Cause
Repetitive stress or injury to the growth plate of the tibial tubercle results in
inflammation and subsequent pain
The injury has a waxing-and-waning course. Even after pain has subsided for some
time, repetitive stress can cause a flare-up
Risk factors
Activities that involve jumping and/or jogging
Boys, especially those between the age of 11 and 18
Rapid skeletal growth
Poor physical conditioning
Symptoms
Swelling, warmth, and/or tenderness below the knee
A firm bump under the knee that is exquisitely tender to touch
Pain with activity, especially with knee straightening or vigorous activity
Diagnosis
Diagnosis of Osgood-Schlatter disease is made primarily by physical exam
The difficulty may be present with a straight leg raise, especially against resistance
The area of skin overlying the tibial tubercle may be enlarged and firm. This area is
also exquisitely tender to touch
Radiographs may be used to rule out underlying fractures or other bony injuries in
the area
Prevention
Weight loss to acquire a proper body mass index for age and
height
Warm-up and stretching before partaking in physical activity.
Warming the area with a hot compress or shower may improve
stretching
Maintaining appropriate flexibility, endurance, and muscle
strength
Avoidance of open kinetic leg extensions (such as extending the
knee in the sitting position against resistance)
Treatment
Initial treatment of this injury consists of the modification of
activities, ice, stretching, strengthening exercises, and pain medications
Activities such as kneeling, jumping, squatting, stair climbing, and running should be
avoided initially
Ice should be applied for 15-20 minutes to the affected knee every 2 to 3 hours as
needed to help reduce inflammation and pain. Similarly, the application of a heat pack
can be applied to the area before participating in activities or exercises
Your physician can provide a set of at-home exercises to help
improve strength and flexibility. In some instances, a referral
to physical therapy or an athletic trainer is needed to
augment treatment
Pain medications such as nonsteroidal anti-inflammatories
(like ibuprofen or naproxen) or acetaminophen can be used
to relieve pain and irritation. These medications should be
taken as directed by your physician
A patellar band, which is a brace situated between the tibial
tubercle and the kneecap may help relieve symptoms
In rare instances, surgery is necessary if conservative
treatment has failed. A trial of immobilization with an elastic
knee support, cast, or splint may be tried for 6 to 8 weeks
before considering surgery
Complications of this condition include the persistence of a
bump overlying the tibial tubercle, reoccurrence in
adulthood, tearing away (avulsion) of the growth plate from
the tibia
RANGE OF MOTION AND STRETCHING EXERCISES • Osgood-Schlatter
Disease
These are some of the initial exercises you may start your rehabilitation program with until you see your physician, physical therapist, or athletic trainer again or until your symptoms are resolved. Please remember:
Flexible tissue is more tolerant of the stresses placed on it during activities.
Each stretch should be held for 20 to 30 seconds.
A gentle stretching sensation should be felt.
Hamstring Doorway Stretch (fig. 3)
1.
Lie on your back near the edge of a doorway as
shown.
2.
Place the leg you are stretching up the wall
keeping your knee straight.
3.
Your buttock should be as close to the wall as
possible and the other leg should be kept flat on
the floor.
4.
You should feel a stretch in the back of your thigh.
5. Hold this position for 30 seconds.
6. Repeat exercise 2 times, 2 times per day.
Hamstring Ballet Stretch (fig. 2)
1. Stand and prop the leg you stretch on a chair,
table, or another stable object.
2. Place both hands on the outside of the leg you are stretching.
3. Make sure that your hips/pelvis are also facing the leg you are stretching.
4. Slide your hands down the outside of your leg.
5. Lead with your chest/breast bone. Keep your chest upright and back straight. Do not hunch over at the shoulders. Keep your toes pointing up.
6. You should feel a stretch in the back of your thigh.
7. Hold this position for 30 seconds.
8. Repeat exercise 2 times, 2 times per day.
Prone Quadriceps Stretch (fig. 1)
1. Lie on your stomach as shown.
2. Bend your knee, grasping your toes, foot, or ankle.
If you are too “tight” to do this, loop a belt or towel
around your ankle and grasp that.
3. Pull your heel toward your buttock until you feel a
stretching sensation in the front of your thigh.
4. Keep your knees together.
5. Hold this position for 30 seconds.
6. Repeat exercise 2 times, 2 times per day.
Strengthening Exercises for Excessive Lateral Patellar Compression Syndrome. These
are some of the initial exercises you may start your rehabilitation program with until you
see your physician, physical therapist, or athletic trainer again or until your symptoms are
resolved. Please remember:
Strong muscles with good endurance tolerate stress better.
Do the exercises as initially prescribed by your physician, physical therapist, or athletic trainer. Progress slowly with each exercise, gradually increasing the number of repetitions and weight used under their guidance.
Only do your exercises in a pain-free range of motion. If the exercises that involve bending your knees while bearing weight cause pain, stop them and consult your physician, physical therapist, or athletic trainer.
Quadriceps Short Arcs (fig. 4)
1. Lie flat or sit with your leg straight.
2. Place a 3-5 inch roll under your knee, allowing it to bend.
3. Tighten the muscle in the front of your knee as much as you can, and lift your heel off the floor.
4. Hold this position for 30 seconds.
5. Repeat exercise 2 times, 2 times per day.
If okayed by your physician, physical therapist,
or athletic trainer, a 2-5 pound weight, maybe
placed around your ankle for additional weight.
Quadriceps Isometric Contraction (fig. 6)
1. Lie flat or sit with your leg straight
2. Tighten the muscle in the front of your thigh
(Quads) as much as you can, pushing the back of
the knee flat against the floor. This will pull the
kneecap towards the head
3. Hold the muscle tight for 20-30 seconds
4. Repeat exercise 10 times, 3 times per day.
Quadriceps Leg Lift (fig. 5)
1. Tighten the muscle in front of your thigh as
much as you can, pushing the back of your knee
flat against the floor.
2. Tighten this muscle harder.
3. Lift your leg/heel 4 to 6 inches off the floor.
4. Tighten this muscle harder again.
5. Lower your leg/heel back to the floor. Keep the muscle in front of your thigh as tight as possible.
6. Tighten this muscle harder again.
7. Relax.
8. Repeat exercise 3 times, 2 times per day.
Strengthening Exercises for Excessive Lateral Patellar Compression Syndrome,
Continued:
Quadriceps Wall Slide (fig. 7)
1. Stand with your back against the wall. Your feet should be shoulder-width apart and approximately 18 to 24 inches away from the wall. Your kneecaps should be in line with the tip of your shoes or your second toe.
2. Slowly slide down the wall so that there is a 70-
90-degree bend in your knees. (Your physician,
a physical therapist or athletic trainer will
instruct you how to progress the amount of bend
based on your symptoms and diagnosis.)
3. Hold this position for 30 seconds. Stand up and
rest for 30 seconds
4. Repeat exercise 3 times, 3 times per day.
Quadriceps Kneels (fig. 8)
1. Stand on the edge of a step/stair. Make sure your kneecap is in line with your second toe.
2. Slowly step down and touch the heel of your opposite leg on the stair below you. Return to the starting position.
3. Do not go into a painful range. Stop short of the step if necessary to avoid any pain.
4. Use your stair rails for balance as needed.
5. Repeat exercise 3 times, 3 times per day.
Quadriceps Squats (fig. 9)
1. Stand with your feet shoulder-width apart and place equal weight on both legs.
2. Keep your kneecaps in line with your toes.
3. Slowly bend both knees, keeping equal weight on both legs, and return to a standing position.
4. Do not bend your knees more than 90 degrees.
5. You may use the edge of a table or counter for balance if needed.
6. Repeat exercise 3 times, 3 times per day.
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