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Osgood Schlatters - Treatment Approaches


What is Osgood Schlatters

Osgood-Schlatter Disease (OSD) is a pathology that normally occurs within the ages of 10 through to 16 or 17. Individuals with the condition normally present with pain pain through the anterior portion of the knee along the tibial tuberosity. This is normally caused by excessive knee flexion activities like running, jumping and hard landings. This causes inflammation over the bony prominence and may cause soft tissue swelling. This can differ itself from patella-femoral pain and aggravation by the pain from the pressure placed directly through the tibial tuberosity or pain while kneeling. In less chronic stages the swellingmay resolve itself but when it starts to progress into the chronic stages, itcan lead into avulsion fractures or bony ossicle remains around the insert ofthe patella (Vaishya, Azizi, Agarwal &Vijay, 2016).


Common Treatment Options

Conservative treatment comes in the form of; cold therapy for the knee, non-steroidal anti-inflammatory drugs (NSAIDs), stretching, braces, de-loading through the knee and its equivalent activities and exercises. In regards to how individuals should exercise, it all comes down to appropriate loading of the knee and the amount of hours if not days that they are spending completing the exercises or activities. At the end of the day they are exercising more than their body can recover from resulting in its break down. When approaching OSD and deciding what exercises could/should be done for the client, start by strengthening the quadricep with as little knee flexion as possible which is followed by little to no aggravation during the exercise or the days following.

Exercises recommended by Kim & Poinier (2020), start with supine isometric knee extension while lifting the heel off the ground. This is a good start for re-introducing exercises through the knee as it starts loading the patella tendon at a reduced rate. With slow progression at re-introduction of patella tendon tension being the basis of exercises for OSD, exercises may go from isometric extension to active flexion of the knee in supine position of<30 degrees placing a roller behind the knee to do so in reps of 8-12 with isometric holds at end range (3 -5 seconds). The next progression in exercises are slight bending in the knee’s at standing position them moving onto slight step-ups then slight stepping downs. At this point patella tendon tension starts to peak and will indicate some readiness to return to some small form of exercises if this exercise can be completed in repetitions without pain or aggravation in the days following.

Alternative Treatment Methods

On the other side of OSD treatment there have been some studies focusing on the injection therapy into the deep infrapatellar bursa for symptomatic relief of OSD. Nakase et al. (2016) had completed a double blind study on a group of boys between the ages of 10-14 where a ultras sound guidance injection was completed on the deep infrapatellar bursa and another side was injected into the distal attachment of the patellar tendon. They compared saline solutions injections to dextrose injections but found no difference between the two but found better a greater difference of the two groups and the “usual care” of OSD when compared by the Victorian Institute of Sport Assessment.

Whats Next

Going forwards OSD is a condition to be proactive about if early signs do start to show and being ahead of the load management for the individual to make sure it doesn’t progress further. OSD has been seen as a self-limiting condition as in most cases pain and symptoms subside with the maturation of the bones. This condition is more common through boys and becomes infrequent in the ages past 16. If pain continues into early adulthood, further interventions may be needed as the excessive knee flexion activities may no longer be the cause of the pain.


How we can help?

Fortunately as Accredited Exercise Physiologist we are able to help you when it comes OSD, as exercise specialisits to help minimise pain and return to full function as soon as possible.

If you would like more information on how we can HELP contact us at Ex Phys Australia today on 1300 869 169 or email info@exphysaustralia.com.au

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