Osgood Schlatter

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What is Osgood-Schlatter disease?

Osgood-Schlatter disease is an inflammation and painful enlargement of the tibial tuberosity – a bony bump, just below the knee joint, where the patella tendon connects to the shinbone. Osgood-Schlatter disease occurs most frequently between the ages of 9 and 13, and usually in a period of rapid growth. Boys have a much higher risk of developing Osgood-Schlatter disease than girls. In 25% of cases, the condition affects both knees.

How can it occur?

Osgood-Schlatter disease is related to a number of predisposing factors but often appears as an overuse injury from intense ballet training. A dysfunction of the quadriceps, causing abnormal tension in the patellar tendon and high traction forces on its insertion site can typically be found in an acute episode of the condition.
Muscle dysfunction can appear as muscle tightness (contraction) or weakness (inhibition). Typically, the outside muscles of the quadriceps (vastus lateralis and rectus femoris) will be tight, whereas the vastus medialis on the inside will be weak in an overuse situation. As a result, the patella will be pulled to the outside of the trochlear groove and the patellar tendon will be loaded asymmetrically. This can lead to local inflammation of the tendon, especially on its bony insertion sites. In the long run, strong pulling on the growth area of the tibial tuberosity can cause bony deformation typical for Osgood-Schlatter disease.
Muscle overuse often occurs when the body fails to compensate for existing muscle dysbalance. Muscle dysbalances are very common and naturally occur as the body adapts to specific training demands over time. As long as compensation is effective – or, in other words, as long as the dysbalance is well managed by the body – this need not cause any problems. However, with high training loads, insufficient rest or after a minor injury, the body may struggle to compensate, leading to muscle dysfunction in the various muscle groups involved in the compensation. This is why symptoms may simultaneously occur in different parts of the body in an overuse situation.

What are the typical symptoms of Osgood-Schlatter disease?

Symptoms range from a stinging sensation in the front of your shin bone to swelling of the tissues around the tibial tuberosity and the occurrence of a painful lump. Pain may worsen when you keep your knee in a bend position for a longer time.

How can Osgood-Schlatter disease be diagnosed?

Your doctor will examine your knee and review your symptoms as well as your current training activities. He will especially check for swelling, bone abnormalities and pain around the tibial tuberosity. He will also put a focus on joint range of motion, leg alignment and knee stability. Correct diagnosis of this issue demands a thorough functional clinical examination, including specific tests to identify joint and muscle dysfunction. Finding out the exact causes of patellar subluxation is sometimes challenging and your doctor may ask a specialist in manual medicine for his opinion.
An X-ray of both knees is usually performed to find out about bony deformation that is typical for Osgood-Schlatter disease. The final diagnosis is often based on the X-rays taken.

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This side-view X-ray of the knee shows bone fragments at the tibial tuberosity that are typical for the Osgood Schlatter disease.

What are the treatment options?

If you have severe or constant knee pain, you should take a break from your ballet training immediately. Ignoring the pain can have serious consequences, as the situation will become increasingly complicated the longer you train with pain.
The RICE concept (rest, ice, compression and elevation) is an easy guideline that can be used to initially treat acute as well as overuse injuries. Please read my “First Aid” post to obtain some background information that you will need to adapt this concept successfully and learn about the use of painkillers.
In order to handle a given overuse situation successfully, its underlying causes – namely muscle dysfunction and muscle dysbalance – have to be addressed specifically in the rehabilitation process. Muscle dysfunction can appear as muscle tightness (contraction) or weakness (inhibition) and the muscles affected have to be treated accordingly in the rehabilitation process. Some muscles will have to be stretched whereas others will rather have to be strengthened. A well-suited training program including corrective exercises as well as a general strengthening and endurance routine is the most effective way to deal with most overuse situations.
Manual medicine and especially deep myofascial release treatment is recommended to address present joint and myofascial dysfunction. Dysfunction of the fascia plays a key role in all overuse issues and can be addressed effectively with manual medicine. Ensure that you follow your specific training routine after the rehabilitation is finished. Myofascial rollers (Blackroll, Triggerpoint Roll, etc.) as well as Lacrosse balls and resistance bands are easy to use in the studio and will help you remain balanced in the long run.
Special braces exist, that temporarily reduce the traction on the tibial tuberosity by applying local pressure on the patella tendon. These “patellar straps” can be used during ballet training as well.
Pain from Osgood Schlatter disease usually resolves with treatment but may reoccur until you are fully grown. In less than 10% of patients the symptoms continue into adulthood, despite all therapeutic measures and may need surgery.

Next steps

Do you think that you might have Osgood Schlatter disease and want to have it sorted out? These are the next steps:

  • See a doctor

Dancers seek help from various different kinds of therapists, many of whom may employ treatments that are outside of mainstream medicine. Before considering the use of such alternative medicine, you should see a doctor for an evaluation and diagnosis.
Finding a doctor who is familiar with the specific medical issues faced by dancers is often challenging and you may need to see several different specialists in order to get a full picture of your diagnosis. A good place to start is to ask your friends and fellow dancers for the names of their favorite doctors.

  • Find a specialist in manual medicine

Doctors who specialize in manual medicine practice a whole-body approach. They will try to identify and specifically treat the underlying causes of your problem, rather than just the localized symptoms. This approach is important in addressing all aspects of the often very complex overuse problems that dancers experience. A specialist in manual medicine will perform a functional examination on every part of your body and will treat you according to these thorough findings.
To find a physician who specializes in this field, search for “Manual Medicine”, “Osteopathic Manipulative Medicine” or “Osteopathic Physician” on the internet.

  • Start working on your problem

There is a lot that you can do to work on your problem after a proper diagnosis has been set. Ultimately, it often comes down to addressing the same fundamental issues. Here are some useful exercises that I recommend to my patients:

Flexibility trainingITB release, Rectus femoris release, Hamstrings release, Adduktor release, Psoas stretch, Lumbar spine releasePiriformis release,

Strength training: Core training – resistance band workout, Core training – Abs crunches, “The clamshell” – Piriformis training, “The monster walk” – Piriformis training

Please refer to your doctor to confirm that the exercises you choose to do are suited to your individual problem, and obtain supervision from a professional trainer to ensure that you are performing them correctly.

  • Talk to your ballet master or dance teacher

Technical issues and faulty dance technique are important predisposing factors of overuse and injury in dancers. Amending dance techniques often plays a crucial role in the treatment and prevention of overuse and injury and you should not hesitate to address any issues, if necessary.


 

 


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