#1 Why ONLY doing nothing is a poor recommendation
According to the scientific literature, the most common advice by General Practitioners is for OSD sufferers to simply rest for a few weeks or wait until their symptoms resolve as they get older.3 While stopping a sport for a couple of days due to pain can be really beneficial, it is not recommended to stop all activities for longer periods of time. The evidence for the “wait-until-you-have-out-grown-it” advice is unfounded and quite the contrary is true. Adolescents with OSD can have knee pain for much longer than anticipated and pain often does not go away by simply sitting it out.4,5 If you want to read more about the prognosis of OSD please click here.
#2 The better option: Activity modification
There is compelling evidence that activity modification is one promising option to treat OSD. Activity modification means reducing the overall physical load to the knee joint.6 This could be achieved by reducing the overall training volume (i.e. playing less often) and/or reducing the intensity. This can be done by slowing down, swapping positions or reducing painful activities such as sprinting, kicking, cutting or jumping.
Research studies have shown, that modifying activities in this way, in combination with specific exercises, resulted in:
- 68% of OSD sufferers returning to their sport after 3 months6
- 79% after 6 months6
- 86% after 16 months6
Exercises for flexibility, strength and coordination are an essential and scientifically proven part of improving Osgood Schlatter symptoms.6
- Flexibility: As OSD often occurs during growth spurts, the muscles and tendons have a hard time keeping up with the rapid increase in bone length. One of the muscles affected is the quadriceps muscle. This muscle has a large tendon that attaches to the top of the shin bone. The “tighter” this muscle becomes, the more it pulls on the shin bone and causes knee pain.11 Flexibility exercises will reduce the pull on the shin bone and therefore reduce knee pain.
- Strength: Strength is needed to produce power. Power is needed to move, jump, sprint, brake and change direction. During a growth spurt, muscles and tendons have to work harder to hold up a larger body frame. If the growing athlete is not sufficiently strong and an intense training schedule is layered on top, they may be at higher risk of developing knee pain. What starts as growing pains around the knees, can easily become early signs of Osgood Schlatter.
- Coordination: A growing athlete may move in an uncoordinated manner. This is normal. As the athlete grows, the brain has to learn new movement patterns to coordinate all the limbs.
But, the growing athlete may be at a higher risk of injury, if they continue to move poorly and to simultaneously train hard. These inefficiencies may predispose the athlete to overuse injuries such as OSD or acute injuries such as anterior cruciate ligament injuries. Based on the above recommendations, here is a sample programme of exercises to help prevent or treat OSD symptoms.
#4 Ask to be referred to a physical therapist
Typically, a physical therapist will help to improve flexibility, strength and coordination by treating the individual with hands-on techniques, massage tools or specific exercises. However, the unique quality of in-person physical therapy is not solely based on the treatment received, but on the individual guidance of exercises and activity modifications that match the individual's specific needs.5 With the help of a physical therapist, new movement skills can be learnt, inefficient ones can be unlearnt and a plan can be made for a sporting future.
But despite all the advantages, good physical therapy costs money and not everyone can afford it. Also, therapists with an expertise in youth sports can be rare in some places. For OSD sufferers that live remotely, these experts are impossible to reach and telehealth often doesn`t work as well as promised.
Hence, having an effective solution that is affordable, does`t need fancy equipment and can be done at the comfort of your own home is needed. That's when the OSD app comes in handy. It's something to get started with right away. Based on scientific evidence that shows excellent results with education, activity modification and specific exercises, the app is a trusted resource to help get rid of pain.6
#5 Quick fixes, won´t fix it!
Icing, painkillers, straps, and so on are all good options for pain relief. Anti-inflammatories can reduce the inflammation around the shinbone and can thereby reduce pain. Ice is a good painkiller, but does not change inflammation. Straps reduce pain by diverting the pull of the tendon when it tugs on the bone. All of these things work. But none of them are game changers. What will change the pain is having a long-term management plan: Initially, reducing the load to the knee and then gradually building up the knee`s capability to load (i.e. more training volume or intensity). But all these changes take time and discipline. An OSD sufferer cannot expect to be pain-free immediately. Rather, it's a process that will need patience and have its ups and downs. The good thing is, the body is an amazing adaptive being. Doing an OSD rehab programme regularly will reduce symptoms of pain, despite still having a visible bump.6 Remember, the best programme for OSD pain is the one that gets done!
Can injections help? Unfortunately not. Injections, in the form of dextrose (prolotherapy), into the area of symptoms are not recommended based on the scientific literature. In fact, these injections do not offer any significant benefit when compared to a placebo injection.7,8
Surgery as a treatment method is only very rarely necessary and reserved for extreme circumstances. Only once the skeletal bone has matured (approximately at the age of 17-18 years of age) and conservative treatment has failed, can surgery be recommended if symptoms persist.9 Individuals who went for surgery were able to get satisfactory outcomes and get back to sports. The research cautions however, that being completely pain free is not always guaranteed after surgery.9,10 Furthermore, an extensive rehabilitation programme is needed and it may take up to a year to get back to previous sporting level.9 If you want to learn more about this topic then click here.