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Osgood-Schlatter Disease

 

Introduction

Osgood-Schlatter (pronounced as: slot'-er) disease is a painful swelling of the bump on the front of the upper tibia (lower leg bone) in an area called the anterior tibial tubercle. This disease is probably caused by microtrauma (small, usually unnoticed injuries caused by repetitive overuse) which occurs before the complete maturity of the anterior tibial tubercle attachment.

The disorder is typified by a painful swelling just below the knee on the front (anterior) surface of the lower leg bone. The area is tender to pressure, and swelling ranges from minimal to very severe. Running, jumping, and climbing stairs cause discomfort. Symptoms occur on one or both legs. The disorder is seen most often in active, athletic adolescents, with boys more frequently affected than girls.

This disease was named after the two physicians who defined it in 1903, Dr. Robert Osgood and Dr. Carl Schlatter. Recently, a Finnish study found that 13% of the teenagers of Finland had symptoms of Osgood-Schlatter. Today there are over 25 million children in the United States of America, and over 350 million worldwide, who are in the typical 8-16 year old age group which is most susceptible to Osgood-Schlatter. The condition is caused by the powerful thigh muscles pulling on the attachment point of the patellar tendon on the tibial tuberosity (see below) during activities such as soccer, basketball, track, wrestling, hockey, baseball, gymnastics and other sports. It is also a common problem for ballet dancers, as well as participants in Highland, Irish and other athletic dancing styles. Originally Osgood-Schlatter was reported as being more common in boys. However with increasing participation in sports by many young ladies, it is becoming almost equally as common in them. In fact, perhaps because of the more delicate skeletal structure in girls, they could be more susceptible. They have a smaller tendon attachment point, with greater tension per square mm. It can even appear spontaneously during a child’s “growth spurt”, and has often been called “growing pains."

Causes

Bones generally grow from the ends, versus in the middle. New bone forms from a cartilage growth plate (epiphysis), located at either end of the bone. Cartilage isn't as strong as bone, and stress on the growth plate can cause it to become swollen and painful. This may be especially so if your child is very active during his or her growth spurt.

The cause of Osgood-Schlatter disease is activities that place repeated stress on the top of the tibia, the big bone in the lower leg, where the tendon of the kneecap inserts. During activities that involve a lot of running, jumping and bending — such as football, soccer, basketball, volleyball, gymnastics and ballet — the pull of the quadriceps can place tension on the band of tissue that connects the knee to the tibia (patellar tendon). Symptoms are clearly exacerbated by exercise - jumping and pivoting sports are the worst; repetitive trauma the most likely source

In Osgood-Schlatter disease, a small growth center on one of the leg bones (the tibia) degenerates, causing pain.  The pain is on the front of the leg, just below the kneecap, where a small bony bump is located on the tibia.  This bump is there because it is a point of attachment for a muscle and is called the tibial tuberosity.  Everyone has this bump, but it is not painful normally. The patellar tendon may begin to pull away from the raised area on the tibia where it attaches , resulting in pain and swelling. In severe cases, the tendon stretches to the point where it comes away from the tibia, and may take a bone fragment with it.

Symptoms

  • Pain, swelling and tenderness at the bony prominence (tibial tuberosity) on the shinbone (tibia), just below the kneecap

  • Knee pain that worsens with activity, especially running and jumping, and improves with rest

  • Tightness of the surrounding muscles, especially the thigh muscles (quadriceps)

The pain varies from person to person. Some have only mild pain while performing certain activities. For others, the pain is nearly constant and debilitating. Osgood-Schlatter disease usually occurs in just one knee, but sometimes it develops in both knees. The discomfort can last from weeks to months and may recur until your child has stopped growing.

Diagnosis

Your doctor will conduct a physical examination of your child's knee — looking for tenderness, swelling, pain, redness and range of motion. X-rays may be taken to look at the bones of the knee and leg and to more closely examine the area where the patellar tendon inserts into the tibia. Ultrasound is often more valuable than radiography for demonstrating the features of Osgood – Schlatter disease and may be useful in the assessment of clinically atypical cases.

Treatment

Osgood-Schlatter disease usually gets better without formal treatment. However, you and your child can take a number of steps to relieve the inflammation and pain. The main form of treatment involves resting the area so that it can heal. This may mean that your child needs to limit the time spent doing activities that aggravate the condition, such as kneeling, jumping and running, or must stop them completely for a period of time. These other tips may help:

  • Ice the affected area.

  • For pain relief, try nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprophen (Advil, Motrin, and others), or take acetaminophen products (Tylenol, others). Not all NSAIDs are approved by the Food and Drug Administration for use in children. Talk to your child's doctor or your pharmacist.

  • When participating in sports, wear a pad over the affected knee at the point where the knee may become irritated.

  • Wear a strap across the patellar tendon during high-impact activities, to help diminish the stress on the area in which the patellar tendon inserts.

  • Cross-train with or switch to different activities that don't involve jumping or running, such as cycling or swimming, until symptoms subside.

  • Stretch the quadriceps muscles.

In the infrequent cases where pain is severe and other treatments don't help, your doctor may suggest your child use crutches until the knee heals, in about six to eight weeks. Surgery is almost never a treatment, but may be needed if fragmented ends of the bones haven't healed by the time the bones have stopped growing.

When your child is able to resume play depends on his or her pain tolerance. Most children can continue playing through a low level of pain without doing any damage. However, if your child plays through severe pain, the condition may worsen and might be more difficult to treat. Severe pain can also inhibit muscle function and make your child more at risk of some other lower extremity injury.

Once the pain has gone away, your child can gradually return to his or her prior activity level. However, your doctor may recommend that your child perform specific strengthening or stretching exercises for the quadriceps muscles to lessen the chances of symptoms developing again.

Your child may need to temporarily stop or cut back on activities that aggravate this condition until the knee heals. This may upset your child, especially if he or she plays at a competitive level. Make sure your child is aware that as long as the pain isn't too severe, he or she can continue at a reduced level of activity. Your child may be able to perform other activities that don't involve running and jumping, such as cycling and swimming, at a high level. Explain to your child that this is a temporary condition and one that goes away with age.

Pain may recur over time, but Osgood-Schlatter disease usually disappears once your child stops growing. Some adults who have had Osgood-Schlatter disease are left with "knobby" appearance to the front of the knee.

Nutritional supplements that may be helpful based on the personal experience of a doctor who reported his findings, some physicians recommend vitamin E (400 IU per day) and selenium (50 mcg three times per day). One well-known, nutritionally oriented doctor reports anecdotally that he has had considerable success with this regimen and often sees results in two to six weeks.

A group of doctors has reported good results using a combination of zinc, manganese, and vitamin B6 for people with Osgood-Schlatter disease; however, the amounts of these supplements were not mentioned in the report.  Most physicians would consider reasonable daily amounts of these nutrients for adolescents to be 15 mg of zinc, 5 to 10 mg of manganese, and 25 mg of vitamin B6. Larger amounts might be used with medical supervision.

Editorial Comment -- What you have just read is the traditional medical point of view. I have become convinced from kids in our gym that there is a very effective treatment for this stubborn disorder.  I am usually skeptical of such claims, but there is a treatment called Oscon that, in the cases I have seen, really works -- and relatively quickly. You can reach the folks that produce it at OsgoodSchlatter.com. - USGyms (let us hear from you if you have a similar or different experience - email us).

"Oscon is fantastic. My son had reduced pain in 15 days. Pain free after 30. I made him take for 60 days and he has no further symptoms." G. Moore, Toronto, Ont.

Prevention

Osgood-Schlatter disease may not be preventable. However, it may help if your child limits his or her activity level if he or she notices the symptoms of Osgood-Schlatter disease. Tight quadriceps muscles cause a "tugging" stress on the patellar tendon where it inserts into the tibial tuberosity, so doing stretching exercises for the quadriceps, hamstrings and calves may help prevent this condition. Being properly warmed up before engaging in athletics and performing cooling down exercises afterward also may help.

Similar Condition

Sever's Disease involves pain in the back end of the heel bone, due, as with Osgood-Schlatter, to degenerative change in a growth center.

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