The Osgood-Schlatter disease is medically termed as epiphysitis of the tubercle of the tibia (the large calf bone). Sometimes it’s termed as knobby knees too. It refers to the irritation of the ligament of the patella at the tibial tuberosity, causing characterised painful bumps and lumps just below the knee.
It’s most seen in young adolescents as the adolescent bone growth is the main cause of it, but other risk factors including being overweight and/or overuse injuries from activities that involve running and jumping. This condition generally happens in boys and girls between 9-16 years old, during the years of growth spurts. It happens more frequently in boys than in girls, and it’s likely due to an increased participation by boys and males in sports and higher risk activities compared to girls.
The Osgood-Schlatter disease is often self-limiting and is caused by the stress on the patellar tendon that attaches to the quadriceps muscles that is located at the front of the thigh to the tibial tuberosity. This may lead to multiple subacute avulsion fractures along with the inflammation of the tendon, which can lead to excess bone growth in the tuberosity and producing a commonly visible lump. This visible, exterior lump can be very tender and painful when pressed or hit. Activities that include kneeling and knee flexion may irritate the tendon.
Intense knee pain is the common symptom that patients complain about which accompanies activities that include jumping, running, kneeling, squatting and especially going up and down stairs. If the knee gets a direct traumatic impact, the pain is much more intense. This same pain can be reproduced by extending the knee against resistance, stressing the quadriceps muscle or direct impact on the knee.
Usually the pain is mild and on-off at the beginning, but in the acute phase, the pain can be sharp and severe and continuous. In 20-30% of patients often includes the involvement of both knees.
On average, the symptoms usually resolve with physiotherapy and deep tissue release but it may come back, on-and-off for about 12-24 months before it completely resolves at full skeletal maturity, which is when the epiphysis of the tibia fuses. In about 10% of patients, the symptoms may continue without resolutions, but can be managed with a mix of physiotherapy and deep tissue release.
Physiotherapy and Deep Tissue Release Intervention
In our physiotherapy clinic, our physiotherapists will assess your knees and diagnose your condition, and early treatment is conservative with Rest, Ice, Compression and Elevation (RICE), and where necessary, paracetamol and ibuprofren may be useful.
The use of splints, braces or casting to immobilize joints is rarely required but at times, may provide comfort and help reduce pain as it will help to reduce strain on the tibia. Surgery and surgical excision may be rarely be required in skeletally mature clients. However, in cases where the condition has been chronic and non-responsive to conservative treatment, surgery may be helpful.
Surgery may be a good solution for patients whose bones that will no longer grow but their knee is still affected by the Osgood-Schlatter disease. Usually following the removal of the painful lumps, there will be immediate pain relief and return to activity is a few weeks.
Sometimes after surgery, there may be a decreased blood flow and circulation to the knees and feet, but don’t worry, it’d be back to normal soon enough. You may feel pain occasionally that is caused by either the decreased blood flow, or the scar tissues, but the pain will decrease over time. Studies show that functional outcome of surgical intervention of unresolved Osgood-Schlatter disease is excellent or good, residual pain intensity is low, with low rates of postoperative complications or subsequent reoperations.
After the symptoms have resolved, gradual physiotherapy progression to the desired activity level may start. Often, tightness in the quadriceps and hamstrings is present and should be addressed with physiotherapy and stretching intervention.
After our physiotherapists or your doctors diagnose you, you should consider
resting for several days and decrease the use of the knee intensively for about
2 weeks with minimal physical activities. If the disease progresses such that
the joint becomes very stiff or inflamed, then clients should seek medical
advice as soon as possible as it can limit one’s joints movement severely in
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