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Sports Medicine: Physiotherapy: Osgood-Schlatter Disease (OSD)
The tibial tubercle
Osgood-Schlatter Disease is not a disease but rather a group of symptoms involving the tibial tubercle epiphysis which is a small bump on the shin bone where the quadriceps muscle attaches. The tibial tubercle is a growth center located just below the knee joint on the front of the tibia.
OSD is most commonly characterized by the big tibial tubercle and pain on activities like kneeling or repeated jumping. OSD arises from a strong pull of the quadriceps muscle on the tibial tubercle during a child’s growth spurt. This normally occurs around the ages of 9 – 16 years old .
A strong pull is a result of sports that exerts a quick, strong contraction of the quadriceps, like soccer, martial arts, basketball, etc.
The effect on the tibial tubercle has an avulsion-fracture like effect with would cause an inflammation of the periostium (a tough membrane covering the bone). Wit a highly involved child, this effect is magnified as the action is repeated.
The frequency and repetitive nature of participating in a beloved sport does not allow the periostium to heal and causing a chronic inflammation and the prominence of the tubercle. This leads to a constant, persistent pain, especially on impact. This pain will not only limit the child’s performance in the sport, preventing them from excelling, it would also cause a lot of inconviences later on in their growing years.
Management
When one complains over pain over the tibial tubercle, it’s highly advisable to follow the RICER principle (Rest, Ice, Compression, Elevation, and Referral).
A sports physician might manage the pain with oral NSAIDs or injecting the NSAIDs directly over the painful area.
Another alternative management by a sports physician is an ultrasound guided Extracorporeal Shock Wave Therapy (ESWT). This would breakdown the scarred tissues and allows for the tubercle to heal.
Stretches and improving muscle control are common physiotherapy management for OSD. The use of ultrasound may also be used by the physiotherapist to manage the pain and swelling. Assessing for biomechanical factors that may cause OSD are also done by sports physiotherapists to prevent recurrence of the pain and to maximize the child’s performance in their sport.
Prevention
The best way to prevent the onset of OSD is to ensure adequate stretching of the quadriceps and also to ensure good control of the quadriceps. Adequate prehab should thus be a key before starting any form of sport.
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