Why doctors recommend rest for treatment
Osgood Schlatter Disease (OSD) was first described by two doctors in 1903. Since then OSD has always been described as a “self-limiting disease”, which means that it is believed to heal by itself within 6 months. This advice is based on the theory that within a six-month time frame the bony area around your shin will have matured and hardened and therefore not cause lasting pain.2–4 Today, this continues to be the most commonly prescribed advice given by medical professionals and often no further treatment is recommended.5 Thus, leaving OSD sufferers in a void.
Despite resting, kids are still not getting better
Since 2010 many studies have shown that healing times for OSD were underestimated. Despite the majority of children improving within 6 months, many adolescents continue to complain about knee pain for much longer than the previously advised resting period.6–8
If we look at Osgood Schlatter's prognosis as a spectrum, we can begin to understand these differences. On one side of the spectrum, most kids will do just fine with a little rest, activity modification, and some exercise. Then there is a group in the middle, about 30 % of kids, who can suffer from the disease for a year or more until things improve. 6,7 On the right side of the spectrum, there is a small proportion that suffers for much longer and might be resistant to treatment and activity modification. Their knee pain, which has become persistent, may last into adulthood.
What may cause symptoms to persist
Every individual with Osgood Schlatter is unique and the context surrounding the problem can have a significant impact on how the pain is experienced. The reasons why one experiences pain, while the other doesn't, continues to be complex. There are however, many aspects that can be controlled by the OSD sufferer and their parents, to influence the development of the disease. Here are some examples and what can be done about it:
Don't ignore early warning signs
Many young athletes suffer from growing pains, before they develop significant Osgood Schlatter symptoms.1 The child is at risk of experiencing increased problems around the knee. During periods of rapid growth and high levels of sporting activities, such as with repetitive jumping and sprinting, it is normal that children may notice pain and aching muscles in the evening or night-time (which goes away by the morning). There are many reasons for knee pain, if you are not sure if you have Osgood Schlatter then click here.
However, what should not be ignored are the early warning signs of the pain becoming more severe and longer lasting. For example, if the pain doesn't go away so easily and persists during, immediately after and 24 h after sports and/or the pain carries on into daily activities. This is a sign that the pain may not be about the muscles themselves, but more localized around the top of the shin bone where the thigh tendon inserts. This area may be swollen and tender to touch.
What you should do:
- Reduce the training load immediately.
- Communicate your problem to parents and coaches.
- Use our App for pain relief.
- After a period of rest, slowly restart your sport and modify certain provocative movements if possible.
Don`t push through pain
This story may sound familiar to an OSD sufferer:
- Your knee hurts bad during practice on monday but you persist through the pain.
- That night the symptoms worsen, but you train lightly on Tuesday hoping they will get better.
- On Wednesday morning the symptoms are worse, so you take the day off.
- On Thursday the pain is not better, but your friends are going to the field to play. So you go along.
- The pain increases even more on Friday and you are forced to take another day off.
- Pain has miraculously improved on Saturday afternoon. Hurray, you go back and train hard as you need to catch up.
- It's Sunday and your knee really hurts and you struggle to calm it down. Now even daily activities such as walking, steps and kneeling are painful, and you are forced to sit on the couch with a bag of ice on your knee.
This story demonstrates how easily a week can slip away whilst trying to ignore the symptoms. Because the child did not listen to their body, and pace themselves, they could end up with pain that lingers on for much too long.
Instead, use the 24h Pain Rule:
Pain should be evaluated, using this pain scale, during, immediately after and 24 h after doing sports.
Follow these guidelines:
- Pain remains in the green zone (0-2/10) - Keep going as usual.
- Pain is in the orange zone (3-5/10) - Take a rest day from the sport, but continue with all activities that don't hurt.
- Pain is in the red zone (6-10/10) - Stop the activity and take at least 2 rest days. Your knee needs a break.
Don't expect quick fixes to get rid of OSD long term
Quick fixes, such as strapping, painkillers, anti-inflammatories or repeated ice applications are often recommended by doctors and therapists to treat OSD symptoms. These quick fixes do not however provide a long term solution. In the majority of cases, they can even prolong your symptoms or, as with any medication, can have serious side effects.
Instead, the young athlete must take a proactive approach to dealing with OSD. With the help of their parents the athlete should:
- Communicate what they are experiencing using our pain scale.
- Do some pain relieving techniques found in the OSD app.
- Progress to daily exercises that work on flexibility, strength and coordination to reduce the forces around the knee.
- Work with a physical therapist to get guidance in personalizing your care and finding some alternative activities or sports that are fun and don't provoke your symptoms.
Don't always blame the bony growth for all your knee pain
As OSD symptoms persist, there may be many other factors outside the knee that contribute to the pain experienced. The evidence demonstrates that many individuals with persistent symptoms have significant deficits in strength and endurance compared to peers.7 Having these deficits may in turn provoke other structures around the knee to hurt, such as the patella tendon or the bursa. Furthermore, the mechanisms of the muscles that straighten and stabilize the knee may be affected and result in pain around the kneecap when loading (patellofemoral pain or anterior knee pain).
It is therefore important to:
- Seek medical advice when symptoms persist for longer than 6 months, or if symptoms spread to other areas of the knee.
- See a physical therapist for an individual treatment plan and correct any abnormal movement patterns.
- Work on deficits in flexibility, strength and coordination.
Don`t ignore your personal wellbeing
It's important to understand that an illness such as OSD can have a significant impact on an individual’s social life and their overall quality of life.1,4,5 How an individual feels can have a significant impact on how they experience pain in the long run.
For parents, it is initially heartbreaking to experience their child's disappointment when they are told to stop all sports due to their diagnosis. Subsequently, many kids fall into a void and continue to struggle with their mental well-being. As the problem persists longer than usual, children start losing hope and many quit sports altogether.
It is therefore important to:
- Communicate with your child openly and seek professional advice if needed.
- Involve your child early in other fun activities with their peers.
- Seek the help of a physical therapist, who can make an individual treatment plan.
The Osgood Schlatter App - Personal trainer and physiotherapist in your pocket
It can’t be said enough: The best program is the one that gets done. Doing the exercises on the APP on a regular basis will help to reduce pain and get you back to doing what you love. The OSD APP, developed by experienced professionals, is part personal trainer and part physical therapist.
In the app you will find:
- pain relieving massages
- taping techniques
- over 30 different exercises and 15 different fun workouts
- partner exercises and progressions
- lots of supplementary information to help communicate your knee problem to friends, parents, and coaches.
Over twenty years’ expertise in your pocket!
It is our mission to get you back to your sport with all your friends again.
So download the APP now and don't let Osgood Schlatter stop you!