Managing Osgood-Schlatter Disease: A Physical Therapy Approach
Osgood-Schlatter disease, sometimes called traction apophysitis of the tibial tubercle, or Osteochondrosisis a prevalent cause of anterior knee discomfort in the population of younger athletes. The condition is especially common in young athletes who play sports like football, basketball, volleyball, sprinting, gymnastics, and other activities that cause repeated knee stress1. Despite the benign nature of the condition, healing may take longer than expected, causing missed sports time. The condition often develops gradually and is linked to knee joint activities. One of the most prevalent overuse injuries to the lower limbs in children and adolescents is OSD, which is often a self-limiting disorder. Ossification of the tibial tubercle occurs, in males at ages 12–14 and in girls at years 10–12. This phase of bone development is when Osgood Schlatter disease manifests itself. While in adults it manifests as overuse injury. Other conditions and abnormalities include hyperactivity, meniscal and patellar tendon injuries, and compartment syndrome have been linked to OSD2. The patellar tendon attaches to the tibial tubercle, which forms as a secondary ossification center. The apophysis experiences greater strain as a result of bone expansion exceeding the muscle-tendon unit’s capacity to extend. The apophyseal ossification center may weaken and partially avulse with repetitive contraction of the quadriceps muscle mass, particularly with repeated forceful knee extension as observed in sports involving running and leaping (basketball, football, gymnastics), leading to OSD3. Osgood Schlatter disease is present in 9.8% of adolescents between the ages of 12 and 15 (females: 8.3%, males: 11.4%). In 20% to 30% of cases, bilateral symptoms are present4.
If you are suffering from Osgood Schlatter disease, you may feel
- Pain & swelling at inferior part of knee.
- Tibial tuberosity pain that becomes worse when you exercise or play sports
- Tenderness felt while pressing the tibial tuberosity.
- Enhanced bone protuberance at the tibial tuberosity in certain instances.
- Difficulty in climbing up to stairs & kicking a ball5.
A physical therapist will do an extensive assessment, beginning with a comprehensive review of the patient’s history and examination in order to support an Osgood-Schlatter Disease diagnosis. They may also do a thorough evaluation of running, jumping biomechanics which leads to identification of altered knee biomechanics. By conducting ely’s test6 and resisted knee isometrics quadriceps muscle control and tightness can be identified. Imaging tests, such as X-rays, could sometimes be referred to verify the diagnosis or measure the severity of the condition. The physical therapist will next create a customized treatment plan to control pain and encourage healing based on these results. First priority of physical therapist is to reduce pain, to improve mobility & functions. Treatment plan often begins with ice applications and activity modification. According to R vaishya et al; Applying ice after physical activity helps with anterior knee discomfort5. A major element of the treatment strategy would involve activity adjustment, which will promote recovery from high-impact exercises like running and leaping while introducing low-impact exercises like cycling or swimming to preserve fitness5. Gradually exercise protocol will be added for quadriceps and hamstrings muscles. According to ghlove et al; gradually introducing low intensity quadriceps workouts and hamstring stretches has been shown to be beneficial, with a high evidence rating7. Physical therapist will also use kinesiotaping technique to promote better stability. Taping redistributes the forces that are normally focused at the point of discomfort, so reducing the strain on the patellar tendon and tibial tuberosity. With less discomfort, the patient can resume low-impact activities. According to Kuchmacz, K et al; Patients with Osgood-Schlatter disease had improved physical therapy outcomes when using kinesiology taping8. Low-intensity exercise is essential for healing from Osgood-Schlatter disease and frequently has greater advantages than total immobility.
A physical therapist can guide low-intensity exercises that maintain knee stability without stressing the tibial tuberosity. While avoiding the detrimental consequences of muscle atrophy and loss of mobility that might happen with total rest, this balanced strategy permits tissue recovery. Additionally, controlled movement enhances circulation, which helps to lower inflammation and quicken the healing process. According to Gerulis et al; that conservative treatment, physical load restriction and limited physical activity are more effective9. Physical therapy is essential for Osgood-Schlatter Disease management and recovery because it provides practical answers for pain management, increased mobility, and long-term knee health. With customized low-intensity workouts, taping methods, and progressive strengthening, you can resume your activities without the fear of re-injury.
References:
1. Karunarathna, I., Bandara, S., Jayawardana, A., De Alvis, K., Gunasena, P., Hapuarachchi, T., … & Gunathilake, S. Adolescent Knee Pain: Understanding and Managing Osgood-Schlatter Disease.
2. Corbi, F., Matas, S., Álvarez-Herms, J., Sitko, S., Baiget, E., Reverter-Masia, J., & López-Laval, I. (2022, May). Osgood-Schlatter disease: appearance, diagnosis and treatment: a narrative review. In Healthcare (Vol. 10, No. 6, p. 1011). MDPI.
3. Seyfettinoğlu, F., Köse, Ö., Oğur, H. U., Tuhanioğlu, Ü., Çiçek, H., & Acar, B. (2020). Is There a Relationship between Patellofemoral Alignment and Osgood-Schlatter Disease? A Case-Control Study. The journal of knee surgery, 33(1), 67–72.
4. Smith JM, Varacallo M. Osgood-Schlatter Disease. [Updated 2023 Aug 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441995/
5. Vaishya, R., Azizi, A. T., Agarwal, A. K., & Vijay, V. (2016). Apophysitis of the tibial tuberosity (Osgood-Schlatter disease): a review. Cureus, 8(9).
6. Marks, M. C., Alexander, J., Sutherland, D. H., & Chambers, H. G. (2003). Clinical utility of the Duncan-Ely test for rectus femoris dysfunction during the swing phase of gait. Developmental medicine and child neurology, 45(11), 763-768.
7. Gholve PA, Scher DM, Khakharia S, Widmann RF, Green DW. Osgood schlatter syndrome. Current opinion in pediatrics. 2007 Feb 1;19(1):44-50
8. Kuchmacz, K., Żmijewska, K., Mikos M., et al. (2024). Effect of Selected Kinesiology Taping Applications on Reducing Pain and Accelerating Rehabilitation in Children with Osgood-Schlatter Disease. Med Rehabil, 28(1), 16-22. https://doi.org/10.5604/01.3001.0054.4667.
9. Gerulis, V., Kalesinskas, R., Pranckevicius, S., & Birgeris, P. (2004). Konservatyvaus gydymo ir fizinio krūvio ribojimo reiksme Osgood-Schlatterio ligos eigai [Importance of conservative treatment and physical load restriction to the course of Osgood-Schlatter’s disease]. Medicina (Kaunas, Lithuania), 40(4), 363–369.
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