Osgood-Schlatter Disease

In 1903, Robert Osgood and Carl Schlatter first described a paediatric condition of the knee which was marked by pain localised over the tibial tubercle, caused as a result of repetitive strain on the quadriceps femoris muscle at the proximal tibial apophysis insertion.

Patients with Osgood-Schlatter disease often experience pain and swelling in the tibial tuberosity which intensifies after performing physical activities that involve running or jumping such as soccer, basketball or gymnastics. This pain tends to be severe and continuous in the acute phases, usually resolving with skeletal maturity.

The four radiological stages of tibial apophysis maturation are widely regarded as the cartilaginous, apophyseal, epiphyseal and bony stages; most cases of the disease occur in the apophyseal stage which is between the ages of 11 and 14 years.

Studies have suggested that the pathophysiology of the condition involves an avulsion fracture of the secondary ossification centre of tibial tuberosity followed by the subsequent growth of extra bone between the fragments; this results from an inability of the centre to endure repetitive forces from the patellar tendon.

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As further described by Smith and Bhimji in their study on the condition: “The physis is the weakest point in the muscle-tendon-bone-attachment and therefore, at risk of injury from repetitive stress. With repeated contraction of the quadriceps muscle mass, especially with repeated forced knee extension as seen in sports requiring running and jumping (basketball, football, gymnastics), softening and partial avulsion of the apophyseal ossification centre may occur with a resulting osteochondritis.”

Management strategies for Osgood-Schlatter disease advocate rest and activity restriction as the first line of treatment. This helps in reducing the severity of symptoms which, in some cases, can take up to several months.

Application of ice packs and NSAIDs such as ibuprofen and naproxen are usually recommended as measures to alleviate pain and swelling in addition to knee pads for protection from direct trauma during sports or kneeling activities.

A study by Nakase et al. established increased quadriceps femoris muscle tightness and muscle strength during knee extension, and flexibility of the hamstring muscles as risk factors for the Osgood-Schlatter disease.

Considering this, physiotherapy as part of an active rehabilitative programme in the form of exercises for improving functioning of the quadriceps, hamstrings and gastrocnemius muscles can be highly beneficial.

Approaching treatment modalities from a biomechanical perspective involves reviewing the anatomical factors that can predispose an individual to Osgood-Schlatter disease such as an excessive anterior pelvic tilt and increased Q-angle that result from hyperpronation of the feet.

The early recognition of such biomechanical discrepancies can help in minimising abnormal compensatory movements with the use of MASS4D® foot orthotics, particularly to decrease internal tibial and femoral rotation and reduce torsional stresses to the quadriceps.

MASS4D® customised foot orthotics can also be included in rehabilitative programmes involving eccentric exercises to increase the strength of lower extremity muscles in the absorption of eccentric loads whilst training and to reduce any stress on the affected muscles for a speedy recovery.

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