Children, unfortunately, are not always exempt from aches and pains, particularly during periods of intensive growth. Active children often experience knee and ankle pains in both their left and right legs, repeatedly brushed off as growing pains. This is the case to an extent, but let’s look deeper!
ADOLESCENT KNEE PAIN
OSGOOD SCHLATTERS
OR JUMPERS KNEE
What is Osgood Schlatters or Jumper’s Knee?
First reported in the 1900s (Circi, Atalay, & Beyzadeoglu, 2017) by two physicians, adolescents complained of pain around the tibial tubercle (at the front of the knee) when playing jumping and running sports; hence, both Osgood and Schlatter were recognised as identifying this condition and explained it as a process occurring in children undergoing rapid growth and who place stress on the developing tubercle or growth plate through pulling forces of the patella tendon (Circi et al., 2017). The cause of pain in adolescent boys and girls is the repetitive loading of the area—the medical term deemed traction apophysitis of the tibial tuberosity—in which the patella tendon is tensioned by the quadriceps muscles, straining the unfused growth plate and tibial tuberosity attachment point, or its point of insertion. In recent studies, shortening of the rectus femoris muscles has also been identified as a contributing factor (Circi et al., 2017).
What is the cause or etiology of Osgood-Schlatters?
The cause or aetiology behind the disease is an inflammatory process that starts in the region and, if not treated and monitored appropriately, can develop into patella tendinopathy (a continuum of tendon pathology) and multiple subacute fractures leading to irregular ossification of the underlying bone matrix (Circi et al., 2017)
Who does Osgood-Schlatters affect? – What is the epidemiology?
Osgood-Schlatters, or Jumper’s knee, was previously thought to affect boys more than girls. However, we are seeing more and more young females develop the condition, with some studies finding no significant difference in prevalence between girls and boys (de Lucena, dos Santos Gomes, & Guerra, 2011). It is typically seen between the ages of 8 and 13 in females and 12 and 15 in boys (Gholve, Scher, Khakharia, Widmann, & Green, 2007). It affects approximately 21% of the athletic population and 4.5% of age-matched non-athletic people; it is bilateral in 20–30% of patients (Kim & Karpas, 2002).
What is the physiotherapy and podiatry treatment for Osgood Schlatters or Jumpers Knee?
The severity of symptoms usually guides the treatment of Osgood Schlatters or Jumper’s knee. Osgood-Schlatters is a self-limiting injury that resolves with skeletal maturity (Circi et al., 2017). It may reoccur for 12–18 months as the epiphyseal plate (growth plate) ossifies. Conservative treatment can include:
- Sporting and Activity load management
- Manual therapy techniques
- Dry Needling or Western Acupuncture
- Cryotherapy (icing)
- Anti-inflammatory Medication
- Strapping or Bracing
- Maximisation of the biomechanical chain to minimise and alter joint force production and absorption
- Home-based exercises, including foam rolling
- Correct, individualised footwear
When required, use customised orthotics to maximise the biomechanical chain.
All treatments aim to maximise the patient’s ability to perform while managing pain and being aware of the underlying condition. At times, with severe cases that do not respond to conservative management and those that do not receive early intervention, injection therapies and surgical techniques are, in a minority of instances, viable options (Circi et al., 2017).
It is important to get assessed by your physiotherapist or podiatrist to determine the stage of the injury and the appropriate management to assist in alleviating symptoms and keeping you on the move!
References
Circi, E., Atalay, Y., & Beyzadeoglu, T. (2017). Treatment of Osgood-Schlatter disease: a review of the literature Formerly, La Chirurgia degli Organi di Movimento, 101(3), 195–200. doi:10.1007/s12306-017-0479-7
de Lucena, G. L., dos Santos Gomes, C., & Guerra, R. O. (2011). Prevalence and Associated Factors of Osgood-Schlatter Syndrome in a Population-Based Sample of Brazilian Adolescents The American Journal of Sports Medicine, 39(2), 415–420. doi:10.1177/0363546510383835
Gholve, P. A., Scher, D. M., Khakharia, S., Widmann, R. F., & Green, D. W. (2007). Osgood Schlatter syndrome Curr Opin Pediatr, 19(1), 44–50. doi:10.1097/MOP.0b013e328013dbea
Kim, M. K., & Karpas, A. (2002). The Limping Child Clinical Paediatric Emergency Medicine, 3(2), 129–137. doi:10.1053/epem.2002.126756