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[PATIENT ADVISER]

Coping With Osgood-Schlatter Disease

Robert C. Meisterling, MD; Eric J. Wall, MD; Michael R. Meisterling

THE PHYSICIAN AND SPORTSMEDICINE - VOL 26 - NO. 3 - MARCH 98


If your doctor has told you that your knee pain is caused by Osgood-Schlatter disease (OSD), you're not alone. OSD is common in active, rapidly growing teens. It usually goes away on its own within 12 to 24 months, but during its course, you and your doctor can work together to cope with the symptoms.

Taking a break from activity, applying heat or ice, and stretching may relieve some pain. Exercises can strengthen bone, cartilage, and tendons in your knees and make you less susceptible to flare-ups. And if your symptoms are severe enough that you've had to wear a cast or brace, strengthening exercises can help you get back in action.

What Is OSD?

OSD is an inflammation (irritation) where the tendon from the patella, or kneecap, attaches to the tibia, or shin bone (figure 1). Preteens and young teens are particularly susceptible to stresses in this area, because the bone is growing rapidly at this age. Any activity can cause OSD, but it's more common following activities that involve a lot of jumping and cutting, like basketball, volleyball, soccer, figure skating, and gymnastics.

[FIGURE 1]

A typical symptom of OSD is pain in the front of the shin about 2 to 3 inches below the kneecap. There may also be swelling in the area, especially if you've had the condition for several months. Symptoms can range from mild knee pain only during sports to constant pain that makes participation impossible.

Easing the Pain

If your pain is mild, you can probably continue to participate in your sport. Using a heating pad or warm, moist compresses at the site for 15 minutes before activity and/or using ice for 20 minutes after activity may help.

If symptoms are severe, treatment may include taking a break from sports or wearing a cast or brace. If you don't need a cast or brace, the following stretches for the quadriceps and hamstrings may relieve some of the pain and allow you to continue with your sport. Hold each stretch for 10 seconds, and repeat 10 times for each leg, 2 to 3 times per day.

If there is no improvement after 7 to 10 days of doing the stretching exercises, or if your symptoms worsen, consult your doctor.

Quadriceps stretch. To stretch the quadriceps (the muscles in front of the thigh), lie stomach down and bend one knee (figure 2). Using the hand on the same side as the bent knee, reach back and grab your ankle. Pull the foot downward until the heel is touching your buttock, if possible.

Hamstring stretch. The "hurdler's stretch" works the hamstrings (in back of your thigh, figure 3). Sit with one leg straight out in front and the other leg bent as shown, and lean forward, keeping your knee straight. Try to lean from your hips and keep your back fairly straight. You'll feel a stretch in the back of your thigh.

Building Strength After a Rest

If you've needed rest or a cast or brace for severe OSD, exercises to strengthen your leg muscles will be helpful afterward. The exercises should focus on your quadriceps.

A typical rehabilitation program starts with straight-leg raises followed by short-arc quadriceps exercises. Wall slides are also helpful. After doing strengthening exercises, it's a good idea to follow with quadriceps and hamstring stretches.

Straight-leg raises. To do straight-leg raises (figure 4), lie on the floor with your back propped up a few inches on your elbows. Bend your unaffected knee to a comfortable position. Start with an ankle weight that you can lift 10 times on the affected leg. (Note: At a sporting goods store you can buy an adjustable ankle weight that has 1/2-pound increments.) Tighten the thigh muscles and lift the leg about 12 inches, keeping it straight. Hold for 5 seconds. Slowly lower the leg and relax. Start with 10 repetitions for each leg, and increase to 15. When you can do 15 repetitions, increase the weight by 1/2 to 1 pound and drop back to 10 repetitions. Once you can do 15 repetitions again, add more weight, up to a maximum of 7 to 12 pounds.

Short-arc quadriceps exercises. To do short-arc quadriceps exercises (figure 5), lie back with your unaffected knee bent, as for straight-leg raises. Place a couple of rolled-up towels or a blanket under the affected knee to raise it about 6 inches from the floor. Tighten your thigh muscles and straighten the leg until it is about 12 inches from the floor. Hold for 5 seconds. Slowly lower the leg and relax. Start with 10 repetitions for each leg and increase to 15, using the same ankle weight and repetition progression as for straight-leg raises.

Wall slides. To do wall slides, or quarter-squats (figure 6), stand about a foot from a smooth wall and lean back against it. Your feet should be shoulder-width apart. Holding a light dumbbell in each hand with your arms straight, bend your knees and slowly lower your body 4 to 6 inches. (If you feel knee pain, you have squatted too far.) Hold for 5 seconds, then rise up quickly. Start with 10 repetitions and increase to 15, gradually increasing the dumbbell weights in the same type of progression as for straight-leg raises.

[FIGURES 2-6]

Later you can advance to a single-leg wall slide. Do this the same way as a standard wall slide, but keep the unaffected leg about an inch from the floor as you slide, squat, and straighten. Single-leg wall slides allow you to double the resistance on the affected leg. In place of wall slides, working each leg individually on a leg-press weight machine is another way to safely strengthen your quadriceps muscles.

Jumping rope. If you're an athlete, off-season and preseason jumping exercises can also help. A 6-week preseason jump-rope program, starting at 1 minute a day and progressing by 10 seconds each day to 5 minutes, will slowly strengthen the quadriceps muscles.

Remember: This information is not intended as a substitute for medical treatment. Before starting an exercise program, consult a physician.

Dr Robert Meisterling is an orthopedic surgeon in private practice at St Croix Orthopaedics in Stillwater, Minnesota. Dr Wall is director of sports medicine in the department of pediatric orthopedic surgery at the Cincinnati Children's Hospital Medical Center. Michael Meisterling is a fourth-year medical student at Creighton University in Omaha.


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