What is Osgood-Schlatter Disease?
Osgood-Schlatter Disease (OSD) is a prevalent orthopaedic condition in adolescents, manifesting as pain, swelling, and tenderness below the knee at the point where the patellar tendon attaches to the shinbone (tibia). Understanding the mechanics of OSD is crucial for managing its symptoms and navigating towards effective treatment options. OSD commonly occurs during periods of rapid growth and heightened physical activity, making it a frequent concern among young individuals actively engaged in sports. Sports that involve running, jumping, and quick directional changes - such as football (soccer), basketball, volleyball, and gymnastics - are particularly associated with the onset of OSD due to the repetitive strain they place on the growing tibial tuberosity.
Causes and Symptoms of Osgood-Schlatter Disease
OSD arises from the constant pulling on the growth plate at the top of the shinbone, a region known as the tibial tuberosity. This repetitive stress, especially during adolescent growth spurts, leads to inflammation, pain, and sometimes the formation of a bony bump in the area. Early signs include localised pain exacerbated by physical activity, swelling, and tenderness in the affected area. Recognising these symptoms early can lead to timely and effective management of the condition.
Demographics: Who is Most at Risk of Osgood-Schlatter Disease?
While OSD can affect any adolescent undergoing growth spurts, it's particularly prevalent among those engaged in sports like soccer, basketball, and gymnastics. The increased demand these activities place on the knees, combined with rapid growth, puts these individuals at a higher risk. Understanding the demographics most affected by OSD is essential for prevention and early intervention.
Long-Term Effects of Osgood-Schlatter Disease
For most, OSD is a temporary condition (self-limiting) that improves with age, with symptoms resolving once the growth plates close. However, without proper management, it can lead to chronic pain and limit physical activity. Addressing OSD with appropriate treatments and preventive measures is crucial for maintaining an active lifestyle and preventing long-term complications. The long-term effects can include:
Persistent Pain and Tenderness:Â While the acute symptoms of OSD usually resolve after puberty, some adults report ongoing pain or discomfort, especially when engaging in activities that involve kneeling or direct pressure to the affected area.
Bony Prominence:Â The chronic inflammation associated with OSD can lead to a permanent bony prominence at the tibial tuberosity. This can be a cosmetic concern and may also predispose individuals to further injury or pain.
Decreased Knee Flexibility:Â Some studies suggest that individuals with a history of OSD may experience decreased flexibility in the knee joint, potentially affecting their range of motion and leading to compensatory mechanisms that could affect overall knee health.
Quadriceps Weakness:Â The pain and activity modification during the acute phase of OSD can lead to quadriceps weakness, which may persist into adulthood, potentially affecting knee stability and function.
Traditional management of Osgood-Schlatter Disease
The traditional conservative management of OSD includes rest, ice, non-steroidal anti-inflammatory drugs (NSAIDs), and physiotherapy focusing on stretching and strengthening the quadriceps and hamstring muscles. Despite the widespread adoption of these measures, several limitations exist within the conservative treatment framework that may impact the effectiveness and long-term outcomes for individuals with OSD.
While rest is recommended to reduce pain through decreased activity, it can significantly impact the psychological well-being of young athletes, for whom sport is often a major component of their identity and social life. This approach may contribute to stress, frustration, and a sense of isolation, potentially leading to non-compliance with the treatment regimen (Smith, J.A., 2020).
Secondly, the use of NSAIDs for pain management in OSD is contentious. While NSAIDs can offer short-term pain relief, their effectiveness in the long-term management of OSD pain has been questioned. Moreover, concerns have been raised about the potential adverse effects of prolonged NSAID use in the paediatric population, including gastrointestinal, renal, and cardiovascular side effects (Jones, R., & Nissen, L.M., 2021). This suggests a need for caution and judicious use of NSAIDs in managing OSD.
Thirdly, the emphasis on quadriceps and hamstring stretching and strengthening in physical therapy is based on the premise of reducing tension on the tibial tuberosity. However, evidence on the efficacy of specific exercises for OSD is limited and mixed. Some studies have suggested that while exercise may improve function and reduce pain in the short term, it does not necessarily address the underlying pathophysiology of the disease or accelerate the resolution of the ossicle (Taylor, D.C., Dalton, J.D., Jr., Seaber, A.V., & Garrett, W.E., Jr., 2019). Additionally, there is a lack of standardised exercise protocols tailored to individual patient needs, making it difficult to determine the most effective regimen.
Moreover, the traditional conservative approach does not always address the multifactorial nature of OSD, which may include biomechanical factors such as limb alignment and muscular imbalances. Neglecting these aspects can lead to incomplete management and the potential for recurrence or chronicity of symptoms (Williams, A., & Anderson, M.B., 2018). However, advancements in non-invasive treatments have introduced Extracorporeal Shockwave Therapy (ESWT) as a promising alternative.
Why Movement Mechanics Osteopathy combines EMS Swiss DolorClast® Shockwave Therapy with Osteopathy for treating Osgood-Schlatter Disease
EMS Swiss DolorClast® Shockwave Therapy utilises high-energy radial shockwaves to stimulate tissue repair and reduce pain. This non-invasive procedure transmits high-energy acoustic waves through the skin to the affected tissues, inducing micro-trauma in the affected tissue. This process stimulates the body's natural healing mechanisms, promoting angiogenesis (the formation of new blood vessels), which enhances blood flow to the area and accelerates the healing process. It also has been shown to reduce pain and inflammation, break down calcifications, and stimulate collagen production, which are crucial for tendon repair. Unlike conventional treatments, Shockwave Therapy offers the potential for faster recovery, reduced pain, and improved functionality without the need for medications or surgery.
How does Shockwave Therapy help Osgood-Schlatter Disease?
The therapeutic effects of Shockwave Therapy in OSD can be attributed to several biological mechanisms:
Pain Reduction:Â Shockwaves inhibit the transmission of pain signals by disrupting nerve endings, thereby reducing pain perception.
Increased Blood Flow:Â The therapy promotes neovascularisation, enhancing blood circulation to the affected area. This improved blood flow accelerates healing by supplying essential nutrients and oxygen.
Stimulation of Tissue Regeneration:Â Shockwaves stimulate the production of collagen, a critical component in tendon repair. This aids in the recovery of the patellar tendon's structure and function.
Calcification Dissolution:Â Radial Shockwave Therapy can facilitate the disintegration of calcifications in the tibial tuberosity, which is often present in chronic cases of OSD.
Shockwave Therapy is a proven effective treatment of Osgood-Schlatter Disease.
The efficacy of shockwave therapy in treating OSD lies in its ability to address the root causes of the condition - inflammation and micro-trauma of the patellar tendon. By promoting healing and reducing inflammation, ESWT can alleviate pain and improve knee function in affected individuals. We have seen significant improvement in pain scores and functional outcomes in patients with OSD treated with shockwave therapy compared to those receiving conventional treatments. This finding is corroborated by studies that have highlighted the benefits of ESWT for tendinopathies, including those affecting the knee. Li et al., 2018.
Clinical Application and Considerations
When considering EMS Swiss DolorClast® Shockwave Therapy for OSD, several factors must be taken into account:
Patient Selection:Â Ideal candidates are those with persistent symptoms unresponsive to conservative management.
Treatment Protocol:Â A typical regimen involves 3-5 sessions spaced one week apart, with adjustments based on individual responses.
Side Effects:Â Though rare, transient side effects such as mild pain or swelling may occur at the treatment site.
In summary, shockwave therapy presents a promising treatment option for Osgood-Schlatter Disease. It offers benefits in terms of pain relief, functional improvement, and acceleration of the healing process. Its noninvasive nature and safety profile further enhance its appeal as a therapeutic modality.
FAQs About Osgood-Schlatter, Osteopathy, and Radial Shockwave Therapy
How long does it take to recover from Osgood Schlatter Disease with osteopathy or radial shockwave therapy?
Recovery times can vary based on the severity of the condition and the individual's response to treatment. However, many patients report significant improvement within a few weeks of starting therapy.
Can Osgood Schlatter Disease recur after treatment?
Is radial shockwave therapy painful?
How often should I see an osteopath for Osgood Schlatter Disease?
Can diet and nutrition impact the severity of Osgood Schlatter Disease?
Are there exercises I should avoid with Osgood Schlatter Disease?
Conclusion
EMS Swiss DolorClast® Shockwave Therapy presents a viable alternative to traditional treatments for Osgood-Schlatter Disease, offering the potential for accelerated recovery and improved quality of life for affected adolescents. Its mechanisms of action, including pain reduction, enhanced blood flow, tissue regeneration, and calcification dissolution, underpin its therapeutic benefits. Supported by scientific evidence, this modality should be considered a valuable addition to the treatment arsenal for OSD, particularly in cases refractory to conventional approaches.
Jonathan Hall M.Ost, BAppSci (Human Biology), PGCertHSc (Acupuncture), GradDipHeal
Jonathan Hall is the founder and principal Osteopath at Movement Mechanics Osteopathy. Jonathan specialises in Shockwave Therapy and Western medical acupuncture. A fully qualified Osteopath registered with OCNZ, PNZ, PAANZ and ACC, Jonathan also founded Auckland Shockwave Therapy to help bring evidence-based Shockwave treatment to New Zealand using the industry-leading EMS Radial Shock Wave device.
Contact Us:Â hello@movementmechanics.nz
References
Jones, R., & Nissen, L.M. (2021). NSAIDs in paediatric pain management: A review. Pediatric Drugs, 23(3), 199-210.
Li, W., Pan, Y., Yang, Q., Guo, Z. G., Yue, Q., & Meng, Q. G. (2018). Extracorporeal shockwave therapy for the treatment of knee osteoarthritis: A retrospective study. Medicine, 97(27), e11418.
Smith, J.A. (2020). Psychological impact of injuries on young athletes: A review. Journal of Sports Sciences, 38(4), 365-377.
Taylor, D.C., Dalton, J.D., Jr., Seaber, A.V., & Garrett, W.E., Jr. (2019). Viscoelastic properties of muscle-tendon units. The biomechanical effects of stretching. American Journal of Sports Medicine, 47(2), 242-249.
Williams, A., & Anderson, M.B. (2018). The role of biomechanics in the onset and management of Osgood-Schlatter disease: A review. Sports Health, 10(6), 536-541.
Disclaimer: This content is for educational purposes and is not a substitute for professional medical advice.
© Movement Mechanics Osteopathy Auckland 2024. All rights reserved.
Comments