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Osgood Schlatter’s Disease

What it is

Osgood Schlatter’s Disease, or “tibial tuberosity apophysitis”, is a common condition affecting children and teenagers where the bone at the site of the tibial tuberosity growth plate is inflamed. It is characterised by a gradual, non-traumatic onset of knee pain that worsens rapidly. It most commonly affects physically active children, particularly boys, but any child can develop the condition.

It is a fairly common condition, with estimates that 15-20% of athletic children will experience it at some point, and up to 5% of non-athletic children. Despite this, many parents are unaware of the signs and symptoms, the management on the condition and the long term prognosis for their child. This blog will help explain the nature of the condition and management strategies used by physiotherapists.

 

What causes it

Osgood Schlatter’s Disease is an inflammation and subsequent pain in the growth plate or “epiphyseal plate” in the tibial tuberosity, which is a bony prominence at the front of the shinbone. Growth plates are found at the ends of developing bones and contain cartilage cells that form into adult bone. This process occurs during a growth spurt in children and is how their bones grow and usually occurs in “spurts” over a two-year period.

When this process is occurring the growth plates are weaker as they have not fully formed into adult bones. In this period of rapid growth, a child’s bones grow faster than their muscles causing them to be become tight. In the instance of Osgood Schlatter’s disease the quadriceps muscles and patellar tendon are pulled tight, resulting in pain and inflammation where it attaches to the weakened tibial tuberosity.

Signs and Symptoms:

The most common symptom is intense pain just below the front part of the knee, which presents on activities such as jumping, squatting, running, kicking, climbing stairs and kneeling. The pain tends to start off relatively mild and then increase in intensity until the patient is unable to effectively complete the task due to pain. In addition to pain on activity, the tibial tuberosity may be swollen and tender, even at rest.

In 20-30% of cases, children will experience these symptoms in both knees. In later stages, the growth plate itself may enlarge which tends to look like a bump on the tibial tuberosity. This will often stay even after the condition resolves.

Risk factors

The largest risk factor for developing a patella tendinopathy includes acute changes in load for jumping based tasks. Often such load changes include competing in a tournament, increased playing/training frequency, alterations in shoe-wear or alternations in playing surfaces. Weight gain can also be a contributing factor as this places extra load onto the joints. Patella tendinopathy is a highly prevalent condition in younger, jumping athletes, less than 30 years old.

Factors that can contribute to it

  • Active boys from 11-15 years old are the most likely to experience Osgood Schlatter’s Disease, but girls aged 8-13 years can also be affected. If a child plays multiple sports, they are more likely to experience OSD.
  • Having chronically tight thigh muscles can also make you more likely to experience Osgood-Schlatter’s Disease.
  • Activities involving repetitive, strong quadriceps contractions produce the highest risk. Children who participate in jumping, running, and kicking sports such as football, netball, basketball, soccer etc. are most at risk.

Diagnosis

An accurate diagnosis can usually be made based on the symptoms by a physiotherapist, imaging often won’t be required. An X-ray may or may not show bony fragments at the site of attachment from the patellar tendon to the tibial tuberosity. It is important to see a qualified practitioner for diagnosis, however, as there are several alternative diagnoses that you may be experiencing, including:

  • Sinding-Larson-Johansson syndrome (a similar condition affecting the bottom of the kneecap as opposed to the tibial tuberosity)
  • Patellar tendinopathy
  • Patellofemoral pain
  • Infrapatellar bursitis
  • Fat pad injury
  • Fracture of tibial tuberosity
  • Slipped capital femoral epiphysis

Treatment

The treatment will depend on the findings of the physical assessment, but will likely include pain relief, activity modification, supervised exercise and stretching.

Perhaps the most important treatment we can provide is activity modification. Osgood Schlatter’s is a self-limiting condition, which usually means that the pain experienced during activity is directly related to the amount of inflammation at the tibial tuberosity, rather than a sign of ongoing damage being caused. Activity modification involves modifying the duration, intensity, frequency or type of activity the patient undergoes in order to “manage” symptoms. If the pain is quite severe then rest from strenuous activity may be recommended for a short period of time.

Other treatments may involve strengthening of the muscles surrounding the knee, icing, low intensity activity such as walking and swimming. Stretching, massaging and foam rollers may be used to help to lengthen the tight quadriceps muscles.

Prognosis

As previously mentioned, Osgood Schlatter’s, while painful, is a mostly self-limiting condition. The typical lifespan of the condition lasts for a few weeks to a few months, however in some scenarios people experience symptoms for up to two years.

Once the condition has resolved, most people will not have any ongoing effects, however a small portion of patients will experience an enlargement of the tibial tuberosity, and some will have ongoing discomfort while kneeling on the affected leg.

 

 

At Total Physiocare Heidelberg, Reservoir, Camberwell and Footscray we treat many knee and overuse sporting injuries.

Book an appointment today for your assessment!

Blog by Nicholas Musso (Physiotherapist)

Patella Tendinopathy – Blog by Christian Bonello

The patella tendon is a continuation of the quadriceps tendon and has a role in connecting the quadriceps femoris (4 quadriceps muscles at the front of the thigh) to the tibial tuberosity of the shin. The patella tendon has a principle role in transmitting force through the lower limb, particularly in powerful jumping movements.

Patella tendinopathy is defined as a pathology or injury of the patella tendon, commonly due to overuse mechanisms. For further information please refer to the “What is a tendon and tendinopathy” blog.

Symptoms:

The main symptoms of a patella tendinopathy is pain and tenderness localised to the inferior pole of the patella (ie bottom of knee cap). Patients often report load-related pain that increases with the demand on the knee extensors. Notably this includes activities that store and release energy in the patellar tendon such as jumping and change of direction activities.

Prevalence:

Patella tendinopathy is highly common in jumping athletes with a 45% prevalence reported in basketball players, 32% reported in volleyball players and is common in AFL ruckman. Conversely patella tendinopathy only has a 2.4% prevalence in “in-season” soccer players due to the altered demands of the sport.

Risk factors:

The largest risk factor for developing a patella tendinopathy includes acute changes in load for jumping based tasks. Often such load changes include competing in a tournament, increased playing/training frequency, alterations in shoe-wear or alternations in playing surfaces. Weight gain can also be a contributing factor as this places extra load onto the joints. Patella tendinopathy is a highly prevalent condition in younger, jumping athletes, less than 30 years old.

Diagnosis:

Patella Tendinopathy is medically diagnosed by a physiotherapist.

A physiotherapist will conduct a strength and lower limb power assessment to highlight any differences between the symptomatic and unaffected side, and as a comparison to dominate limb function. Palpation may reveal localised pain and tenderness over patella tendon.

In rare cases, ultrasound may be utilised in the diagnosis of the condition, however is not often required as there is a poor correlation between imaging findings and patient reported symptoms and level of function.

Treatment:

Multiple interventions can be utilised in the treatment of a patella tendinopathy but should primarily be gym based. As the condition can become chronic and often debilitating, treatment is most successful when commenced early.

Your physiotherapist will guide the appropriate management based on your assessment findings and the severity of symptoms which may include:

– Rest from aggravating exercises

– Graduated strengthening exercises (starting with static contractions and building through range with resistance to power based activities)

– Taping

– Load  management strategies or advice

At Total Physiocare Heidelberg, Reservoir, Camberwell and Footscray we treat many knee and overuse sporting injuries.

Book an appointment today for your assessment!

Blog by Christian Bonello (Physiotherapist)

Meniscus Tear

What is the Meniscus? – Blog By Ryan Harris

The meniscus is a crescent shaped disc of fibrocartilage that is located in the knee joint. The role of it is to distribute the weight of the body and absorb shock within the knee during movement. Each knee has two meniscus, one laterally and the other medially.

Mechanism of Injury

There are two main reasons for tearing this structure.

Traumatic

A Traumatic meniscus tear is more likely seen in the younger, more active population. It most commonly occurs when the foot is planted on the ground and a twisting force is applied upon the knee. This twisting force is often caused by another person.

Degenerative

In the older adult, a degenerative tear is most likely to occur. This may be due to the natural age related changes of the meniscus or arthritic changes of the femur tearing into the meniscus.

Signs and Symptoms

  • An incident of a painful twist of the knee,
  • Some people may describe a tearing sensation,
  • Clicking, popping, or locking of the knee,
  • Minimal immediate swelling which increases of the next 24hours
  • Tenderness of the knee joint line.

Healing

The location of the meniscus tear will determine its capacity of healing. 

The outer rim of the meniscus has a blood supply from the synovial capsule. This allows it to have a capacity to heal overtime with conservative treatment, depending on the size and type of the tear.

The central part of the meniscus has no blood supply, instead gaining its nutrients from the synovial fluid. Injuries to this area of the meniscus do not usually heal overtime and often require surgery.

Assessment

Your Physiotherapist will perform a comprehensive physical examination and perform special test to diagnose your injury

It is important to undergo a thorough physiotherapy assessment as other knee injuries such as an ACL tear and/or medial and lateral collateral ligament tears may be present.

If a meniscus tear is suspected, your physiotherapist, doctor or surgeon may refer you for a MRI. This will aid in determining the location and type of tear and will help guide the appropriate treatment pathway.

Conservative Rehabilitation

Small tears and tears that occur in the outer ring that have no restriction of movement can be treated conservatively. Conservative treatment consists of:

  • Eliminating swelling
  • Restoring full range of motion
  • Strengthening of the knee and lower limb,
  • Enhancing pelvic stability
  • Improving lower limb proprioception and jumping/landing strategies
  • Sport specific activities, 
  • Gradual return to sport.

Surgical Management

Meniscectomy

Surgical intervention may be required

Following a period of conservative treatment, surgical intervention may be required. This is performed arthroscopically (keyhole). During the surgery, the surgeon will inspect the meniscus and surrounding structures via a small camera. Once the tear is identified, the surgeon will remove the affected tissues and clean up the surrounding area. The aim of surgery is to protect as much of the meniscus as possible, although it may be necessary to have a complete removal of the meniscus. 

Meniscal Repair

The surgeon may decide to repair the tear in younger patients with a recent tear in the outer rim as these tears have a chance to heal over time. Rehabilitation for meniscal repairs are greater as time is needed to get the meniscus a chance to heal.

Rehabilitation

It is important to commence rehabilitation prior to surgery. “Prehabilitation” can increase the recovery speed post operatively and in some cases, the patient can avoid surgery all together.

Monitoring of the knee is crucial during rehabilitation as the remaining meniscus and underlying articular cartilage need to adapt to the new load that is being placed upon them. Your physiotherapist will continue to reassess your knee after each progression of exercises to ensure your knee is coping with the new stresses. If an increase in pain or swelling is seen, the rehabilitation program will be altered as a result. 

The same rehabilitation principles apply for both, conservation and post surgical care. The principles are outline above. The exception being a meniscal repair which requires an initial period of rest to allow for healing to occur before commencing rehabilitation.

At Total Physiocare Heidelberg, Camberwell, Reservoir & Footscray, we have seen many knee arthroscopy surgeries due to the close hospital affiliations we have.

Book an appointment today for your assessment!

Post by Ryan Harris(Physiotherapist)