other tips may help:
-
Ice
the affected area.
-
For
pain relief, try nonsteroidal anti-inflammatory drugs (NSAIDs),
such as ibuprophen (Advil, Motrin,
and others), or take
acetaminophen products (Tylenol, others). Not all NSAIDs
are approved by the Food and Drug Administration for use
in children. Talk to your child's doctor or your
pharmacist.
-
When
participating in sports, wear a pad over the affected knee
at the point where the knee may become irritated.
-
Wear
a strap across the patellar tendon during high-impact
activities, to help diminish the stress on the area in
which the patellar tendon inserts.
-
Cross-train
with or switch to different activities that don't involve
jumping or running, such as cycling or swimming, until
symptoms subside.
-
Stretch
the quadriceps muscles.
In the infrequent cases
where pain is severe and other treatments don't help, your
doctor may suggest your child use crutches until the knee
heals, in about six to eight weeks. Surgery is almost never a
treatment, but may be needed if fragmented ends of the bones
haven't healed by the time the bones have stopped growing.
When your child is able
to resume play depends on his or her pain tolerance. Most
children can continue playing through a low level of pain
without doing any damage. However, if your child plays through
severe pain, the condition may worsen and might be more
difficult to treat. Severe pain can also inhibit muscle
function and make your child more at risk of some other lower
extremity injury.
Once the pain has gone
away, your child can gradually return to his or her prior
activity level. However, your doctor may recommend that your
child perform specific strengthening or stretching exercises
for the quadriceps muscles to lessen the chances of symptoms developing again.
Your child may need to
temporarily stop or cut back on activities that aggravate this
condition until the knee heals. This may upset your child,
especially if he or she plays at a competitive level. Make
sure your child is aware that as long as the pain isn't too
severe, he or she can continue at a reduced level of activity.
Your child may be able to perform other activities that don't
involve running and jumping, such as cycling and swimming, at
a high level. Explain to your child that this is a temporary
condition and one that goes away with age.
Pain may recur over
time, but Osgood-Schlatter disease usually disappears once
your child stops growing. Some adults who have had Osgood-Schlatter
disease are left with "knobby" appearance to the
front of the knee.
Nutritional
supplements that may be helpful
based
on the personal experience of a doctor who reported his
findings, some physicians recommend vitamin E (400 IU
per day) and selenium (50 mcg three times per day). One
well-known, nutritionally oriented doctor reports anecdotally
that he has had considerable success with this regimen and
often sees results in two to six weeks.
A group of doctors has
reported good results using a combination of zinc, manganese,
and vitamin B6 for people with Osgood-Schlatter
disease; however, the amounts of these supplements were not
mentioned in the report. Most physicians would consider
reasonable daily amounts of these nutrients for adolescents to
be 15 mg of zinc, 5 to 10 mg of manganese, and 25 mg of
vitamin B6. Larger amounts might be used with medical
supervision.
Editorial
Comment -- What you have just read is the
traditional medical point of view. I have become convinced from kids in our gym
that there is a very effective treatment for this stubborn disorder. I am
usually skeptical of such claims, but there is a treatment called Oscon
that, in the cases I have seen, really works -- and relatively quickly. You can
reach the folks that produce it at OsgoodSchlatter.com.
- USGyms (let us hear from you if you have a similar or different
experience - email us).
