A common cause of knee pain in adolescents is Osgood Schlatter Disease (OSD). Excessive tension in the quadriceps (front of the thigh) causes a pull on the top of the shin. The point at which these muscles join the bone is the site of a growth plate. As a result, this area is particularly susceptible to change. Tension causes inflammation and pain at the growth plate, and causes the bone to grow outward slightly. Once the condition subsides, the bony prominence remains, but is otherwise asymptomatic. Roughly 10% of adolescents develop the condition, so a significant proportion of adults have the lasting prominence.
Symptoms of Osgood Schlatter Disease
The primary complaint of OSD is knee pain just below the knee cap. This may be worse during or after exercise, but may also be aggravated by rest. Pain first thing in the morning is not unusual. Symptoms might be eased by stretching or using ice on the painful area. Heat is sometimes relieving if applied to the tight muscle, not the painful area.
There may be visible swelling at the front of the knee, which is tender when pressed. Pain while kneeling may be an early symptom of the condition. Tightness of both the quadriceps and hamstrings (at the back of the thigh) can occur.
Risk Factors
OSD develops in adolescents who have not yet finished growing. Once the growth plate has ossified (turned to bone), the process cannot happen. There is a broad window of time in which ossification can happen: anywhere between 12 and 19 years old is considered normal. OSD is typically diagnosed around 10-14 years old, with girls developing it younger than boys.
As symptoms are made worse by exercise that puts demand on the quadriceps, exercise is considered a risk factor. Sports that involve a lot of jumping or sprinting can be particularly irritating to the knee. Picking up a new sport or suddenly increasing the intensity or frequency can play a role. Young footballers are often affected, and may avoid treatment in case their club finds out. You can trust that all aspects of your appointments with us are completely confidential.
There is also a strong association with growth spurts, which is another reason that girls and boys are affected at slightly different ages. If the thigh bone grows quickly and the quadriceps can’t keep up, there will of course be additional tension in the muscle. OSD is self limiting as the quadriceps grow and the shin bone ossifies.
Managing Osgood Schlatter Disease
Evidence suggests that stretching can help to manage the condition. Your osteopath can provide your child with an exercise plan, as well as offering hands-on treatment in clinic. Advice about using heat or ice is also within our remit, but we cannot advise about the use of painkillers.