Osgood-Schlatter Disease: Impact of Playing Sports & Reducing Pain in Children
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This article will review the symptoms, causes, and management of Osgood-Schlatter disease. Symptoms include pain over the upper shin below the kneecap that is made worse by activities — often on one side — that also involves tenderness and swelling in the affected area.
What is osgood-schlatter disease?
Osgood-Schlatter disease is a painful swelling that occurs at below the kneecap at the upper part of the shin in physically active, rapidly growing children (typically 10 to 15 years old). It is one of several growth plate disorders called osteochondroses.
Symptoms include pain over the upper shin below the kneecap that is made worse by activities — often on one side — that also involves tenderness and swelling in the affected area.
Treatment will depend on the severity of symptoms; however, they typically resolve entirely once growth spurts have subsided. Conservative options include rest or activity modification, pain relievers, and supportive devices. More intensive measures may include physical therapy, immobilization, steroids, or even surgery.
You can safely treat this condition on your own. The problem will go away on its own without any specific treatment. Over-the-counter pain medication may help with the occasional flare-up.
Osgood-schlatter disease symptoms
Pain over the upper shin (tibial tubercle at patellar tendon insertion) is the most common symptom. Further details regarding this pain may include the following.
- Pain is usually made worse by activities: Especially that involve knee bending, such as running, jumping, and squatting, and improves with rest
- Unilateral pain: Symptoms usually are worse on one side of the body, although about 30% of patients are affected in both legs.
- Tenderness: Direct contact to the shin and kneecap tendon often causes irritation.
- Swelling: This is also common in the area of the upper shin and knee.
Osgood-schlatter disease causes
Osgood-Schlatter disease is a type of growth plate disorder among several childhood disorders of the developing skeleton called osteochondroses. Bones grow most rapidly at growth plates, segments of developing tissue near the ends of long bones. When these dynamic areas are injured, overused, or grow abnormally, inflammation, pain, and disability can follow. Other related disorders include Sever disease, medial epicondyle apophysitis, Scheuermann disease, and Legg-Calve-Perthes disease.
Osgood-Schlatter disease occurs at the point where the kneecap connects to the shin via the patellar tendon (tibial tubercle).
- Overuse of the legs: Osgood-Schlatter disease often occurs in youth who engage in activities involving lots of running and jumping, such as ballet, soccer, basketball, volleyball, or football, but can also occur in youth who don’t regularly play sports.
- Repetitive knee bending: This can result in the accumulation of tiny injuries (micro avulsion fractures) to the vulnerable developing bone.
- Resultant inflammation: As the body responds to injury, the shin swells and becomes tender to the touch. The associated pain is likely worsened by further activity.
Who is most often affected
The following people are more often affected by Osgood-Schlatter.
- Growing youth: Typically between the ages of 10 to 15
- Boys: Boys are more commonly affected than girls, but the number of affected girls is increasing with increased involvement in youth sports.
- Physically active: Half of patients are involved in sports or other regular physical activity.
- Hereditary: It seems to run in families, with other osteochondroses.
Treatment options and prevention
Treatment typically focuses on reducing symptoms so regular activities can be continued, although in rare cases more invasive treatments are available.
In mild cases
The majority of cases of Osgood-Schlatter are considered mild. Your physician may recommend the following measures.
- Activity modification: Physicians usually do not recommend completely avoiding activity, although a temporary reduction in activity can make symptoms resolve more quickly. It is best to avoid particularly bothersome activities such as squatting, running uphill, jumping, deep knee bending, and activities that put direct pressure on painful areas, such as kneeling. Lower impact activities such as biking or swimming may be advisable alternatives. If symptoms do not resolve with a reduction in activity, your physician may recommend a complete break from sports for a few months to allow bone recovery.
- Pain relievers: Acetaminophen (Tylenol) or non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin, Advil) and naproxen (Aleve) are available over-the-counter and can effectively reduce the pain associated with Osgood-Schlatter disease.
- Ice packs: Application of ice packs for 15 to 30 minutes, two to four times each day, can help reduce inflammation and relieve pain. Although ice can help relieve pain after activity, it does little to improve long-term resolution.
- Reduction of rough impacts on the knees: This can be achieved through ensuring your child has well-fitting, stable, cushioned shoes may help reduce impacts on the knee. Exercising on soft surfaces, as well as using knee pads and patellar tendon straps (that keep the tendon from pulling harshly on the bone) can also be very helpful to reduce the impact on the knee.
In moderate cases
If symptoms do not improve with the simple interventions listed above, more targeted or restrictive interventions can help.
- Physical therapy (PT): This may be recommended to further address symptoms. Physical therapists can help your child learn stretches and exercises that help to improve the flexibility and strength of leg muscles in order to reduce tension on the shin and stabilize the knee joint.
- Immobilization: Plaster casts or braces can support the leg in order to reduce further injury and enable healing. The brace is often used for six to eight weeks.
- Crutches: These are sometimes used to keep weight off of the painful leg.
In severe cases
Rarely, pain is so severe or persistent that more invasive interventions may be considered, such as when older patients with mature skeletons continue to experience symptoms that interfere with daily activities. These interventions include:
- Corticosteroid injections: Steroid shots around the knees can reduce inflammation when pain is severe.
- Orthopedic surgery: In some cases surgery is used to remove tiny loose bone fragments or remove bone overgrowth.
Osgood-Schlatter disease usually improves without significant interventions within several weeks or months. It typically goes away entirely once the child has finished growing and the growth plates have closed.
When to seek further consultation
If the knee is red, associated with fever, or the joint locks or becomes unstable
Contact your physician promptly or seek care in an emergency room if any of the above symptoms occur, as they may be signs of serious conditions requiring more urgent treatment.
If the swelling continues to increase
If the swelling continues to increase, despite following initial treatment recommendations from your physician, such as activity modification and NSAIDs, then the child should be re-examined.
If your child requires pain medicine multiple times each day
All medications come with side effects and their use should be minimized when possible. NSAIDs can be associated with stomach irritation and kidney injury with long-term use. If your child needs NSAIDs multiple times each day to control pain, it is advisable to discuss other interventions, such as activity modification or stretching exercises that may reduce the need for pain medications.
If your child’s pain impacts their daily activities
Although the pain from Osgood-Schlatter disease often resolves with time and further growth, if your child finds that the pain impedes typical activities, such as going to school, then a further discussion with your physician is warranted.
If your child has completed growing and still has knee pain
The pain associated with Osgood-Schlatter disease should resolve with time and the closing of the growth plates. If your child continues to experience pain in their late teens, after they seem to have stopped growing, then the condition should be re-evaluated with their physician.
Questions your doctor may ask to diagnose
- How would you explain the cause of your knee pain?
- Is your knee pain constant or come-and-go?
- Is your knee pain getting better or worse?
- Which of these if any make your knee hurt worse?
- How severe is your knee pain?
Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.
Dr. Becker is a psychiatry resident at the Mount Sinai Hospital. He received his undergraduate degree in Urban & Regional Studies from Cornell University (2012) and completed his medical degree at the Perelman School of Medicine at the University of Pennsylvania (2018). Prior to medical school, he worked as a pre-medical teaching assistant at Weill Cornell Medicine-Qatar, where he received an Excellence in Teaching Award. His research has focused on global health (including explanatory models of mental illness in Botswana, epidemiology of head trauma, and psychosocial aspects of HIV), adolescent and young adult mental health, and quality improvement. He enjoys communicating health-related science through writing and teaching and joined Buoy Health as a writer in 2018. In his free time he enjoys running, hiking, and exploring new places.
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