Osgood Schlatter : growing knee pain and osteopathy

Osgood and Schlatter were the two people who identified this condition and described it for the first time in 1903.

Osgood Schlatter's disease is one of the growth pathologies of children and more particularly of adolescents. It is characterized by pain at the insertion of the patellar tendon on the anterior and superior part of the tibia, which is called the anterior tibial tuberosity or ATT.

This pathology, although painful and embarrassing, is benign and improves spontaneously in 98% of cases.

Osgood Schlatter can affect all children, however, this pathology more often affects adolescents (about 4%) and more particularly sports children (20%). Boys are more frequently affected than girls.

Some sports have a higher risk of developing this pathology, these are sports in which there is a lot of impulse, jumping/reception and flexion-extension. Here are some examples:
- Soccer
- Track and field
- Gymnastics
- Basketball
- Tennis, etc.

The causes of osgood schlatter are numerous; they correspond to all the mechanisms that are likely to cause too much traction on the tendon and therefore to pull on its disc insertion at the tibia. Indeed, when a child grows, it is first the bone that pushes and then the muscles will follow and grow as they are stretched. In non-sporting children, the onset of this pathology is rare and growth occurs with little pain. However, in children who are athletes, when running, jumping, etc., the muscle already under tension due to the fact that the bone is larger will pull even more. And by dint of being stressed, it will pull on its distal attachment to the anterior tibial tuberosity and may even tear it off.

Factors that increase the risk of developing Osgood Schlatter include:

• Rapid growth
• Sports:
  • Too intensive practice,
  • Lack of physical condition,
  • Poor technique in the practice of the sports gesture
  • Practical on a hard floor,
  • Unsuitable shoes.
• No stretching (cold)
• Possibly patella alta, i.e. patella too high
• Static knee disorders such as genu valgum or varum
• Poor diet, deficiencies in vitamin D, etc.

The clinic makes the diagnosis of Osgood Schlatter.

Nevertheless, an X-ray can be performed to visualize the severity and to adapt the management.
Ultrasound also highlights this pathology.

The quadriceps muscles are muscles located on the anterior aspect of the thigh that end in a common tendon called the quadricipital tendon, which extends into the patellar tendon and then inserts onto the TTA. The goal in the management of knee growth pathology is to grow the quadriceps so that it pulls less on its tendon.

In order for the muscle to grow, it is necessary to stretch and stimulate it, but gently and in a non-traumatic way so that it does not pull on its attachments but only on its muscle fibers.

X-shaped knees (valgum) or varus knees are examples of static disorders that increase the tension on the patellar tendon. A podiatric assessment with possible inserts is recommended to limit the traction of the tendon on the bone.

Shoes alone can be a source of pathology, it is necessary to choose them well according to the activity but also the type of ground. For example, soccer shoes on synthetic surfaces are not the same as those on grass.

The goal in osteopathy is to harmonize the body as best as possible to allow it to function optimally. 

In prevention as well as in the treatment of an injury, the osteopath will test the different joints of the patient and treat all imbalances.

In Osgood Schlatter's pathology, the osteopath will try to restore good mobility to the affected knee but will also treat the repercussions on the rest of the body. The practitioner also has an advisory role regarding stretching, exercises, etc.

In case of a bone tear (very advanced stage of Osgood), it is however recommended to wait before consulting an osteopath as in the case of fractures. If in doubt, do not hesitate to ask your osteopath.

The kinesio taping bands are effective to relieve the patient, they improve the drainage of the inflammation but also limit the traction of the tendon on the tibia.

These strips can be applied at the onset of symptoms or upon resumption of activity. They are water resistant and can be kept for 5 days. 

Immobilization is very rarely necessary and may instead slow down the treatment.

As explained above, the quadriceps muscle needs to lengthen and for this it needs to be stimulated and stretched gently without forcing but immobilization would prevent this muscle from working and when the young person resumes activity the pain will return very quickly and worse.

However, the activity must be reduced to limit the traction of the tendon on the bone. The priority is to stretch the muscle fibers.

In cases of bony tearing or very advanced stages, immobilization with a splint is essential because it is imperative to prevent the patellar tendon from pulling on the tibia. Immobilization can be variable and can last up to 6 months. After the immobilization, it is recommended to consult an osteopath and to benefit from a follow-up in physiotherapy. In all other stages, the activity must be adapted but continued with possibly a short rest.

Surgery is extremely rare, and if it must be done at all, it is only done after growth is complete. The purpose of this procedure is to remove the excess bone tissue from the APD, which is called the Thomson technique. There are other techniques with mixed results.

Marie Messager
Osteopath D.O
in Versailles Chantiers
78000 - Yvelines