Physical Therapy Guide to Osgood-Schlatter Disease
Osgood-Schlatter disease is an overuse injury causing pain in the knee area. OS most often develops because of excessive stress to the front of the knee during periods of rapid bone growth. A visible boney growth may appear just below the kneecap. Because teens typically experience the highest rate of bone growth, this age group is most affected by OS. Physical therapists help people with OS ease their pain, increase their muscle strength, and restore their function and movement.
What Is Osgood-Schlatter Disease?
Osgood-Schlatter disease occurs when there is an irritation to the top, front portion of the shin bone (tibia). This is where the tendon that attaches to the kneecap (patella) meets the shin bone. OS can develop when an increased amount of stress is placed upon the bones where the tendons attach. OS most often results from increased activity levels by teen athletes.
Our musculoskeletal system consists of bones and surrounding soft tissue structures. These surrounding structures include muscles, ligaments (which connect bone to bone), and tendons (which connect muscle to bone). These bones and soft tissues all play a role in helping us move.
During the teen years, our bodies grow at a fast rate. As our bodies develop, our bones grow longer. Throughout this phase, our growth plates ‒ the points at the end of a bone where new bone tissue is made ‒ can be injured. Females usually experience rapid growth at 11 to 12 years of age. Males typically experience this growth surge between 13 and 14 years of age. Males experience OS more often than females, likely due to an increased rate of playing sports. However, it is becoming more common in girls as their participation in sports grows. Generally, OS occurs in children between 9 and 14 years old.
Structures in our body can become irritated if they are asked to do more than they are capable of doing. Injuries can occur in an isolated event. But repeated trauma most often causes OS. Teens who regularly run, jump, and "cut" (make rapid changes in direction) experience OS more often.
When too much stress is present, the top of the shin can become painful and swollen. This stress can be caused by rapid growth or when the body is overworked (i.e., too much exercise or repetition of movements). The body’s response to bone stress can be an increase in bone production. Some teens may begin to develop a boney growth that feels like a bump on the front of the upper shin.
OS can start as mild soreness. But it can progress to long-lasting pain and limited function, if not addressed early and appropriately.
How Does It Feel?
With OS you may experience:
- Pain below your knee, at the top of the shin bone that gets worse over time.
- Pain that worsens with exercise or playing sports.
- Swelling and tenderness at the top of the shin.
- A boney growth at the top of the shin.
- Loss of strength in the quadriceps muscle (connecting the hip to the knee).
- Increased tightness in the quadriceps muscle.
- Loss of knee range of motion.
- Discomfort when you kneel, squat, or walk up and down stairs.
How Is It Diagnosed?
Diagnosis of OS begins with a thorough medical history, including specific questions about sports played, frequency of practices and games, and positions. Your physical therapist will assess areas such as sensation, motion, strength, and flexibility. They will also determine if you have tenderness and swelling. Your physical therapist will perform several tests specific to the knee joint. They may ask you to demonstrate the activities or positions that cause your pain.
Your physical therapist will likely examine your hip as well as other nearby areas, such as your feet and core (midsection). Testing these areas will help determine whether they, too, might be contributing to your knee condition.
If your physical therapist suspects more than a stress-related irritation, they will likely refer you to an orthopedic physician. Symptoms like a recent significant loss of motion or strength, or severe pain with certain movements, may suggest the need for diagnostic imaging (i.e., ultrasound, X-ray, or MRI).
How Can a Physical Therapist Help?
Once other conditions are ruled out and OS is diagnosed, your physical therapist will work with you to develop a personalized treatment plan. This plan will address your specific knee condition and your goals. The goal of physical therapy is to speed up your recovery for a return to pain-free activity. Many physical therapy treatments are effective in treating OS. Your treatment plan may include:
Patient education. The first step to addressing your knee pain is to rest it. Your physical therapist will explain why this is important and develop a plan for your complete rehabilitation.
Range-of-motion therapy. Your physical therapist will assess the motion of your knee and its surrounding structures. They will design gentle exercises to help you return to a normal range of motion.
Strength training. Your physical therapist will teach you exercises to strengthen the muscles around the knee. Strengthening these muscles will ease the stress on your knee joint and help protect it.
Manual therapy. Physical therapists are trained in manual (hands-on) therapy. If needed, your physical therapist will gently move your kneecap or tendon and the surrounding muscles to improve their motion, flexibility, and strength. These techniques can focus on areas that are difficult to treat on your own.
Pain management. Your physical therapist may recommend therapeutic modalities, such as ice and heat, or a brace, to aid in pain management.
Functional training. Physical therapists are experts at training athletes to function at their best. Your physical therapist will assess your movements and teach you to adjust them to relieve any extra stress on the front of your knee.
Can This Injury or Condition Be Prevented?
Fortunately, there are several ways to help prevent OS. Physical therapists:
- Educate coaches, parents, and athletes on guidelines for participating in sports.
- Explain the common cause of overuse injuries. They provide strategies for prevention.
- Inform athletes about the risks of playing through pain and the benefits of scheduling enough rest time to recover between events.
- Track a young athlete’s growth curves (height, weight, body-mass index). This helps to identify periods of increased injury risk.
- Develop athlete-specific flexibility and strengthening routines for athletes to follow throughout the season.
When OS symptoms appear, consult a physical therapist immediately!
Early treatment helps prevent the injury from getting worse. Following the advice and training of your physical therapist helps prevent the injury from happening again.
What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and clinical experience to treat a variety of conditions or injuries, including Osgood-Schlatter disease. You may want to consider:
- A physical therapist who is experienced in treating people with orthopedic or musculoskeletal injuries.
- A physical therapist who has experience treating pediatric athletes.
- A physical therapist who is a board-certified clinical specialist or has completed a residency in orthopedic or sports physical therapy. This physical therapist will have advanced knowledge, experience, and skills that apply to an athletic population.
You can find physical therapists with these and other credentials by using Find a PT, an online tool provided by the American Physical Therapy Association. This tool will help you search for physical therapists with specific clinical expertise in your geographic area.
General tips when you're looking for a physical therapist (or any other health care provider):
- Ask for recommendations from family, friends, or other health care providers.
- When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping young athletes with knee pain.
- During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and report activities that make your symptoms worse.
The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions, and also prepare them for a visit with their health care provider.
The following articles provide some of the best scientific evidence related to physical therapy treatment of athletic injuries. The articles report recent research and give an overview of the standards of practice both in the United States and internationally. The article titles are linked either to a PubMed* abstract of the article or to free full text, so you can read it or print out a copy to bring with you to your health care provider.
Kienstra A., Macias C.G. Osgood-Schlatter disease (tibial tuberosity avulsion). Summary on UpToDate. Published 2019.
Whitmore A. Osgood-Schlatter disease. JAAPA. 2013;26(10):51–52. Article Summary on PubMed.
Maffulli N., Longo U.G., Spiezia F., Denaro V. Aetiology and prevention of injuries in elite young athletes. Med Sport Sci. 2011;56:187–200. Article Summary on PubMed .
Stein C.J., Micheli L.J. Overuse injuries in youth sports. Phys Sportsmed. 2010;38(2):102–108. Article Summary on PubMed.
* PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.
Authored by Allison Mumbleau, PT, DPT, board-certified clinical specialist in sports physical therapy. Revised and reviewed by Heidi Nelson, PT, DPT, DSc, board-certified clinical specialist in pediatric physical therapy, on behalf of the Academy of Pediatric Physical Therapy.