Remember! Our guides are to be used following an assessment with a qualified medical professional. Do not attempt these exercises if you have not been given a formal diagnosis, or given consent to complete these exercises by a Physical Therapist.

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Osgood Schlatters Physical Therapy Guide

What Is Osgood Schlatters?

Osgood Schlatters disease is a condition that occurs at the growth plate in children’s knees, specifically at the tibial tuberosity. Osgood Schlatters is extremely common in highly active adolescents who are going through their growth spurt. It is usually associated with sports that involve repeated contraction of the quadricep (thigh) muscles, normally knee extension activities such as running, jumping and kicking. Pain at the front of the knee below the knee cap is often aggravated by exercise. Osgood Schlatters lesion is a self-limiting condition that is often settled once the adolescents bones fuse together and they go through puberty. Athletic children and their parents need to understand the nature of the condition, as symptoms may persist for up to 2 years!

What Causes it?

The onset of Osgood Schlatters Disease is associated with repetitive thigh muscle (quadriceps) contraction whilst performing activities that involve running, jumping and quickly changing direction. These repetitive movements cause the muscle to pull on the tendon that connects the kneecap to the shinbone over time. This repeated stress can cause the tendon to pull away from the shinbone, which causes the inflammation and pain in adolescents. In some adolescents with chronic Osgood Schlatters they develop a bony lump at the site of pain called a bone spur.

What Are The Symptoms Of Osgood Schlatters?

  • Osgood Schlatters typically presents with varying degrees of pain over the tibial tuberosity.
  • Tight muscles of the surrounding muscles (quadriceps, hamstrings, calf)
  • Warmth under the knee and over the shinbone.
  • Pain that gets worse when exercising or performing high impact activities.

What Are The Risk factors?

  • Activities that involve jumping and/or jogging
  • Males, especially those between the age of 11 and 18
  • Recent Growth Spurt
  • Poor physical conditioning

Does It Get Better?

Absolutely! Most cases of Osgood Schlatters do not last, however the pain does not often go away overnight. Typically the pain will cease once the patient stops growing, and can last up to 2 years. Management of the condition requires activity modification. As this condition occurs in young athletes who perform a high level of physical activities, it is useful to suggest that they try to eliminate a handful of the number of sports they generally play. There is no need however to rest completely! The patient must use pain as a guide to activity modification, stop the painful activities, continue the non-painful ones!

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Osgood Schlatters Knee Support

If you are suffering from Osgood Schlatters Disease but are still needing to compete and perform your physical activities, you will more than likely need to purchase a good knee support! The use of a knee support will help relieve pain but more importantly prevent the knee injury from getting worse.

What Are My Treatment Options?

There are many treatment options available to adolescents who suffer with Osgood Schlatters disease!

Rest & Time

Initially, you need to stop doing the activities that caused the osgood schlatters injury to develop in the first place but also prevent agitating it further. When you feel any of the symptoms listed above, you should commence the RICE protocols below:

  • Rest. Rest, relax and protect your painful knee joint. Stop, change, or take a break from any activity that may be increasing your pain.
  • Ice. Cold packs will help reduce the pain and swelling. Apply the ice or cold pack for 10 to 20 minutes, 3 or more times a day. Do no place ice directly on to skin, wrap it in a towel first to avoid ice burn! You can find our favourite ice pack here!
  • Compression. Wrapping the thigh with a compression sleeve will help decrease swelling and improve recovery time. You can find our favourite knee compression sleeve here!
  • Elevation. Elevate your feet to reduce swelling and bruising in your thigh.

Physical Therapy

Although resting and activity avoidance is a vital component of the recovery process, it doesn’t mean the affected knee has to be completely immobilised. In fact,  to reduce your pain and get you back to competing as quickly as possible, you need to complete various strengthening and stretching exercises!

Osgood Schlatters Exercises

1) Quadriceps Stretch

This is a fantastic lower quadricep stretch which can also progress to a hip flexor stretch.

How to do it:

  • Start off in lunged position, with your non-affected foot forward. Then, slowly drop your affected knee to the ground.
  • Take a few seconds to find your balance, and once you're stabilized, reach back for your toes on your affected foot.
  • Hold for 30 seconds. Slowly release your hold on your foot.
  • To progress, slowly lean forward whilst stretching.

Repeat 5 stretches, 3 times per day.

2) Hamstring Stretch

The hamstrings are the large muscles on the back of the thigh, and are often very tight in adolescents who suffer from Osgood Schlatters Disease. It is also a great idea to get into the habit of stretching these muscles regularly to prevent re-injury.

How to do it:

  • Lying on your back with a resistance loop around the leg to be stretched.
  • Slowly pull your straight leg up towards the ceiling until you feel a comfortable stretch at the back of your thigh or behind your knee.
  • Hold stretch for 15 seconds.

Repeat 5 stretches, 3 times per day.

3) Static Quads

An easy yet effective quadricep strengthening exercise to maintain the muscle power in the affected knee and reduce the Osgood Schlatters pain.   Put your fingers on your quadriceps to feel the muscle tighten during contraction. Hold for 5 seconds and repeat 10 times as hard as possible without increasing your symptoms.

How to do it:

  • Place a pillow or rolled up towel underneath your affected knee.
  • Slowly tighten your quad muscles and push your knee into the towel below.
  • Put your fingers on the quadriceps to feel the contraction happening.
  • Hold for 5 seconds before releasing.

Repeat 10 reps, 3 times per day.

4) Calf Eccentric Stretch

The stair stretch is both a stretching and eccentric strengthening exercise, and places a great amount of tensile load through the achilles tendon which is often tight in adolescents who perform a lot of physical activity.

How to do it:

  • Standing on a step or a block with the heels of your feet overhanging the edge.
  • Slowly allow your heels to continue going in a downwards direction until you feel a comfortable stretch in your calves.
  • Hold the stretch for 10-15 seconds, before slowly going back to neutral.

Repeat 5 times, three times throughout the day.

5) Wall Squats

Squats are often cited as the most effective lower limb strengthening exercise and one you shouldn't avoid. There are hundreds of variations but we will focus on wall squats, as you can really concentrate on slowly strengthening the tendons that cover the site of the Osgood Schlatters lesion.

How to do it:

  • Place the exercise ball between the wall and your lower back, walking your feet out slightly.
  • Lower your body toward the floor in a squat position as you continuously push back into the ball.
  • Straighten your legs, keeping your weight over your heels to return to standing position.

Repeat 12 reps, twice a day.

6) Crab Walks

This is a great exercise to commence once pain has stopped and you are soon to be returning to sport / activity.  It places a great deal tensile load through the the hip muscles and strengthens them very quickly.

How to do it:

  • Using a loop band! Step into the loop so that it is wrapped around your ankles.
  • Stand hip width apart and sit into a squatted position.
  • Slowly step side to side like a crab whilst maintaining a good squat position (5 steps each direction)
  • Try and step as slowly as possible to really activate the hip stabiliser muscles.

Repeat 5 lengths, 3 sets. Try to do this 3 times per day.

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Osgood Schlatters Shoe Inserts

Many Adolescents with Osgood-Schlatters disease have issues relating to flat feet (excessive subtalar pronation), which can act to increase internal rotation of the lower limb, contributing to alignment issues of the hips and knees. These patients are often best treated with a orthotic device placed in their shoes to assist in controlling foot function. Our favourite is available here! 

When Can I Return To Sport?

This is often the hardest challenge with any injury, and especially so with a painful recurring one like Osgood Schlatters. The only true way to find out if you're suitable to return to training, is to gradually do it once the pain / heat has subsided in your knee!  You can also utilise many tools to reduce your risk of re-injury such as the use of a knee support or KT Tape. The aim is to gradually increase your level of training over time and to prevent the injury from returning. Ideally, it should be pain free when running immediately after and for around 48 hours later. If your pain increases in this time or the overall trend is that it’s getting worse, you may have to rest until it’s more settled.