I certainly see quite a few boys with knee pain in the clinic and the following is quite a common diagnosis.

Osgood-Schlatter disease is a self limiting, overuse injury that occurs in the knee area of growing adolescents. It is more common in boys and is caused by inflammation of the tendon below the kneecap (patellar tendon) where it attaches to the shinbone (tibia). This tendon becomes inflamed and micro-fractures of the tibial head can result.

The condition tends to occur during the adolescent growth spurt often between the ages of 10 and 15 years for boys. At this time the bones, tendons and muscles grow quickly but not always at the same rate. With exercise, differences in size and strength between the muscle groups place unusual stress on the growth plate at the top of the shinbone.

The body repairs the fractures by laying down extra bone tissue. The result is a larger than normal bump at the tibial head.

Young adolescents who participate in certain sports, including soccer, gymnastics, basketball, and distance running, are most at risk for this disease. It usually occurs in one knee but can occur in both.

Symptoms

• Pain and swelling below the knee.
• Gradual onset.
• Relieved by rest and made worse by activity, particularly running   or jumping.
• Tightness of the muscles around the knee especially the Quadriceps.
• Pain is provoked by knee extension against resistance.

Treatment

• Most adolescents respond to conservative management consisting of rest from painful activities and use of ice packs to settle the inflammation.
• Once symptoms have decreased to a reasonable level, low-impact quadriceps exercises can commence before gradually increasing the intensity of exercise. If symptoms recur, patients should stop exercises or reduce their intensity.
•  A good stretching program, focusing on the hamstring and quadriceps muscles, before and after activity is important.
•  An over-the-counter pain medicine, such as ibuprofen, or prescription anti-inflammatory medicines may be used.
• Referral to a physiotherapist can be beneficial to manage rehabilitation, particularly if recovery is slow. Taping or a knee strap may be recommended to distribute the stress on the shin bone.

Complications are rare but about 60% of adults who had OSD as kids experience some pain with kneeling.

Margaret Bates
School Nurse