Physical Therapy for Osgood-Schlatter Disease

Osgood-Schlatter disease is an inflammatory condition of the knee caused by repetitive trauma to the patellar tendon during growth spurts that is common among active adolescents. Osgood-Schlatter disease (OS) is a common cause of knee pain in growing and active pre-teens and teens, affecting 1 in 10 adolescents. Osgood-Schlatter disease can be managed conservatively and effectively with physical therapy. Physical therapy can help teens with OS ease pain, increase muscle strength, and restore function for a safe return to sport.

What is Osgood-Schlatter Disease?

Osgood-Schlatter disease (OS disease) is an inflammatory condition of the knee caused by repetitive trauma to the patellar tendon during growth spurts that is common among active adolescents. OS disease is a common cause of knee pain in growing pre-teens and teens, affecting 1 in 10 adolescents. It is most common among young athletes who engage in sports requiring excessive jumping, running, and rapid changes of movement, such as soccer, basketball, volleyball, and gymnastics.

When teens go through rapid phases of growth during puberty, typically between ages 10-15 in boys and 8-12 in girls, the patellar tendon can pull abnormally on its insertion point on the shin bone, which can lead to pain and a noticeable OS lesion, or bump, just below the kneecap. During the pre-teen and teen years, the patellar tendon attaches to a soft tissue growth plate of the tibia [this growth plate hardens to bone over time].  The constant pulling of the patellar tendon on the shin’s growth plate can be exacerbated by sports activities; as the quadriceps muscle at the front of the thigh works, it pulls on the patellar tendon, which pulls on the tibial tuberosity growth plate, resulting in pain and inflammation.

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An OS lesion, or visible bump, can develop below the kneecap. This is a raised area at the tibial tuberosity that is caused by a combination of patellar tendon fiber misalignment and increased calcification at the tibial tuberosity due to heightened bone activation at the growth plate from the constant pulling of the tendon on the growth plate.

Symptoms of Osgood-Schlatter disease can include:

• Pain below the knee at the top of the shin bone that worsens over time

• Pain that worsens with exercise or playing sports

• Swelling and tenderness at the top of the shin

• Boney growth (OS lesion) at the top of the shin

• Loss of strength in the quadriceps muscle

• Loss of knee range of motion

• Discomfort when kneeling, squatting, or walking up or down stairs

Physical Therapy for Osgood-Schlatter Disease

Physical therapy can help teens with OS ease pain, increase muscle strength, and restore function for a safe return to sport. Osgood-Schlatter disease can be managed conservatively and effectively with physical therapy.

Physical therapy treatment for Osgood-Schlatter disease can include:

• Patient education on activity modification to reduce stress on the patellar tendon and tibia

• Pain management using ice, heat, or braces to alleviate swelling, inflammation, and pain

• Range of motion therapy, involving gentle exercises to move the knee and surrounding structures to restore normal range of motion

• Stretching exercises of the hamstrings, quadriceps, calf muscles, and IT band. It’s especially important to stretch the quadriceps to decrease pulling on the patellar tendon.

• Strength training, targeting muscles around the knee to ease stress on the knee joint as well as strengthening of the quadriceps, hamstrings, and hip muscles for proper muscular balance, stability, and lower extremity alignment. The therapist may also implement core strengthening to establish a strong base of support for the athlete’s movement.

• Manual therapy, involving gentle soft tissue and joint mobilizations of the kneecap and patellar tendon to improve motion and flexibility in the knee joint

• Functional training and sport-specific training to prepare for a safe return to sport and ensure proper alignment and body mechanics when doing sports activities to reduce stress on the knee

A 2020 study assessed the intervention of activity modification and knee-strengthening exercises on pain, function, and return to sport in 51 adolescents with Osgood-Schlatter disease. The intervention consisted of activity modification, pain monitoring, progressive strengthening, and a return-to-sport paradigm. Researchers found that the intervention was associated with improved self-reported outcomes, hip and knee muscle strength, and jumping performance in OSD athletes. After 12 weeks of the intervention, 80% reported successful outcomes, which increased to 90% at 12 months.

Is your teen suffering from Osgood-Schlatter’s disease? Work with a physical therapist to manage OS pain, improve knee function and mobility, and return to sport safely!