Osgood-Schlatters - - more than just growing pains in the knee

Young kids playing basketball

Osgood-Schlatter Disease (OSD)—also referred to as tibial tubercle apophysitis—is one of the most frequent causes of anterior knee pain in growing, active adolescents. It’s a self-limiting, overuse injury that, while benign, can significantly impact sports participation, function, and overall quality of life during key developmental years.

As Osteos: recognizing and supporting early intervention can make all the difference—not only in pain management but also in long-term musculoskeletal health.

What Is Osgood-Schlatters Disease?

OSD is a traction injury that affects the tibial tuberosity, where the patellar tendon inserts into the growing bone. During adolescence, rapid skeletal growth can outpace the adaptability of muscle-tendon units, especially in high-demand activities like running, jumping, and squatting. Meaning the bone grows faster than the muscle supporting it.

Commonly Affected Sports:

• Basketball and netball

• Volleyball

• Football - Particular AFL when the grounds are hard

• Runners / long jump or high jump

• Gymnastics

These repetitive, high-impact activities place mechanical stress on the knee’s extensor mechanism, leading to microtrauma and inflammation at the tibial apophysis.

Mechanism of Injury: A Biomechanical Perspective

The tibial tubercle in adolescents is still developing, and repeated tension from the quadriceps—especially during forceful knee extension—can lead to irritation or even partial avulsion of this growth center.

Predisposing Biomechanical Factors:

• Tight quadriceps or hamstrings

• Poor pelvic alignment or posture

• Muscle imbalances in the lower limb

• Rapid growth spurts

• Improper training load progression

These are all areas where osteopathic treatment can play a proactive role in reducing risk and improving resilience.

What symptoms do we often see (also known as the clinical picture):

Young athletes (typically ages 10–15) may present with:

• Gradual onset of pain localized to the tibial tuberosity

• Pain worsened by activity, improved with rest

• Swelling or bony prominence below the kneecap

• Pain on resisted knee extension or passive knee flexion

• Difficulty kneeling, jumping, or squatting

In 20–30% of cases, the condition may be bilateral.

Diagnosis

Osgood-Schlatter is a clinical diagnosis, supported by history and physical exam. Imaging (X-ray) is reserved for atypical cases, severe pain, or when ruling out other serious pathologies such as fracture / infection or deformity of the knee cap which may cause instability.

Xrays may show soft tissue swelling, fragmentation of the tibial tubercle, or calcification at the tendon insertion—but these findings must always be interpreted in a clinical context - frequently the imaging may not give an accurate view of the complaint - with xray findings not always matching the clinical picture. If we have concerns, we may refer back to yoyr GP or a Sports Medical Dr if we require further imaging.

Management Strategies

The goal of treatment is pain management and functional recovery, with an emphasis on maintaining safe levels of activity while maintaining fitness - rather than complete rest.

First-Line Treatment:

• Activity modification (not stopping)

• Ice therapy post-activity

• Topical anti-inflammatories for short-term pain relief

• Patellar tendon taping or protective knee padding if needed

• Stretching tight musculature (especially hamstrings and quads)

• Functional strengthening of the kinetic chain (aka - hip / knee and ankle)

The Role of Osteopathy

Osteopathic treatment can help address contributing biomechanical dysfunctions:

• Addressing muscle imbalances

• Improving joint mobility (e.g., hips, knees, ankles)

• Enhancing postural alignment and gait mechanics - advising on footwear / gel inserts or other assistive devices

• Providing patient education on load management and recovery

In persistent cases, referral for podiatry, physiotherapy, exercise physiology or sports medical review.

Severe, refractory cases may require temporary immobilization—but surgery is rarely indicated and typically only considered after skeletal maturity.

Prognosis & Long-Term Outlook

Most adolescents recover fully as the tibial tuberosity ossifies and fuses—usually by age 16–18. However, symptoms may persist for up to two years and, in about 10% of cases, into adulthood if poorly managed.

While a small residual bump on the tibia is common, it’s typically asymptomatic and does not impact long-term function. If you take a look at many adult knees - we have the signs of past impacts of OSD.

Supporting Active Adolescents Holistically

Osgood-Schlatter management is most effective when guided by an interdisciplinary care model, including:

• Osteopaths

• Sports physicians

• Physiotherapists and podiatry

• Pediatricians or General practitioner

• Coaches and families

Whst you should chat about with your health provider:

• Shared decision-making with families and young athletes - let the athlete have some autonomy

• Gradual return-to-play strategies and modifications to positions (e.g half game in full foward, half in mid-field)

• Biomechanical screening to identify modifiable risk factors and encourage ankle and hip mobility

• Educating on training volume, rest, and recovery

Prevention: Setting Up for Long-Term Joint Health

• Ensure gradual increases in activity load (no more than 10% per week)

• Encourage proper warm-up and cooldown routines

• Emphasize flexibility and appropriate loading during growth spurts

• Promote multisport participation to avoid overuse from only completing one sport (e.g - netball and football)

Osgood-Schlatter Disease is a common challenge for active youth, but with timely, coordinated care, most patients return to full function without long-term issues. Osteopaths can play a pivotal role in recovery and prevention—supporting not just symptomatic relief but also assisting with appropriate loading and advice.