Osgood Schlatter Disease - the big overview

You are reading this because you or your child has been diagnosed with Osgood Schlatter disease (OSD). Like many others in this situation, you may have questions about the disease and are looking for answers in order to move on.

Why we wrote this and made the app.

In order to make a difference to your or your child’s life, we have written this big overview in simple English and with the latest evidence on the disease. Together with our App, we hope that you will find some answers to questions and take back control of your or your child's life. Don't let Osgood Schlatter stop you. 

Medical Information

The Author

This article was written by Sebastian Cormier, who has graduated with an MSc Physiotherapy at King’s College in London & BSc Sports Medicine & Exercise Science at Elon University, USA . He also has more than 10 years of practical experience in treating many high performing children with Osgood-Schlatter Disease.

Sources of Information

Every article on our website is written based on sources from scientific research papers.

You will find the sources at the end of this article.

Table of Content

Defintion 

Definition of Osgood Schlatter

Let's understand what Osgood Schlatter is so that we can make sense of the best available treatments to get it better.  

Osgood Schlatter Disease (OSD) is an overuse condition of the knee that affects children and adolescents mostly between the ages of 8 to 15. The problem zone is usually a small painful area or bump below the kneecap on your shinbone. You can usually put your finger precisely onto it.[4]

The mechanism of the disease is not yet fully understood. But, a combination of high-impact sporting activities, during a period of a growth spurt, is likely to be the cause of the symptoms.Irritation in this area occurs, as this area of bone is softer during growth and has not yet fully hardened to take on the frequent pull of your strong thigh muscles. In some occasions, the tendon part itself and the underlying structures may even become the source of pain. 

History of the disease

The surgeons Robert Bayley Osgood and Carl Schlatter, who gave the disease its name, first described the painful overuse condition of the knee in children as early as 1903. Nowadays, Osgood Schlatter is seen as one of the most common knee conditions in children. [5]

Epidemiology

Understanding the signs and symptoms

Running, jumping, and kicking cause particularly high forces around the area of your knee where the thigh muscle attaches to the shin bone.During a period of growth, this repeated pulling on the bony attachment on your shin leads to inflammation and pain. At first, symptoms may only occur occasionally, but get better quickly after sport or the next day. If however the knee continues to be stressed when it's irritable, then the pain takes much longer to disappear. Patients often experience pain during daily activities such as walking, stair climbing and standing up from a chair. 

Am I the only one that has Osgood Schlatter?

No, not by a long shot. Osgood Schlatter is the most common knee pathology in children. Up to one in 10 children suffer from it.  Boys are affected slightly more often than girls. Very active children who play single sports are four times more likely to suffer from it than kids who play multiple sports.

Who gets the disease the most?

Boys are slightly more affected and tend to suffer from it between the ages of 10-15 years of age. Girls, on the other hand, suffer from it more often a little earlier on, at an age of 8-12 years.   It is noticeable that most children are usually very active and often do more than 2 hours of sports per day. [11,12,13]

What makes my knee hurt?

The scientific community is still unsure what causes Osgood Schlatter pain in the first place. In the growing child, it's believed that the pain is caused by the frequent pulling on the bony tendon attachment by the thigh musculature. As a result of frequent and intense sporting activities, this bony attachment can become highly inflamed and painful. In many cases, this leads to the formation of extra bone on the front of your shin. This visible bump is typically highly sensitized and provoked by kneeling and squatting down. [8]

What makes my knee pain worse? 

Pulling on the growing thigh bone may not explain the whole pain story. Many aspects of your life can affect how intensely your pain is perceived and how it affects your movement. For instance, your pain may cause you to limp and avoid movements, which over time may create other types of problems that overlap with the disease. More often than not, stress, fear, and worrying may turn up the pain dial and increase your pain sensation. Some kids can’t even touch the bump because they perceive it as being „disgusting“ and avoid looking at it. 

Diagnosis of Osgood Schlatter

How is Osgood Schlatter diagnosed by a doctor?

Actually, Osgood Schlatter is very easy to diagnose. You can usually point a finger onto the painful spot on the top of your shin bone. This spot hurts especially when kneeling. Only very rarely do you need X-ray imaging or an MRI. A clinical diagnosis is easily made and should leave no hesitation. Unfortunately, far too many healthcare resources are spent on exhaustive diagnostic imaging, several specialist visits, and expensive healthcare professionals to come to the same conclusion: You have got Osgood Schlatter.

What other knee pain conditions are there apart from Osgood Schlatter disease?

There are many causes of knee pain in young children. There are growing pains, overuse injuries and traumatic injuries. 

Growing pains are not serious and their origin is unknown. They are usually located in the muscles and surprisingly, not always related to growing itself. They can be felt as a throbbing pain or aching pain in both legs. Growing pains often occur in active children and are often felt in the evening or night-time. The pain disappears by the next morning. 

Osgood Schlatter is a form of growing pain and an overuse injury. These forms of knee pain may occur after the athlete has overdone it in training, practiced a new activity repeatedly or changed surface or shoes. It is important to stress that in overuse injuries, we talk about structures being sensitized, not broken. Lots of overuse injuries hurt, but you cannot always see a reaction from the body, such as swelling (a sign of inflammation). Lots of overuse injuries around the knee affect the kneecap. This condition is called anterior knee pain or Patellofemoral Pain. Another condition is called Jumpers Knee or Patella Tendinopathy and this condition affects the tendon itself.

Traumatic injuries differ from overuse injuries as there is usually a strong impact to the knee or a forceful twist that precipitated the injury. Traumatic injuries usually have a specific event that caused the problem. For example, a fall onto the kneecap may cause it to fracture. Big twists of the leg may cause injuries to the internal structures of the knee such as Anterior Cruciate Ligament injuries (ACL). These are often accompanied by deep pain in the joint, immediate swelling, reduced range of motion, an inability to weight bear and a feeling of „giving way“ when attempting to. 

Please seek medical advice if you feel that your knee pain may come from other sources apart from Osgood Schlatter. 

Do I need an X-ray or an MRI to diagnose the disease?

X-ray or MRI imaging is not usually necessary to diagnose Osgood Schlatter. However, if there was a traumatic onset or there are other symptoms around the knee that do not correlate with a point of tenderness on the shin bone, then seek medical advice to get an appropriate diagnosis. [15]

Can I have Osgood Schlatter on both knees?

Yes, unfortunately. In 20-30% of cases, children are affected on both knees.[5]

Treatment of Osgood Schlatter

What is the most promising treatment option?

Any treatment strategy should focus on a long-term strategy. An immediate cure is not possible. Every Osgood Schlatter patient is different, thus needing a milestone-based treatment approach that is done proactively and consistently for many weeks: 

This approach should be focused on the three pillars of success that are the cornerstone of our App: [16]

  • Education and a treatment plan based on milestone progressions. 
  • Regular stretching, strengthening and coordination exercises to reduce the pull on the shin bump. 
  • Managing the pain through activity modification. 

What is good physiotherapy / physical therapy?

A good physical therapist will become your new coach. He or she will help you understand the condition, provide you with treatment solutions and modify painful activities so that you can still do sports without suffering from knee pain. It is your therapist's job to guide you through flare ups and provide a treatment plan to get you back to your goal. Remember that you are part of the rehab team. Let your therapist know when you are feeling low, struggle with the program or hurt after a treatment session. The more you can work together with your therapist, the better the outcome. Teamwork makes the dream work. 

Are there exercises that I can do right now?

Yes, you can start with our “Top 5 exercises for Osgood Schlatter”. They provide a good starting point for most kids. So click here to read more about it!

How to know when you are doing too much?

Since others cannot feel your pain, it is important that we use a scale that helps us communicate our knee issues with parents and coaches.  

Using a 10 point pain scale, we can identify three zones of discomfort. There is the Green Zone. This is the Zone from 0-2 and where we want you to be during, after, and 24h after your exercise. The goal is to find as many sporting activities as you can that you can do in this range.  

If you are in the orange Zone during, after and 24 h your sport, you have overdone it and need to take a rest day or modify your activities until your back in the Green Zone.

Everything in the red Zone we do not want. Here, your knee is unable to handle the stress and reacts with pain. Be honest with yourself and don`t push through it. The longer you stay here, the harder it is going to get to be to get things to calm down.  

Let's give you an example of modifying your activities:  

Let's say you are playing Basketball and jumping and cutting cause you to be in the Orange - Red Zone. Talk to your coach and see if he can find you some drills to work on that keep you in practice and "in the Green". Then, while the others are doing other work, you can do the exercises that we show you in the APP.

What about straps for the Knee?

You may have seen some of your peers walking around with these. They can help to reduce pain, but from our point of view, they should be seen more like a band-aid. They relieve some symptoms but won't tackle the underlying problem.

How about Injections, will they help?

Injections, in the form of dextrose (prolotherapy), into the area of symptoms cannot be recommended based on the scientific literature. In fact, these injections did not offer any significant benefit when compared to a placebo injection.

Does surgery speed up my recovery?

According to the scientific literature, surgery is only very rarely the right choice for children with Osgood Schlatter disease as less than 2% are actually operated on. Surgery can be indicated if symptoms persist, the skeletal bone has matured (approximately at the age of 17-18 years of age) and conservative treatment has failed. A study showed that after surgery, individuals were able to get satisfactory outcomes and get back to sports. But, it took nearly half a year to a year of rehabilitation to get there.

Can I treat myself?

The first step is to see a doctor to confirm the diagnosis of Osgood Schlatter. There are many problems around the knee that can mask Osgood Schlatter Symptoms, which require an alternative course of action. Once the diagnosis has been made, you can either see a physiotherapist who can provide you with an individual treatment plan. Or, you can download the Osgood Schlatter Treatment App and get guidance from experienced physiotherapists online! If you want the best of both worlds, show our App to your therapist and let’s work on it together.

Why is Osgood Schlatter managed so poorly?

There continues to be a lack of helpful advice on Osgood Schlatter. Compared to many other knee conditions such as ACL injuries for example, Osgood Schlatter is a neglected topic by the medical community and scientific evidence is lacking. [20]

In addition to poor evidence, many health professionals haven’t caught up to the most effective treatments either. And you can’t blame them. Evidence shows that it takes 17 years for research to make it into clinical practice. [21]

Yet, recent scientific studies for Osgood Schlatter Treatment show, that following a specific exercise program:

  • 68% were back doing playing sport after 3 months,
  • 79% after 6 months
  • 81% after 12 months
  • 86% after 16 months. [16]

Prognosis of Osgood Schlatter

Can Osgood Schlatter heal by itself?

In theory, the condition should heal by itself with prolonged rest, bone maturation and getting older. However, studies have identified that many patients still suffer from daily knee pain even 4 years after the onset of their symptoms. It seems that this approach of prolonged rest from sports and pain avoidance, lasting between six to twelve months, doesn’t seem to work in practice. In fact, symptoms often reappear once the athletes resume their sport. This can be frustrating for many athletes and parents.

How long does the disease last?

In reality, the duration of symptoms can vary between individuals and personal circumstances. Usually Osgood Schlatter symptoms last from some weeks to 2 years, but can vary in intensity from little to no pain in competitive sports to severe pain during daily activities. A recent study, identified that 30% of patients still experienced knee pain and sports disability longer than this 2 years year period. [3]

When does the knee bump go away?

After your shin bone has hardened, your knee bump will remain in place and become less sensitive. It may not look pretty, but the pain during sport should lessen and disappear. Kneeling however, can continue to be quite uncomfortable for a long time. 

Removing the knee bump can be a surgical option for some, if pain continues to persist or when it has grown into the knee joint and affects your knee mobility. Rarely is this done before the child has stopped growing. 

What can I do to prevent Osgood Schlatter from happening to me or my child?

Identifying patterns of what causes Osgood Schlatter continues to be complex and research is inconclusive of its origin. If you put two similar aged athletes next to each other, doing the same sport, with the same intensity, we cannot predict who gets Osgood Schlatter Disease and who doesn’t. 

However, over the years, we have been able to identify a few patterns in youth sports that may reduce the problem from occurring or the symptoms to be only mild: 

We encourage:

  • flexibility, strength and coordination work early on;
  • multiple sports over single sports; 
  • seasonal breaks;
  • age appropriate training (kids are not small adults);
  • kids to communicate problems early on;
  • coaches to provide a safe space to communicate problems;
  • that sports should be about fun and games, rather than competition, for as long as possible.

The Osgood Schlatter App

Your personal physical therapist in your pocket.

We, the Osgood Schlatter team, have made it our mission to empower you to take action and learn about this new treatment method.

For this reason, we have developed the Osgood Schlatter App. The App is part personal trainer and part physical therapist. We have squeezed in, over twenty years of our experience into it. The step-by-step program will help you get back on track, all from the comfort of your home.

In the app, you will find, short and fun educational videos that tell you everything you need to know about the disease and what to do about it. Massage and taping techniques for pain relief and many short exercise programs are done by kids for kids.

So what are you waiting for? Let's take action and get going with the program!

Don`t let Osgood Schlatter stop you.

Start your treatment today

Stretches

We will show you different stretches for Osgood Schlatter to relief the pain and to strengthen your knee.

Workouts

3 Levels with different workouts to get you back to your sport as soon as possible! All exercises are research approved and selected by experienced physiotherapists!

Taping Techniques

Dedicated taping techniques for Osgood Schlatter, that you can do yourself to relief pain and tension in your knee!

Milestone Tests

Get to know when to train & when to rest with our milestone tests you can do regularly.

Sources

1. Çakmak S, Tekin L, Akarsu S. Long-term outcome of Osgood-Schlatter disease: not always favorable. Rheumatol Int. 2014;34(1):135-136. doi:10.1007/s00296-012-2592-0

2. Guldhammer C, Rathleff MS, Jensen HP, Holden S. Long-term Prognosis and Impact of Osgood-Schlatter Disease 4 Years After Diagnosis: A Retrospective Study. Orthop J Sports Med. 2019;7(10):2325967119878136. doi:10.1177/2325967119878136

3. Holden S, Olesen JL, Winiarski LM, et al. Is the Prognosis of Osgood-Schlatter Poorer Than Anticipated? A Prospective Cohort Study With 24-Month Follow-up. Orthop J Sports Med. 2021;9(8):23259671211022240. doi:10.1177/23259671211022239

4. Studer D. Overview Überlastungsschäden.

5. de Lucena GL, dos Santos Gomes C, Guerra RO. Prevalence and associated factors of Osgood-Schlatter syndrome in a population-based sample of Brazilian adolescents. Am J Sports Med. 2011;39(2):415-420. doi:10.1177/0363546510383835

6. OSGOOD RB. Lesions of the Tibial Tubercle Occurring during Adolescence. Boston Med Surg J. 1903;148(5):114-117. doi:10.1056/NEJM190301291480502

7. Itoh G, Ishii H, Kato H, Nagano Y, Hayashi H, Funasaki H. Risk assessment of the onset of Osgood-Schlatter disease using kinetic analysis of various motions in sports. PloS One. 2018;13(1):e0190503. doi:10.1371/journal.pone.0190503

8. Brukner P, Khan K. Brukner & Khan’s Clinical Sports Medicine: Volume 1: INJURIES. 5th edition. McGraw-Hill Education Ltd; 2017.

9. Suzue N, Matsuura T, Iwame T, et al. Prevalence of childhood and adolescent soccer-related overuse injuries. J Med Investig JMI. 2014;61(3-4):369-373. doi:10.2152/jmi.61.369

10. 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

11. 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

12. Ladenhauf HN, Seitlinger G, Green DW. Osgood-Schlatter disease: a 2020 update of a common knee condition in children. Curr Opin Pediatr. 2020;32(1):107-112. doi:10.1097/MOP.0000000000000842

13. BJSM. Osgood Schlatter- not the self-limiting condition we once thought. Episode #384.

14. Rosenberg ZS, Kawelblum M, Cheung YY, Beltran J, Lehman WB, Grant AD. Osgood-Schlatter lesion: fracture or tendinitis? Scintigraphic, CT, and MR imaging features. Radiology. 1992;185(3):853-858. doi:10.1148/radiology.185.3.1438775

15. Leeuwen G, Schepper E, Rathleff M, Bindels P, Bierma-Zeinstra S, Middelkoop M. The Incidence and Management of Osgood-Schlatter Disease in General Practice. Br J Gen Pract. 2021;72:BJGP.2021.0386. doi:10.3399/BJGP.2021.0386

16. 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

17. Nakase J, Oshima T, Takata Y, Shimozaki K, Asai K, Tsuchiya H. No superiority of dextrose injections over placebo injections for Osgood-Schlatter disease: a prospective randomized double-blind study. Arch Orthop Trauma Surg. 2020;140(2):197-202. doi:10.1007/s00402-019-03297-2

18. Mun F, Hennrikus WL. Surgical Treatment Outcomes of Unresolved Osgood-Schlatter Disease in Adolescent Athletes. Case Rep Orthop. 2021;2021:6677333. doi:10.1155/2021/6677333

19. Weiss JM, Jordan SS, Andersen JS, Lee BM, Kocher M. Surgical treatment of unresolved Osgood-Schlatter disease: ossicle resection with tibial tubercleplasty. J Pediatr Orthop. 2007;27(7):844-847. doi:10.1097/BPO.0b013e318155849b

20. Cairns G, Owen T, Kluzek S, et al. Therapeutic interventions in children and adolescents with patellar tendon related pain: a systematic review. BMJ Open Sport Exerc Med. 2018;4(1). doi:10.1136/bmjsem-2018-000383

21. Morris ZS, Wooding S, Grant J. The answer is 17 years, what is the question: understanding time lags in translational research. J R Soc Med. 2011;104(12):510-520. doi:10.1258/jrsm.2011.110180

22. Kaya DO, Toprak U, Baltaci G, Yosmaoglu B, Ozer H. Long-term functional and sonographic outcomes in Osgood-Schlatter disease. Knee Surg Sports Traumatol Arthrosc Off J ESSKA. 2013;21(5):1131-1139. doi:10.1007/s00167-012-2116-1