Osgood-Schlatter Disease

with Rehab

ExitCare ImageOsgood-Schlatter disease affects the growth plate of the shinbone (tibia) just below the knee joint. The condition involves pain and inflammation below the knee. The tibial tuberbercle is a bony bump (prominence) below the knee, where the patellar tendon attaches to the shinbone. The patellar tendon is connected to the quadriceps thigh muscles, which are responsible for straightening the knee and bending the hip. In skeletally immature individuals, the tibial tubercle contains a growth plate that is vulnerable to injury, from stress placed on it by the patellar tendon. Osgood-Schlatter disease is a temporary condition that typically goes away with skeletal maturity (at about 16 years of age).

SYMPTOMS

  • A slightly swollen, warm, and tender bump below the knee, where the patellar tendon inserts.

  • Pain with activity, especially straightening the leg against force (stair climbing, jumping, deep knee bends, weight-lifting) or following an extended period of vigorous exercise in an adolescent. In more severe cases, pain occurs during less vigorous activity.

CAUSES

Osgood-Schlatter disease is caused by repeated stress to the tibial tubercle growth plate. This stress causes the area to become inflamed, resulting in pain.

RISK INCREASES WITH:

  • Conditioning routines that are too strenuous, such as running, jumping, or jogging.

  • Being overweight.

  • Boys ages 11 to 18.

  • Rapid skeletal growth.

  • Poor strength and flexibility.

PREVENTION

  • Maintain a healthy body weight.

  • Warm up and stretch properly before activity.

  • Allow for adequate recovery between workouts.

  • Learn and use proper exercise technique.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

PROGNOSIS

The outcome for Osgood-Schlatter disease depends on the severity of the condition. Mild cases may be resolved with a slight reduction of activity level. However, moderate to severe cases may require significantly reduced activity and, sometimes, restraining the knee for 3 to 4 months.

RELATED COMPLICATIONS

  • Bone infection.

  • Recurrence of the condition in adulthood, resulting in (symptomatic) bone fragments below the affected knee (ossicle).

  • Persisting bump, below the kneecap.

TREATMENT

Treatment first involves the use of ice and medicine, to reduce pain and inflammation. The use of strengthening and stretching exercises may help reduce pain with activity, especially exercising the quadriceps and hamstrings (thigh) muscles. These exercises may be performed at home or with a therapist. Activities that cause symptoms to get worse should be avoided, until symptoms begin to go away. Severe cases may be referred to a therapist for further evaluation and treatment. Uncommonly, the affected knee may be restrained for 6 to 8 weeks. Your caregiver may advise the use of a brace between kneecap and tibial tubercle, on top of the patellar tendon (patellar band), that may help relieve symptoms. Surgery is rarely needed in a skeletally immature individual, but it may be considered for skeletally mature individuals.

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often advised.

  • Do not take pain medicine for 7 days before surgery.

  • Prescription pain relievers may be given, if your caregiver thinks they are needed. Use only as directed and only as much as you need.

HEAT AND COLD

  • Cold treatment (icing) should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

  • Heat treatment may be used before performing stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or a warm water soak.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve in 4 weeks, despite treatment.

  • You develop a fever greater than 102° F (38.9° C).

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Osgood-Schlatter Disease (Osteochondrosis, Apophysitis of the Tibial Tubercle)

These exercises may help you when beginning to rehabilitate your injury. Your symptoms may resolve with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

ExitCare Image STRETCH - Quadriceps, Prone

  • Lie on your stomach on a firm surface, such as a bed or padded floor.

  • Bend your right / left knee and grasp your ankle. If you are unable to reach your ankle or pant leg, use a belt around your foot to lengthen your reach.

  • Gently pull your heel toward your buttocks. Your knee should not slide out to the side. You should feel a stretch in the front of your thigh and knee.

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

ExitCare Image STRETCH – Hamstrings, Supine

  • Lie on your back. Loop a belt or towel over the ball of your right / left foot.

  • Straighten your right / left knee and slowly pull on the belt to raise your leg. Do not allow the right / left knee to bend Keep your opposite leg flat on the floor.

  • Raise the leg until you feel a gentle stretch behind your right / left knee or thigh. Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

ExitCare Image STRETCH - Hamstrings, Doorway

  • Lie on your back with your right / left leg extended and resting on the wall, and the opposite leg flat on the ground, through the door. At first, position your bottom farther away from the wall.

  • Keep your right / left knee straight. If you feel a stretch behind your knee or thigh, hold this position for __________ seconds.

  • If you do not feel a stretch, scoot your bottom closer to the door, and hold __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

ExitCare Image STRETCH - Hamstrings, Standing

  • Stand or sit and extend your right / left leg, placing your foot on a chair or foot stool.

  • Keep a slight arch in your low back and your hips straight forward.

  • Lead with your chest and lean forward at the waist until you feel a gentle stretch in the back of your right / left knee or thigh. (When done correctly, this exercise requires leaning only a small distance.)

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

STRENGTHENING EXCERCISES - Osgood-Schlatter Disease (Osteochondrosis, Apophysitis of the Tibial Tubercle)

These exercises may help you when beginning to rehabilitate your injury. They may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Increase the resistance and repetitions only as guided by your caregiver.

ExitCare Image STRENGTH - Quadriceps, Isometrics

  • Lie on your back with your right / left leg extended and your opposite knee bent.

  • Gradually tense the muscles in the front of your right / left thigh. You should see either your knee cap slide up toward your hip or increased dimpling just above the knee. This motion will push the back of the knee down toward the floor, mat, or bed on which you are lying.

  • Hold the muscle as tight as you can, without increasing your pain, for __________ seconds.

  • Relax the muscles slowly and completely in between each repetition.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Quadriceps, Short Arcs

  • Lie on your back. Place a __________ inch towel roll under your right / left knee, so that the knee bends slightly.

  • Raise only your lower leg by tightening the muscles in the front of your thigh. Do not allow your thigh to rise.

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

OPTIONAL ANKLE WEIGHTS: Begin with ____________________, but DO NOT exceed ____________________. Increase in 1 pound/0.5 kilogram increments.

ExitCare Image STRENGTH - Quadriceps, Straight Leg Raises

Quality counts! Watch for signs that the quadriceps muscle is working, to be sure you are strengthening the correct muscles and not "cheating" by substituting with healthier muscles.

  • Lay on your back with your right / left leg extended and your opposite knee bent.

  • Tense the muscles in the front of your right / left thigh. You should see either your knee cap slide up or increased dimpling just above the knee. Your thigh may even shake a bit.

  • Tighten these muscles even more and raise your leg 4 to 6 inches off the floor. Hold for __________ seconds.

  • Keeping these muscles tense, lower your leg.

  • Relax the muscles slowly and completely between each repetition.

Repeat __________ times. Complete this exercise __________ times per day.