Osgood-Schlatter Disease: Physical Therapy, Recovery Time

Have you or your child been diagnosed with Osgood-Schlatter disease?

Chances are you’ve never heard of it before…

As a physical therapist, I answer the most frequently asked questions about the treatment, how long it lasts, whether diet plays a role, whether it’s possible to do sport and how.

♻️ Last update: October 26, 2024.
👩‍⚖️ Declaration of financial interests: amazon affiliate link. My complete declaration of financial interests is in legal mentions.
Written by Nelly Darbois, physiotherapist and scientific editor

How can you be sure it’s Osgood-Schlatter disease?

Osgood-Schlatter disease (knee pain) occurs mainly in growing children and adolescents, generally between the ages of 10 and 15.

It occurs when the tibial tuberosity, the point of attachment of the patellar tendon to the tibia, becomes irritated or inflamed due to repeated strain caused by physical activity.

A simple clinical examination and questioning may suffice for the diagnosis to be made by the attending physician.

X-rays are sometimes performed if there is any doubt about the diagnosis, particularly to rule out fractures or other bone problems.

The symptoms are very characteristic:

• Pain in the knee (generally below the kneecap), especially during physical activity (running, jumping, climbing and descending stairs).
• Sensitivity or pain on pressure on the tibial tuberosity, just below the patella.
• Discomfort or pain when moving, especially when kneeling, squatting or standing up.
• Stiffness in the knee, especially after resting or waking up in the morning.
• Slight swelling around the tibial tuberosity.
• Pain on one side only: only in 2 to 3 out of 10 children are both knees affected (bilateral Osgood-Schlatter).
• First appears between the ages of 10 and 15.

What causes it?

Here are the characteristics often (but not always) found in children and adolescents diagnosed with Osgood-Schlatter:

• be male;
• between 10 and 12 years old for girls, 12 and 14 years old for boys;
• to have grown a lot at once;
• intense or excessive sporting activity involving repetitive running and jumping, such as basketball, soccer, track and field, running and gymnastics;
• more anatomical factors (Lucenti 2022).

Source : James 2023

What treatment should I use?

There are around 300 scientific publications on this syndrome.

I identified the most relevant studies to identify the most studied treatments, or those for which the patients I met had the most questions.

Here’s a summary.

Note that there are very few studies comparing the efficacy of one type of management with another, or with doing nothing in particular.

Osgood-Schlatter disease is treated in two main ways:

1. adapt the level of physical activity ;
2. relieve pain.

Resting

In the case of Osgood-Schlatter disease, pain is often accentuated when the child is on his or her feet, particularly when walking, running or jumping for long periods. The mainstay of treatment is therefore relative rest.

Recommendations vary considerably:

• Some doctors recommend a total halt to sporting activities, both in and out of school;
• others adopt a more liberal approach, allowing moderate sporting activity.

✅ Tip: If your child agrees to stop sport altogether, you can do so for a month (the time it takes to calm the inflammation), followed by a gradual resumption. During this period, gentle activities can be considered, as long as they don’t cause pain.

If stopping sport is a tragedy for your child, it is possible to allow him/her to practice, provided he/she is able to adapt the intensity and frequency of activity to his/her pain.

Stretching

Stretching of calf muscles (such as the sural triceps and gastrocnemius) and thigh muscles (quadriceps, hamstrings) may be recommended to help relieve pain associated with Osgood-Schlatter disease.

Here are a few advantages and disadvantages.

✅ Benefits

• Stretching can help relax muscles and tendons, reducing pressure on the painful area.
• They help keep the knee supple when it stiffens.

❌ Disadvantages

• There is no clinical evidence that regular stretching leads to a reduction in pain or a quicker return to sporting activities.
• Stretching can be strenuous, especially for children, and can aggravate inflammation.

Splint, knee brace, orthosis

The use of knee orthoses applying pressure to the patellar tendon can help reduce the tensile load exerted on its insertion point.

This is a theoretical assumption, for which there is no really good empirical evidence.

Medicines

Non-steroidal anti-inflammatory drugs (NSAIDs) can be prescribed to relieve pain, although they have no curative effect. The same applies to other analgesics.

Applying cold can sometimes be a sufficient alternative. TENS can also be tried out.

Physiotherapy treatment

Physiotherapy sessions are sometimes recommended, but approaches can vary.

• Some physiotherapists prefer stretching and muscle strengthening.
• Others focus on pain relief through techniques such as kinesiotaping, cryotherapy or massage.

Your physiotherapist can help you adapt your child’s physical activity to his or her needs and abilities: in my opinion, this is the main advantage of physiotherapists, as it’s often something difficult to do yourself.

Power supply

There is no evidence of a direct effect of diet on this syndrome (apart from general advice on healthy eating):

• adequate protein and carbohydrate intake,
• consumption of vitamins thanks to fruit and vegetables,
• good hydration,
• avoid excess weight, which increases stress on the bone.

What sports are allowed?

No sport is formally contraindicated in cases of Osgood-Schlatter.

Those most at risk of increasing pain are all those involving jumping: gym, trampoline, athletics, dance, etc.

And the ones least at risk are those that take the strain: swimming, water polo, synchronized swimming, cycling, etc.

It ‘s a question of adapting the frequency of training and the intensity of sessions to what is bearable, whatever the sport envisaged.

Changing sporting activity remains a possible scenario, but there is no formal contraindication.

How long does the pain or discomfort last?

A research team followed 50 people who had been diagnosed with Osgood-Schlatter but were not receiving treatment:

• 8 out of 10 were unhindered in their activities: half of them only felt some discomfort when kneeling, the other half none at all;
• a minority had patella pain or instability;
• half had X-ray breaks in bone continuity at the tibial tuberosity, while the other half had only soft-tissue swelling in this area.

What does it mean? It’s possible to have Osgood-Schlatter disease without experiencing pain. If pain does appear, it can disappear even before the structural problem is over (= before the end of growth), and sometimes even without specific treatment.

Are there any possible complications?

There are no serious complications, even with the continuation of sports that aggravate symptoms.

The only complications described are :

• increased pain, which can sometimes also occur at rest and at night, without doing anything;
• aesthetics: the tuberosity

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That’s all I wanted to say on the subject! Any questions or comments? See you in comments!