Osgood-Schlatters Disease and Osgood-Schlatters Treatment
Learn the causes behind Osgood-Schlatters, plus its’ treatment and prevention.
by Brad Walker | First Published February 19, 2007 | Updated September 13, 2017
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.
If you suffer from Osgood-Schlatters or are seeking to prevent its occurrence it is important to follow the information in this article. In addition, adding a few simple stretches to your fitness program will also help. To get started on a safe and effective stretching routine that’s just right for you, check out the Ultimate Guide to Stretching & Flexibility.
The quadriceps tendon attaches to the patella (knee cap) and then continues down to the top of the tibia as the patellar tendon. When the quadriceps muscle flexes it shortens pulling upward on the tendon, which in turn causes the tendon 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 tendon 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-Schlatters Disease.
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. This puts a chronic strain on the quadriceps and patellar tendon. This stress leads to those tiny fractures at the attachment site when the muscle is under stress. These lead to the calcium loading at the site and pain and inflammation result.
What Causes Osgood-Schlatters
Osgood-Schlatters may be caused by any condition that puts extra stress on the patellar tendon resulting in small breaks at the attachment site. Some of the common causes:
- A growth spurt or rapid lengthening of the femur, causing the quadriceps to be tight.
- Repetitive stress to the patellar tendon 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 tendon attachment on the tibia
Signs and Symptoms
Knee pain without an apparent direct cause or pain in the knee during and after exercise may be a sign of Osgood-Schlatters Disease. Although the symptoms may be similar to other conditions, such as patellar tendonitis, in younger athletes this condition should be considered. Some of the common signs and symptoms of this disorder include:
- Pain below the knee cap, 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 tendons attachment site.
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 quadriceps muscle. This condition is rarely a long-term concern and will most often correct itself as the bones harden and mature.
- Nakase, J. Goshima, K. Numata, H. Oshima, T. Takata, Y. Tsuchiya, H. (2015) Precise Risk Factors for Osgood-Schlatter Disease. Archive of Orthopaedic Trauma and Surgery, 135(9):1277-81.
- Antich, T. Brewster, C. (1985) Osgood-schlatter Disease: Review of Literature and Physical Therapy Management. Journal of Orthopaedic and Sports Physical Therapy, 7(1):5-10.
- Ladenhauf, H. Seitlinger, G. Green, D. (2020) Osgood-Schlatter Disease: A 2020 Update of a Common Knee Condition in Children. Current Opinion in Pediatrics, 32(1):107-112.
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.
Preventing Osgood-Schlatters Disease involves avoiding or changing the conditions that lead to it. Knowing that chronic stress on the tendon 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 tendons for the activity and increase the flexibility of the tendon. Warmer tendons are more flexible tendons.
- If particular activities cause pain they are probably causing stress on the area. Reducing or avoiding these activities will help prevent the development of this condition. It is important to distinguish between healthy muscle pain and pain of injury. If it is stiffness and pain in the belly of the muscle and goes away in 24 hours it is simply pain from muscle breakdown and recovery, if it does not go away in a day or two, or is focused around a joint or bone attachment it may be the result of an injury.
- Rest is a key component in prevention of many injuries. For Osgood-Schlatters 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-Schlatters.
- One of the most important preventative measures is to work into any activity 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 tendon and lead to Osgood-Schlatters.
- 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 tendon. 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.
Research and References
- Bahr, R. Maehlum, S. (2004) Clinical Guide to Sports Injuries, 1st Edition (ISBN: 978-0736041171)
- Gabbe, B. Finch, C. Wajswelner, H. Bennell, K. (2004) Predictors of Lower Extremity Injuries at the Community Level of Australian Football. Clinical Journal of Sport Medicine, 14(2):56-63.
- Kader, D. Saxena, A. Movin, T. Maffulli, N. (2002). Achilles tendinopathy: some aspects of basic science and clinical management. British Journal of Sports Medicine, 36:239-249.
- Li, H. Hua, Y. (2016). Achilles Tendinopathy: Current Concepts about the Basic Science and Clinical Treatments. Biomed Research International, 6492597.
- Martini, F. Tallitsch, R. Nath, J. (2009) Human Anatomy, 9th Edition (ISBN: 978-013432076X)
- Miners, A. Bougie, T. (2011). Chronic Achilles tendinopathy: a case study of treatment incorporating active and passive tissue warm-up, Graston Technique®, ART®, eccentric exercise, and cryotherapy. Journal of Canadian Chiropractic Association, 55(4): 269–279.
- Pope, R. Herbert, R. Kirwan, J. (1998) Effects of Ankle Dorsiflexion Range and Pre-Exercise Calf Muscle Stretching on Injury Risk in Army Recruits. Australian Journal of Physiotherapy, 44(3):165-172.
- Porter, D. Schon, L. (2008). Baxter’s The Foot and Ankle in Sport, 2nd Edition (ISBN: 978-0323023580)
- Silbernagel, K. Crossley, K. (2015). A Proposed Return-to-Sport Program for Patients With Midportion Achilles Tendinopathy: Rationale and Implementation. Journal of Orthopaedic & Sports Physical Therapy, 45(11) 876-886.
- Stefansson, S. Brandsson, S. Langberg, H. Arnason, A. (2019). Using Pressure Massage for Achilles Tendinopathy: A Single-Blind, Randomized Controlled Trial Comparing a Novel Treatment Versus an Eccentric Exercise Protocol. Orthopaedic Journal of Sports Medicine, March 21, 2019.
- Tortora, G. Derrickson, B. (2009) Principles of Anatomy and Physiology, 14th Edition (ISBN: 978-1118866096)
- Walker, B. (2018). The Anatomy of Sports Injuries, 2nd Edition (ISBN: 978-1623172831)
- Wikipedia contributors. (2019, July 5). Achilles tendinitis, In Wikipedia, The Free Encyclopedia.
- Wikipedia contributors. (2019, June 25). Achilles tendon rupture, In Wikipedia, The Free Encyclopedia.
About 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.