One of the most common sources of knee pain in sporty children, especially in boys is Osgood Schlatter’s Disease. However, it is not a disease at all, Osgood Schlatter’s is an old term used to describe pain & inflammation just below the knee where the thigh muscles (the quadriceps) attach via a tendon to a growth plate called the tibial apophysis. “Itis” is the latin word meaning inflammation so it should therefore be called tibial apophysitis. In the clinic, we see many kids with this condition who present for a physiotherapy Assessment.
These types of injuries are usually caused by a spike in activity relative to what the young athlete has trained for. Sports Injuries occur when they exceed their current capacity of their immature body. This can occur for a host of reasons such as: – the child did too much too soon, such as at the beginning of a new term, or they might have had a lower capacity than usual due to a virus, a growth spurt or lack of adequate sleep or nutrition.
During rapid growth spurts, the bone grows faster than the muscle can lengthen. This increases the tension in the quadriceps muscle and can cause traction, compression and shearing forces that act on the growth plate causing inflammation and irritation.
WHO GETS TIBIAL APOPHYSITIS ? Tibial apophysitis is more common in sporty children who participate in repeated high intensity and higher volumes of hopping, jumping and change of direction type activities. The children who get symptoms are usually around 9-15 years of age and it is more prevalent in boys than girls, especially those who grow faster and those who have a large growth spurt. These growth spurts may result in the child developing more tension in the hamstrings and this can mean the quadriceps muscle has to work harder to extend the knee during activities like running and kicking.
There have also been links made to low Vitamin D levels so it is worth considering supplementation in some parts of the world. Another theory is that some children may be more at risk due to a slightly altered alignment of their shin bone during growth.
WHAT ARE THE SYMPTOMS?
1.Pain on running, jumping, squatting, hopping
2.Typically eases with rest
3.Swelling at the top of the shin bone
4.Tenderness on pressure such as kneeling
As it starts to heal, it can generate new bone creating a hard bony lump, which can be really sore when kneeling or if the area gets bumped. If the pain does not get worse on activity and does not settle with rest, it is not likely to be tibial apophysitis and therefore should be checked by a health professional.
HOW IS TIBIAL APOPHYSITIS DIAGNOSED?
An experienced physio at the JSSC will know what signs and symptoms to look for and be able to diagnose the condition without x-rays. If the symptoms do not settle down with modifying activity, doing rehab, then an ultrasound or MRI scan can be helpful to grade the severity of the injury and confirm the diagnosis.
CAN I PLAY WITH PAIN?
If the child has been diagnosed with Tibial Apophysitis, it is not usually harmful to continue to play sport. The aim of treatment is to keep them as active as possible. If they do nothing, their tissues get even less tolerant of loading and the muscles get weaker. However, it is important that they do not cause a more extensive injury.
To work out whether they can play with pain, the physiotherapist will need to ascertain:
- How much pain are they in during play?
- Does it settle within an hour of stopping?
- Does it make them limp or have to play differently?
- Is it worse the next day?
- Has it swollen up more?
It is often necessary to adjust their activity level back to a point where their symptoms become more low grade and manageable. We completely understand that limiting sporty kids in their activity is never popular. We will always try to incorporate rehab exercises that will increase the capacity of the body to tolerate more activity.
Building stronger muscles, getting more sleep, improving their energy intake and factoring in days when their body can adapt and recover all help.
HOW CAN I BUILD THEIR CAPACITY TO DO MORE? RECHARGE THEIR BATTERY
Just like our phones need to be recharged so does our brain and body. In the deep part of our sleep, we perform many of the same functions achieved by plugging our phone in to the mains. We perform vital updates, virus scans, repair damaged tissues, build stronger muscles and bones and upload skills learnt in the day to the hard drive. Children need more sleep during growth spurts so make sure they are getting lots of early nights and feel refreshed in the morning.
EAT FOR ENERGY Getting adequate nutritional intake for the level of activity that the child does is important for bone health and growing stronger muscles. Make sure they eat a balanced diet including good protein sources for building muscles and repairing injured tissues. Many children don’t feel hungry in the morning, but it is difficult to achieve adequate energy intake if children miss breakfast. On days when they do more, they may need more regular intake of food and drink, especially during growth spurts. Adjust what they eat to meet the demands of what they do. Just like cars need refuelling, so do young athletes and the faster they go, the more they need.
Many children require a Vitamin D supplement to improve bone health so discuss appropriate dosage with a health professional.
LISTEN TO YOUR BODY SHOULD I TRAIN OR NOT? At times when they are ill, sore, stressed or tired, their body is more at risk of illness or injury. It is important to adapt how much and how hard they play to allow their body to recover and avoid increasing the risk of further injury. Sometimes a day out to recover can avoid weeks off ill or injured. Stronger athletes have been shown to develop fewer injuries and be able to tolerate greater changes in sport volume and intensity. Some muscles may feel tight when they are growing. Doing some daily stretches for the calf, hamstrings, and hips may improve this, however in some children, doing quadriceps stretches can cause greater traction on the attachment of the muscle at the knee and may well aggravate the symptoms, so ask your physiotherapist at the JSSC. Children with Tibial Apophysitis often develop weaker quadriceps muscles over time as they are forced to do less and their level of pain inhibits the muscles from working as effectively. Other muscle groups in the trunk, calf, and hip may also need strength training, so it is recommended to see your physio at the JSSC to learn which exercises are right for you.
HOW TO REDUCE THEIR PAIN If they are still experiencing pain it may be that they are still doing too much and need to do less strenuous activity until it settles. The best way to improve symptoms is to modify what they are doing in terms of volume or intensity until they get stronger. If their pain is greater than a 2/10 then you might be able to settle their symptoms, by using some ice packs, but do not give your child pain killers to help them get through a game. This will mask the pain and is likely to just make the whole episode last longer. The other thing that helps some kids is using a small knee strap or using taping to support the knee cap. Taking a short break from high impact activities such as jumping and running for 2 4 weeks can help. Your physio will guide you on the best approach for your child’s knees.
HOW TO GET THEM SAFELY BACK TO SPORT
After the pains settles, be careful that they do not to go straight back to doing the high levels of sport that they were doing when they got injured. Build back up gradually so their body can adapt to what is being demanded of it and get itself strong.
HOW DO I STOP THEIR PAIN COMING BACK? If they do not change the factors that contributed to developing pain, it is likely that the pain will recur. The highest incidence of apophysitis occurs in the third week of a school term or season. This is because children return to sport after a long holiday and exceed their capacity. The amount of sport they do exceeds the training completed in recent weeks. Their symptoms may also recur at times when their capacity has dropped such as during a growth spurt or if they are ill or stressed, so when the child has a dip in health or energy levels, adjust how much they do that week. The physio team can help you and your child devise a tailored plan to facilitate a swift recovery back to painfree activity. Book now
Adapted from Kidsback2sport.com