What is Osgood-Schlatter disease?

Osgood-Schlatter disease is a common cause of knee pain in young athletes, especially if they participate in football, running, gymnastics, basketball and ballet. It causes swelling, pain and tenderness just below the knee, over the tibial tuberosity. During growth spurts in adolescence, bones can grow faster than muscles, making the thigh muscles at the front of the leg feel tight. These muscles attach to the top of the shin bone just below the knee. When young people take part in activities that involve high impact, jumping or changing or directions, this area can get sore and irritated. As the condition starts to heal, new bone is formed at the front of the shin bone which can create a hard bony lump. The condition tends to settle once full growth is achieved but can last for up to 3 years. One or both knees may be affected. The condition affects around 1 in 10 adolescents. Young people between 9 to 15 years old are especially susceptible, with males more frequently affected than females. Specialising in one single sport at an early age increases the risk by 4 times

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What are the the symptoms?

• Pain or discomfort with running, jumping, squatting, hopping, change of direction
• Swelling at the top of the shin bone
• Symptoms usually ease with rest
• Lump below the knee which can be sore if touched or kneeling 

These typical symptoms often lead to the diagnosis so special tests and scans are generally not necessary. GP or physiotherapist can usually diagnose Osgood-Schlatter just by talking to you and examining your knee.

How to manage the symptoms? 

• Cut down the time on playing aggravating activities. Taking a 2–4-week break may help relieve the symptoms. In the meantime, try low-impact activities like swimming or cycling.
• Take more rest breaks during training
• Try not to do the same activity more than 2 days in a row (or aim to keep it to no more than 4 days a week)
• Pain should not be more than 2 out of 10 when playing sports and should not last longer than one hour after the activities. Pain should not be felt in the following morning.

Activity Modification and Rest:

• Cut down the time on playing aggravating activities. Taking a 2–4-week break
  may help relieve the symptoms. In the meantime, try low-impact activities like
  swimming or cycling.
• Take more rest breaks during training
• Try not to do the same activity more than 2 days in a row (or aim to keep it to no more than 4 days a week)
• Pain should not be more than 2 out of 10 when playing sports and should not last longer than one hour after the activities. Pain should not be felt in the following morning.

Ice

• Wrap the ice pack in a towel and ice the affected area for around 10-15 minutes.
  
  

Pain Relief

• Always discuss with your GP before taking the medications that can be used to help reduce pain and swelling.
• Do not take painkillers to mask your pain when returning to sports.

Sleep

• Rest days are important for both mental and physical recovery
• 8-12 hours sleep is recommended. A high-quality sleep is essential for body to heal.

Diet

• Always eat 3 main meals per day. You can also eat some healthy snacks between meals to fuel up your body during growth spurts!
• Don’t skip meals, especially breakfast!
• Vitamin D supplements also help improving bone health and recovery, especially in winter months. NHS recommended a daily intake of 10 micrograms(400IU).

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Proper footwear

• Try to avoid activities barefoot. Whenever possible, wear a supportive shoe with the laces properly fastened. Supportive shoes can help reduce stress on your knees.

Exercises

Use this scale to help manage your exercises. Try to keep the pain at 2 or less out of a 10.

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There are some exercises that can easily fit into your daily routine. They can help keep your muscles strong and flexible while your knee heals. Here are some recommendations. 

Standing quadriceps stretch

• You can do this when you brush your teeth in the morning and evening. Simply hold foot behind for 20-30 seconds per side, with another hand holding onto the sink for balance. Make sure you do not feel pain but only a mild stretch!
  
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Loading/unloading dishwasher

Let’s help with some housework! If you have a dishwasher at home, this is a great exercise for you. First, stand with your feet hip-width apart with back  straight. Grab a dirty dish (one dish at a time!). Slowly bend your knees as if you are going to sit on a chair and place the dish into the dishwasher. Slowly come back up to standing. Make sure to keep the back straight and chest open throughout. 

Even if you don’t have a dishwasher at home, you can still do this squat. Instead of loading or unloading the dishwasher, you can simply pick up some random things on the floor. Lean against the wall. Start from putting down a light object (such as a pillow, a doll or a empty bag) on the floor and picking it up. If you feel pain more than 2 out of 10, you can put that object on a stool. If you feel you can go further, you can progress it by picking up some heavier things, like a school bag with books or a stack of books. Make sure to be slow and controlled throughout and feel pain that is no more than 2 out of 10.

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Screen time exercises

Sit on the floor with both knees straight. Tighten the thigh and hold for 10 seconds. Relax for 5 seconds and repeat 10 times.

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• Lie down on the floor with both knees bend in a comfortable range.
• Push down onto your heels and lift the bottom up. Hold for 5 seconds and slowly lower it down. Repeat this for 10 times.
• Make sure you are not lifting your hip too high and keep your back straight (no arching!).
• You can progress this by increasing the hold or straightening one leg.

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• In standing, take a large step to the front. Keep the back straight and look forward. Slowly bend the front knee to a degree that you feel pain is no more than 2 out of 10. Hold it for 5 seconds and slowly come back up. Relax for 5 seconds and repeat. You can progress it by increasing the time hold. 

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• In a side-lying position with legs stack on top of each other and straighten. Slowly lift up the leg on top to the ceiling. Hold for 3 seconds and slowly lower the leg down. Repeat 10 times.
  
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Bear in mind to only progress the exercises if you feel pain that is less than a 2 out of 10 while doing the exercises, and the pain do not stay in the following morning. If you find the exercises recommended above is too difficult, reduce the repetition and the time to hold. It is more about you keeping the habit of doing the exercises rather than the repetition and the difficulty you have done! If your pain is severe, lasts longer than expected, or you have trouble walking, please visit your GP for further guidance.