Home » Stretching & Sports Injury Report » Osgood-Schlatter Disease

Osgood-Schlatter Disease (OSD)

Osgood-Schlatter causes, treatment, prevention and risk factors, plus rehabilitation exercises and stretches.

by Brad Walker | Updated November 16, 2021

Osgood-Schlatter Disease is a common cause of knee pain in late adolescent and early teenage boys. The condition is less prevalent in females, although being active in sports increases a young female’s chances.

The term disease is often misleading, as it is not caused by bacteria, virus or other disease-causing substance. It is labeled a disease due to its chronic nature. This condition was named for the two doctors who defined the condition, simultaneously, in 1908: Dr. Robert Osgood and Dr. Carl Schlatter.

Osgood Schlatter Disease

What Causes Osgood-Schlatter

Osgood-Schlatter may be caused by any condition that puts extra stress on the patellar ligament resulting in small breaks at the attachment site. Some of the common causes:

  • A growth spurt or rapid lengthening of the femur (upper thigh bone), causing the quadriceps to be tight. When an adolescent or young teen goes through a growth spurt the muscles often struggle to keep pace with the growing bones and therefore are often too short compared with the accompanying bones. This places additional stress on the attachments and happens often with the femur and quadriceps muscle. The femur grows quickly and the quadriceps does not stretch so the muscle is tight until it has a chance to adapt to the new growth.
  • Repetitive stress to the patellar ligament through knee flexion and extension, such as with kicking or landing when jumping.
  • Chronically tight quadriceps as seen with weight training without proper flexibility training as well.
  • Untreated injury to the knee causing small avulsion fractures to the patellar ligament attachment on the tibia

Anatomy of Osgood-Schlatter

The quadriceps tendon attaches to the patella (kneecap) and then continues down to the top of the tibia as the patellar ligament.

On occasion you may hear of this structure being called the patellar tendon, but for the purposes of anatomy and physiology this structure is a ligament, as it attaches the patella to the tibia. Ligaments attach bone to bone, while tendons attach muscle to bone.

When the quadricep muscles contract, they shorten, pulling upward on the tendon, which in turn causes the patellar ligament to pull up on the tibia, causing the lower leg to extend.

As with any attachment it is under considerable stress when forcibly extending the knee or supporting the bodyweight during dynamic activities. Repetitive forceful contractions of the quadriceps can cause tiny avulsion fractures at the ligament attachment on the tibia.

The bone will attempt to repair itself by adding more calcium to the area to protect and strengthen the attachment. This causes the lump under the knee often associated with Osgood-Schlatter Disease.

Osgood-Schlatter Disease anatomy image from Clinical Guide to Sports Injuries

Signs and Symptoms

Knee pain without an apparent direct cause, or pain just below the knee during and after exercise may be a sign of Osgood-Schlatter Disease. Although the symptoms may be similar to other conditions, such as patellar tendinitis, in younger athletes this condition should be considered. Some of the common signs and symptoms of this disorder include:

  • Pain below the kneecap, worsens with exercise or when contracting the quadriceps.
  • Swelling and tenderness below the knee.
  • A bony prominence may be noted under the knee as the condition advances.
  • A grinding or stretching sensation may be noted at the ligament attachment site.

Osgood-Schlatter Treatment

Knees are complex joints with many ligaments, tendons, bones and cartilaginous surfaces to be considered. Therefore, any serious or chronic knee pain should be evaluated by a sports medicine professional to determine the cause.

Most athletes with this condition find relief from rest and stretching the quadricep muscles. This condition is rarely a long-term concern and will most often correct itself as the bones harden and mature.

“Researchers defined that the most important aspect for the prevention of OSD is an improvement of the flexibility of the quadriceps femoris muscle and conclude that an effective quadriceps stretching program may help to prevent OSD in pre-adolescent footballers.”

Osgood-Schlatter often goes away as the athlete matures and the bone growth slows and allows the muscles to catch up. Reducing the stress on the patellar ligament will help facilitate healing. Resting, or reducing time from activities that cause pain will also allow the area to heal without further injury. Stretching the quadriceps will also alleviate the stress on the ligament and attachment.

Managing the pain and inflammation is important in treating this condition. Icing the area after an activity will help control inflammation and reduce soreness. Anti-inflammatory medication may also be of help in pain and inflammation management. Rest will often reduce the pain as well.

Osgood-Schlatter Prevention

Preventing Osgood-Schlatter Disease involves avoiding or changing the conditions that lead to it. Knowing that chronic stress on the patellar ligament and attachment causes this disorder, it is important to reduce that stress. Some of the strategies for prevention include:

  • Proper warm-up techniques will help prepare the muscles and joints for activity and increase the flexibility of the quadricep muscles.
  • Reducing or avoiding activities that cause pain will help prevent the development of this condition.
  • Rest is a key component in prevention of many injuries. For Osgood-Schlatter it is essential to allow the affected area to heal in between bouts of activity. The body uses rest time to recover and get stronger. Too often young athletes fall into the “More is Better” line of thinking and over-train leading to overuse injuries such as Osgood-Schlatter.
  • One of the most important preventative measures is to work into any activities gradually. This is especially important for younger athletes. The bones are not fully developed and therefore are a little weaker and more susceptible to injury. When strenuous activity is started without adequate conditioning and preparation it can cause too much stress on the skeletal system leading to injury. When a young athlete stresses the muscles of the quadriceps with excessive resistance, such as weight training with too heavy a load or sprinting middle distances before working up to it, it can cause undue stress on the patellar ligament and lead to Osgood-Schlatter.
  • Since a lot of the stress placed on the quadriceps and patellar tendons is due to tight quadriceps muscles, stretching these muscles to relieve the tightness and to lengthen the muscle will help alleviate some of the stress. Developing a balance between the hamstrings and quadriceps is also important. If the hamstrings are proportionately weaker than the quadriceps then they will not be able to act as a counter force against the forceful quadriceps contractions, which could put additional stress on the knee joint. If the quadriceps muscles are weaker than the hamstrings (very rare) they will be chronically tight from resisting the hamstrings. Strengthening the quadriceps also helps facilitate muscle lengthening and increases flexibility if done properly through a full range of motion.
Quad and Thigh Stretch, Kneeling Quad and Thigh Stretch Video, Quad and Thigh Stretching Exercises

Kneeling Quad and Hip Flexor Stretch (1:20) Kneel on one foot and the other knee. If needed, hold on to something to keep your balance. Push your hips forward. Regulate the intensity of this stretch by pushing your hips forward. If necessary, place a towel or mat under your knee for comfort. Hold the stretch position for a minimum of 20 seconds and then repeat on the opposite side.

Best Thigh Stretch, On-your-side Thigh Stretch Video, Thigh Stretching Exercises

Lying on-your-side Quad and Hip Stretch (1:28) Lie on your side and pull your top leg behind your buttocks. Keep your knees together and push your hips forward. This position can put undue pressure on the knee joint and ligaments. Anyone with knee pain or knee injury should avoid this stretch. Hold the stretch position for a minimum of 20 seconds and then repeat on the opposite side.

Get more Quad and Hip Flexor Stretches here

Research and References

Brad Walker - AKA The Stretch CoachAbout the Author: Brad Walker is often referred to as the "Stretch Coach" and has even been called the Stretching Guru. Magazines such as Runners World, Bicycling, Triathlete, Swimming & Fitness, and Triathlon Sports have all featured his work. Amazon (author page) has listed his books on five Best-Seller lists. Google cites over 100,000 references to him and his work on the internet. And satisfied customers from 122 countries have sent 1,000's of verified customer reviews. If you want to know about stretching, flexibility or sports injury management, Brad Walker is the go-to-guy.

Disclaimer: The health and fitness information presented on this website is intended as an educational resource and is not intended as a substitute for proper medical advice. Please consult your physician or physical therapist before performing any of the exercises described on this website, particularly if you are pregnant, elderly or have any chronic or recurring muscle or joint pain.

Check out these related articles…