Physiotherapy for Osgood-Schlatter Disease

Description

• Osgood-Schlatter disease is an inflammatory injury of the growth plate on the tibia (shin bone) just belowthe level of the knee at the tibial tubercle
• This disease may also be referred to as osteochondrosis or apophysitis of the tibialtubercle
• The tibial tubercle is the bony attachment for the quadriceps (front thigh muscle). Contraction of the quadriceps results primarily in straightening of the leg at the level of theknee
• A growth plate is an area of developing tissue near the ends of long bones or areas of muscle attachment. The growth plates in children allow the bones to expand in length thus allowing a child to reach his or her full height by the age of 16 to19
• Compared to the surrounding bone and muscles,the

growth plate serves as a weak point. Thus repetitive pulling on a growth plate, especially from a large powerful muscle like the quadriceps, can result in injury to the growth plate and subsequent pain

• Osgood-Schlatter Disease is usually a self limited disease – upon reaching skeletal maturity, the growth plate seals and thus can no longer causepain
• This condition is very similar in presentation and treatment to Sinding-Larsen- Johansson Syndrome, which is a traction apophysitis of the inferior pole of the patella

Cause

• Repetitivestress or injury to the growth plate of the tibial tubercle results in inflammation and subsequent pain
• The injury has a waxing-and-waning course. Even after pain has subsided for some time, repetitive stress can cause aflare-up

Risk factors

• Activities that involve jumping and/orjogging
• Boys, especially those between the age of 11 and18
• Rapid skeletalgrowth
• Poor physicalconditioning

Symptoms

• Swelling, warmth, and/or tenderness below theknee
• A firm bump under the knee that is exquisitely tender totouch
• Pain with activity, especially with knee straightening or vigorousactivity

Diagnosis

• Diagnosis of Osgood-Schlatter disease is made primarily by physicalexam
• Difficulty may be present with a straight leg raise, especially againstresistance
• The area of skin overlying the tibial tubercle may be enlarged and firm. This area is also exquisitely tender totouch
• Radiographs may be used to rule out underlying fractures or other bony injuries in thearea

Prevention

• Weight loss to acquire a proper body mass index for age and height
• Warm up and stretching before partaking in physical
• Warming the area with a hot compress or shower may improve stretching
• Maintaining appropriate flexibility, endurance, and muscle strength
• Avoidance of open kinetic leg extensions (such as extending the knee in the sitting position againstresistance)

Treatment

• Initial treatment of this injury consists of modification of activities,ice, stretching, strengthening exercises, and pain medications
• Activities such as kneeling, jumping, squatting, stair climbing, and running should be avoidedinitially
• Ice should be applied for 15-20 minutes to the affected knee every 2 to 3 hours as needed to help reduce inflammation and pain. Similarly, application of a heat pack can be applied to the area before participating in activities orexercises
• Your physician can provide a set of at home exercises to help improve strength and flexibility. In some instances, a referral to physical therapy or an athletic trainer is needed to augmenttreatment
• Pain medications such as nonsteroidal anti-inflammatories (like ibuprofen or naproxen) or acetaminophen can be used to relieve pain and irritation. These medications should be taken as directed by yourphysician
• A patellar band, which is a brace situated between the tibial tubercle and the kneecap, may help relievesymptoms
• In rare instances, surgery is necessary if conservative treatment has failed. A trial of immobilization with an elastic knee support, cast, or splint may be tried for 6 to 8 weeks before consideringsurgery
• Complications of this condition include a persistence of a bump overlying the tibial tubercle, reoccurrence in adulthood, tearing away (avulsion) of the growth plate from thetibia