One of the most common knee pains for children, Osgood-Schlatters (OSD), can be a very challenging time for a young athlete. It can keep them off the field, away from their friends, inactive, and frustrated.

Onset usually occurs between the ages of 8-13 for girls and 10-15 for boys, when their skeletal system is near its greatest development. This rapid bone growth paired with a sudden spike in training volume may lead to apophysitis, irritation where tendons attach to bones. For Osgood-Schlatters, this occurs at the tibial tuberosity/tubercle near the knee, where the patellar tendon inserts.

When an athlete experiences OSD, symptoms may include a gradual onset (no trauma), tenderness at the tibial tuberosity, pain that comes on during sports or with prolonged sitting/kneeling, and relief with rest (1). Pain can be on one leg but occasionally occurs on both sides. Athletes may also develop a thickened tibial tuberosity as a result of increased bone development (see photo above on right).

This stubborn pain can sometimes last for months or even years, leading an athlete to miss out on important opportunities to spend time with friends, stay active, make a team, or earn some endorphins. The drop out rate for youth athletics is high and we should do all we can to keep kids active.

Here are a few tips to help your athlete navigate this pain:

Play More Sports

This seem counter-intuitive at first, but the best treatment is always prevention. Research has found that early sport specialization leads to increased risk of countless injuries, and OSD is no exception. One great study looking at over 500 young athletes found that those who participated in only one sport had a 400% increased risk of developing knee pain (2). Researchers believe that this may be due to the repetitive stress on the athletes. Encourage your athlete to participate in several sports to expose them to different loads and for overall health and injury prevention.

Activity modification

When an athlete does develop this condition, one of the top recommendations is to modify activity (3, 4). It is safe to continue playing with OSD and a tolerable level of pain (up to 3/10) but athletes should be encouraged to take breaks when it becomes intolerable or lasts more than 24 hours. To keep your athlete on the field, it may be worth it to limit practice time, reduce jumping, or even switch positions temporarily (such as catcher with prolonged kneeling). Limping is a good sign to have your athlete take a day off. 

Quadriceps Strengthening

A well-designed and supervised strengthening program is safe and beneficial for childrens’ overall health and wellness (5). Improving an athlete’s activity tolerance is one of the best things we can do for OSD (6) and this age is a great time to begin strengthening muscles and bone. Here is a low-intensity exercise to get started, the quadriceps isometric:

Stretching

Stretches for the muscles that attach to the knee has also been shown to help with OSD (7). The main muscles to stretch are the quadriceps muscles (especially the rectus femoris) and the hamstrings.

Improve ankle mobility

Limited ankle dorsiflexion shifts an athlete’s running mechanics and may place additional stress through the knee (8). One way to improve ankle mobility is through slow calf raises on a step, making sure to lower all the way down to feel a nice stretch at the bottom of the movement. Getting calves strong helps with preventing other injuries too!

Infrapatellar Strap

Finally, wearing an infrapatellar strap may help improve symptoms by reducing strain around the tendon insertion. It works similar to using a fret on a guitar.

Final Thoughts

Hopefully these tips can help keep your athlete on the field, rink, or court. At Sapphire Physical Therapy, we love working with our active population and have the space and equipment to help them get back to what they love!

By Ben Blakely PT, DPT, CSCS

           (Photos from https://orthoinfo.aaos.org/en/diseases--conditions/osgood-schlatter-disease-knee-pain/ and https://www.physio-pedia.com/Osgood-Schlatter_Disease)

1. Lucenti L, Sapienza M, Caldaci A, Cristo C, Testa G, Pavone V. The Etiology and Risk Factors of Osgood-Schlatter Disease: A Systematic Review. Children (Basel). 2022;9(6):826. Published 2022 Jun 2. doi:10.3390/children9060826

2. Hall R, Barber Foss K, Hewett TE, Myer GD. Sport specialization's association with an increased risk of developing anterior knee pain in adolescent female athletes. J Sport Rehabil. 2015;24(1):31-35. doi:10.1123/jsr.2013-0101

3. Seyfettinoğlu F, Köse Ö, Oğur HU, Tuhanioğlu Ü, Çiçek H, Acar B. Is There a Relationship between Patellofemoral Alignment and Osgood-Schlatter Disease? A Case-Control Study. J Knee Surg. 2020;33(1):67-72. doi:10.1055/s-0038-1676523

4. Rathleff MS, Graven-Nielsen T, Hölmich P, et al. Activity Modification and Load Management of Adolescents With Patellofemoral Pain: A Prospective Intervention Study Including 151 Adolescents. Am J Sports Med. 2019;47(7):1629-1637. doi:10.1177/0363546519843915

5. Faigenbaum AD, Kraemer WJ, Blimkie CJ, et al. Youth resistance training: updated position statement paper from the national strength and conditioning association. J Strength Cond Res. 2009;23(5 Suppl):S60-S79. doi:10.1519/JSC.0b013e31819df407

6. Nakase J, Goshima K, Numata H, Oshima T, Takata Y, Tsuchiya H. Precise risk factors for Osgood-Schlatter disease. Arch Orthop Trauma Surg. 2015;135(9):1277-1281. doi:10.1007/s00402-015-2270-2

7. Neuhaus C, Appenzeller-Herzog C, Faude O. A systematic review on conservative treatment options for OSGOOD-Schlatter disease. Phys Ther Sport. 2021;49:178-187. doi:10.1016/j.ptsp.2021.03.002

8. Sarcević Z. Limited ankle dorsiflexion: a predisposing factor to Morbus Osgood Schlatter?. Knee Surg Sports Traumatol Arthrosc. 2008;16(8):726-728. doi:10.1007/s00167-008-0529-7