Osgood Schlatter Disease-It Hurts When I Jump!

Osgood-Schlatter disease occurs in adolescent athletes during growth spurts.  As my young cousin Kendyll can attest it hurts! Often found in running athletes like soccer and basketball players OSD can be frustrating to children throughout their childhood until they reach skeletal maturity.

The bones of the body grow in areas called "growth plates."  Growth plates are cartilage collections located at the ends of bones. These centers for growth are the last portion of the bone in children to harden--which occurs at skeletal maturity.  Because the cartilage is softer then the surrounding bone, injury is more likely to happen in these areas. OSD is inflammation of the growth plate just below the knee cap.

Figure #1

The tibia is the shin bone in the lower leg.  It helps form the knee joint and contains a growth plate just below the knee.  The growth plate is at a site called the "tibial tubercle"  a tubercle in the body means a bump in the bone that has a tendon attached to it. Note in figure #1 that the patellar tendon attaches to the tibial tuberosity. As a young soccer player repeatedly runs or jumps the patellar tendon pulls on the growth plate on the tibial tuberosity and can cause pain and swelling. (Figure #2)     

Figure #2

Treatment can include nonoperative management with rest, stretching, strengthening, physical therapy, anti-inflammatory medications, ice, and bracing with a Cho-Pat strap.  The Cho-Pat (figure #3) strap places pressure on the patellar tendon during activities and can provide some relief.       

Figure #3

Unfortunately, even with treatment symptoms may continue to come and go until the child reaches full bone growth.  This maybe be anywhere from around age 14-16 depending on sex.  Even with the resolution of symptoms individuals may have a prominence of the tibial tubercle for their entire life.  This is caused by the trauma to the growth plate which may never totally fuse to the bone underneath.  This is called a "fibrous union" meaning that the growth plate is held on by tough tissue rather then bone. Adult patients usually have no symptoms related to the non-fused growth plate.   

Very often we xray patients in the office and see old evidence that they had OSD as a child.  It no longer effects them but they may have some bulging of the tibia in that area.  Their xray looks like figure #4. Note that the tibial tubercle is slightly separated from the rest of the tibia.  A minority of adults may have some pain with kneeling in this area, and rarely have the small bone growth removed surgically if symptoms are severe.   

Figure #4

Osgood-Schlatter disease can be a struggle for children until they reach the end of their growth.  However with some activity modifications and treatment they are able to have a full active childhood.  Once they achieve full bone maturity they rarely have continued symptoms and can continue with an active adult life.  

Next Topic: How nutrition can help in the healing process. It really is what you eat!

Sources:
http://kidshealth.org/parent/general/aches/osgood.html#   


http://www.mayoclinic.org/diseases-conditions/osgood-schlatter-disease/basics/definition/con-20021911

You Are An Ironman...

An Ironman is a 140.6 mile race that most would agree is the ultimate test of will and endurance.  2.4 mile swim, 112 mile bike, and 26.2 mile run--it's all a bit crazy isn't it?  Well for the last year everyone in our office has been a witness to the preparation, skill, and unbelievable determination it takes to compete an Ironman Triathlon. My friend, and our co-worker Elise just finished her first and we all couldn't be more proud of her.  I thought this might be a good opportunity to both congratulate Elise, as well as use her as an example of cross-training at its extreme.

We often have patients that are runners, this may consist of anyone from someone training for their first 5K to competitive club triathletes like Elise.  The runner may have a variety of lower leg complaints depending on their level of conditioning.  A few of the most common are anterior knee pain and medial tibial stress syndrome (shin splints).  Anterior knee pain is pain over the front of the knee in the area of the knee cap also know as the patella.

The patella is positioned in the front of the knee and has attachments for the quadriceps tendon at its superior portion and the patellar tendon at its inferior. The patella is involved in the flexing and bending of the knee, and with repetitive motions both the patella and the groove it sits in can become irritated or damaged.  As you can image running is one of these activities, actually any activity that involves flexing your knee puts pressure on the knee cap. Squatting, kneeling, jumping, running, wearing high heels (mom :) all put increased pressure on your patella.  In order to treat pain involving the patella you have to first find the reason for the pain.  This can include weakness in muscle groups around the knee, wear in the cartilage on the patella, patella alignment issues, or even modifying the very activities we love to do.  


Medial Tibial Stress Syndrome (MTSS) is what many of know as shin splints.  Symptoms include a painful inflamed area along the inside border of the shin bone (tibia).  Often the person experiencing these symptoms has recently changed their level of activity in some way.  I personally experienced MTSS in high school basketball after running on our hard court/hallways.  As medical providers we always have to remember to rule out a stress fracture in anyone that has the symptoms of MTSS.  There is too much overlap in the symptoms and if you ignore MTSS it can lead to a stress fracture.  If x-rays are negative for fracture treatment will often consist of ice, rest, stretching, possible physical therapy, and modification of activities, as well as a good foot wear analysis.    

 

Standing with her finisher medal

I always tell you about the conversations I have on a daily basis with patients.  Activity modification is another common topic.  This is where Elise comes to light again--Swim, Bike, then Run.  I am a strong supporter of cross-training to allow the knee to recover after activity.  Runners love to run!  However, for the life of a knee taking miles off of the joint with none pounding exercise like swimming, elliptical, and cycling is important.  I consider these "knee friendly" cardio conditioning.  Perhaps if more of our runners turned into triathletes we would have less knee pain.  Will we ever know?


Next Blog Topic: Osgood Schlatter Disease-It Hurts When I Jump!

Elise crossing the finish line.