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Background:

Osgood-Schlatter Syndrome also called Osgood-Schlatter's Diseaseosgood_schlatter_xray.jpg is one of the most common causes of knee pain in adolescent athletes. The condition is most common in active boys aged 10 -14 and is caused by stress on the patella tendon that attaches the muscle at the front of the thigh to the lower leg (Tibia). The tibial tuberosity, or bony bump on the shinbone just below the knee, swells and feels tender and painful when the knee is used.

It occurs when, following an adolescent growth spurt, stress from repeated contraction of the quadriceps muscle is transmitted through the tendon to the tibial tuberosity, which is a growth centre on the bone. This can cause inflammation and sometimes an avulsion fracture of the tibial tuberosity. and eventually results in bone growth in the tendon, producing a visible lump.

More serious consequences, including formation of a free ossicle (bone fragment) at the site of traction that may require surgical excision, can be avoided with early diagnosis and treatment.

Symptoms

The symptoms of Osgood-Schlatter's syndrome depend on the severity of the condition, but may include:

  • Pain in one or both knees
  • Pain when straightening the leg through the knee joint or full squatting
  • Pain on running, or going up and down stairs
  • The pain eases with rest
  • The tibial tuberosity is swollen
  • The skin over the tibial tuberosity is red and inflamed
  • Sometimes, the quadriceps muscles can lose strength and bulk.

Why does a bump develop below the knee-cap?

The quadriceps muscle is joined to the tibial tuberosity by a tendon. In some cases, the force of the muscle pull on the tendon may dislodge the bone (partial avulsion fracture). The body repairs the fracture by laying down extra bone tissue. The result is a larger than normal bump at the tibial tuberosity. Other possible complications of Osgood-Schlatter syndrome include an altered position of the kneecap, which can predispose to an increased risk of future patello-femoral pain.

Examination and Treatment

A thorough case history will reveal around half of all children with the condition report a prior knee injury. It is therefore important for the chiropractor to do a biomechanical assessment of the whole kinematic chain including all the joints and the muscles of the lower limb, the spine and pelvic joints.

X-rays and/or MRI scans can help to rule out more serious causes in persistent pain.

Chiropractic treatment includes rest and ice until symptoms subside, and during this phase, manual therapies such as cross friction and PIR stretching is also used. Ultrasound and laser therapy is also helpful in speeding up the recovery.

Once the symptoms subside, stretching and strengthening exercises of the quadriceps, hamstring and calf muscles can be started. Once the knee is no longer tender, a patient who is compliant with exercises may return to activity, but should use an infra-patella strap to take the pressure off the tendon.

Some orthopaedic books suggest that, "Osgood-Schlatter Syndrome usually resolves by itself within 12 months or so. However, the knee joint may remain uncomfortable for around two to three years until the growth spurt finishes."

For further information and treatment options to deal with the pain and discomfort of Osgood-Schlatter Syndrome, call Dr. Pisarek for an appointment.

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