A real pain

If you've got sporty kids, winter is prime time for Osgood Schlatter disease (OSD) Yvonne Walus explains.

 

1. What are the symptoms of Osgood Schlatter disease?

Osgood Schlatter disease is a difficult name for a relatively simple health issue. The symptoms of OSD vary from person to person, but generally include one or more of the following: • Pain in the child’s knee or leg, ranging from mild and niggly to so severe it limits movement. • Swelling or tenderness under the knee and in the shinbone area, sometimes in the form of a visible and painful lump. • The knee or shin area feels warmer to the touch than the rest of the leg. • The symptoms present after exercise and high- impact activities, for example running, netball, hockey, tennis, ballet, gymnastics, cardio. • The child may limp noticeably after training or running
 

2. Who gets affected?

The disease affects adolescent children and teenagers, particularly after growth spurts. Sometimes it’s dismissed as “growing pains” or “tiredness” (when it happens after a long, active day). According to research from Harvard Medical School, up to 20% of adolescent athletes experience OSD, and the problem is more common in boys than girls.
 

Sever's disease

Sever's Disease affects growing children. Its main symptom is pain, and it occurs when the growth plate at the back of the heel (the point of attachment for the Achilles tendon) is injured by repetitive use such as running in sports. Just like OSD, Sever’s Disease usually presents during early puberty. Although both can cause limping, this pain is localised to the heel, and intensifies if the child tries to tiptoe. Treatment starts with controlling the pain and healing the inflammation. If reducing the level of exercise to eradicate the pain is not an option, a physiotherapist may be able to identify stiff joints that will need to loosen to prevent further stress on the heel. They will also work with your child to restore the foot arch muscle control, and suggest different running and landing techniques to prevent the injury from reoccurring.
 

3. What's going on?

Children grow in spurts, sometimes seemingly overnight. Bones, muscles, and tendons can sprout quickly but not always at the same rate. In girls, the biggest growth spurt usually occurs between the ages of 10 and 16, and in boys a little later, between the ages of 11 and 18. OsgoodSchlatters.net explains the issue really well: “OSD occurs when the thigh bone (femur) grows too fast for the longest quad muscle (rectus femoris) to keep up. This means with every step the athlete takes the muscle is pulling at its attachment site below the knee cap (the tibial tuberosity). This is also compounded by the fact that the attachment sites are not fully bonded, as they need to stay like semi-set glue to allow for further growth and skeletal maturation.” In other words: Your child’s bones are growing too fast compared to their muscles.
 

4. First aid: how to relieve the pain

Most children seem to literally sleep off the pain. They go to bed with a hot wheat bag, and wake up pain-free. Others are not so lucky. If your child’s symptoms persist, see your GP, who can help diagnose OSD by external examination or by taking an x-ray to exclude other causes and injuries. Because this problem usually resolves itself after the growth spurt is complete and the muscles have caught up with the bones, most treatment options focus on relieving the symptoms: Wearing shock-absorbent insoles, heating the area for 15 minutes before sports, icing after physical activity, gentle stretches, over-the- counter pain medication, resting, wrapping the knee, or using a knee brace. However, there is another way to address the underlying problem, with the guidance of an experienced physiotherapist.
 

5. Fixing the underlying problem

The obvious solution is to elongate the quad in order to match the growing bone and take pressure off the attachment area. The difficulty, though, is that stretching the quad pulls on the injured bit, causing pain. So the first thing to do is something physiotherapists refer to as foam rolling: You actually move a roller over the affected area to loosen tight sections of muscle and fascia (fascia is the sheath that covers the muscles). This may be painful in the first week, but the reward is increased fluidity of movement and restoration of muscle function. Once the knee is less painful, your child should be able to start gentle quad stretching. Eventually, the stretches will lead to gentle exercise to strengthen the muscles. This will help the muscles to pull more uniformly against the tendons, which in turn will spread out the stress.
 

6. Prognosis

Osgood-Schlatter Disease symptoms typically go away before age 18, when the growth spurts finish and the bones mature. Sometimes, it may leave behind a painless bump below the knee. However, more than half of adolescents who suffer from OSD will later experience some pain kneeling as adults.
 

7. Dealing with complications

Most OSD cases don’t result in any long-term complications. In rare cases, surgery may be required if the bone and tendons in the knee don’t heal properly. See a physiotherapist or your GP for more advice and information.
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