This was a question from a parent about their 12 year old son who was a middle school basketball player. The parents were very anxious to have him return to play. The kid was not as excited. For one, his knees did hurt and two, he actually preferred playing soccer. However, if his knee pain didn’t decrease, he probably wouldn’t end up playing soccer either.  Read on to learn about Osgood Schlatter disease treatment and causes
So what is the bump?
To understand the bump. We need to review some adolescent knee anatomy. The adolescent knee has growth plates near the ends of the long bones of the body. The growth plates are cartilaginous discs that will later harden into bone once the child is no longer growing.  For the knee this includes the tibia (the shin bone) and the femur (the thigh bone). Growth occurs at the ends of the long bones around the growth plates.  Toward the end of the tibia, just below the knee joint, is a bony bump called the tibial tubercle. The tibial tuberocle is entirely cartilaginous before age 10-11 and begins to harden into bone in adolescence. It also has a growth plate which attaches it to the tibia.  This growth plate is called an apophysis.
The quadriceps muscle is the large muscle on the front of the thigh. It is made up of four muscles that create a common tendon called the patellar tendon. The patellar tendon attaches to the tibial tubercle. With repeated use of a tight quadriceps muscle, inflammation and microvascular tears occur at the apophysis of the tibial tubercle. This results in pain, swelling, and tenderness at the patellar tendon and tibial tubercle. This is called tibial tubercle apophysitis or, it is more commonly known as, Osgood Schlatter’s disease.
Tell me more about Osgood Schlatter’s Disease (OSD)
Osgood Schlatter’s Disease is an overuse injury. It occurs in active adolescent kids and is one of the most common causes of knee pain in this age group. It usually only affects one knee but can be present in both. It normally occurs after a growth spurt. The long bones lengthen faster than the muscles can stretch. With repeated contractions of a tight quadriceps muscle, especially with sports, the patellar tendon will pull on the tibial tubercle. This causes pain and swelling right below the knee cap because the tibial tubercle is not fully fused to the tibia. There may also be a hard raised bump that forms in the area. The good news is that this is a self-limiting condition. It will stop once the tibial tubercle is fused to the tibia. This typically happens at ages 10-12 in females and 12-14 in males.
What ages does OSD affect?
OSD occurs in adolescence as the tibial tubercle is hardening and the growth plates are still open. This is different for girls and boys.
- For females, ages 8-13
- For males, ages 10-15
What sports can lead to OSD?
Any sport that requires a lot of running and jumping can lead to OSD. Unfortunately that is a lot of sports. Here is a list of common sports that might lead to OSD.
- Basketball
- Football
- Gymnastics
- Volleyball
- Track and field
- Soccer
- Cross country
Can anything serious happen if my kid keeps playing?
In the vast majority of cases OSD doesn’t lead to anything more serious than swelling, pain, and a large bump on the shin. However in very rare cases it can cause an avulsion fracture of the tibia tubercle. This is where the tibial tubercle breaks away from the tibia. This occurs almost exclusively in males because of their increased quadriceps strength.
How long will this last?
As previously mentioned this is a self-limiting condition.  It will end when the tibial tubercle fuses to the tibia which is around ages 10-12 in females and 12-14 in males. If properly treated, the pain and inflammation can be controlled until this occurs.
What can we do to?
There are many things that can be done to help decrease the pain and swelling.
- Take a break – The first and best thing to do is to stop doing whatever is causing the pain. This is most likely a sport. I am not saying that the child has to give up the sport but taking a break is a good idea. This might be for a week or two or, maybe, a month or two. This gives the knees some time to heal, and also time to stretch the quadriceps to decrease its pull on the shin bone.
- Taking a break may not be necessary if the OSD is very mild. This means that the pain during and after play is very mild and goes away an hour or two after play. It also means that the pain does not cause a limp or change the way the child runs or walks. Keep in mind that mild pain can get worse if not treated so don’t ignore pain just because it is not interfering with play. Take the steps outlined to help decrease the mild pain and prevent it from becoming worse.
- Relative rest – Relative rest is participating in an activity or sport that does not bother an injury. Switching to a sport that is not so irritable to the knees is also an option. You can always return to your previous sport at a later date if desired. Also it is not advisable to have kids specialize in a sport at this age so getting them involved in a different sport that is less irritating to their knees is a good way to practice relative rest. Swimming is very good for OSD because it is less stressful for the knees but very strengthening for the body.
- Ice – Ice is a natural anti-inflammatory and works great at decreasing pain and swelling. Ice with an ice pack immediately after activity. This includes after practice, games, or even running around outside. Ice for about 15 to 20 minutes. Ice several times a day if the pain is more constant and is occurring with walking or going up and down steps.
- Stretching – Stretching the quadriceps can decrease the pull on the tibial tubercle and help decrease the pain and inflammation. The hamstrings and calf muscles are also probably tight since have not had time to lengthen in relation to the bone growth.  Below is a video on stretching the hamstrings, quadriceps, hip flexors, and calves.  You will need a stretch strap, dog leash, yoga strap, or something similar.
- Bracing – Using a knee sleeve or infrapatellar strap might help take the some pull off of the tibial tubercle.
- Physical therapy – Physical therapy is a good option to help decrease the pain and inflammation and also teach exercises to help lengthen and strengthen muscles.
In review
- OSD is an inflammation of a growth plate at an area of the shin bone called the tibial tubercle.
- Symptoms include pain, swelling, and possible bump below the knee cap.
- It typically occurs during a growth spurt.
- It is caused by repetitive running and jumping.
- It is self limiting and will stop when the tibial tubercle fuses with tibia in adolescence.
- There are many things that can be done to control the pain and swelling.
As always, If you have questions about the content of this post or any other musculoskeletal questions, please e-mail me.
Additional resources
https://www.physio-pedia.com/Osgood-Schlatter_Disease
https://www.ncbi.nlm.nih.gov/books/NBK441995/
https://www.choosept.com/guide/physical-therapy-guide-osgoodschlatter-disease