Does the bump below your knee cap hurt? It could be OSD

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By Calvin Sim, Senior Physiotherapist, Back2Sports

Osgood-Schlatter Disease (OSD) is most commonly characterized by pain on the big tibial tubercle during activities like kneeling or repeated jumping. OSD arises from a strong pull of the quadriceps muscle on the tibial tubercle during a child's growth spurt. This normally occurs around the ages of 9 - 16 years old. This strong pull can happen in sports that require a quick, strong contraction of the quadriceps, like in soccer, martial arts and basketball.

Tibial Tuberosity

(Image courtesy of author)

The pull on the tibial tubercle has an avulsion-fracture-like effect, as if a small bone fragment broke off from the main bone mass. This would then cause an inflammation of the periosteum. If the child is actively involved in the sport, this effect is magnified as the action is repeated. The frequency and repetitive nature of the sport doesn't allow the periosteum to recover, thus causing a chronic inflammation and the prominence of the tubercle. This leads to a constant, persistent pain, especially on impact. This pain will not only limit the child's performance in the sport, preventing them from excelling, it would also cause a lot of inconveniences later on in their growing years.

Management
OSD can be managed through the following:

  • RICER regime (Rest, Ice, Compression, Elevation, and Referral).
  • Oral NSAIDs or injection of NSAIDs directly over the painful area
  • Ultrasound guided Extracorporeal Shock Wave Therapy (ESWT) by a sports physician to break down scarred tissues and allow for the tubercle to heal
  • Stretches and improving muscle control through physiotherapy
  • Assessing for biomechanical factors that may cause OSD by sports physiotherapists to prevent recurrence of pain and to maximise the child’s performance in their sport

Prevention
The best way to prevent the onset of OSD is to ensure adequate stretching and good control of the quadriceps. Adequate prehab is therefore key before starting any form of sport.

Back2Sports – Sports Injury Management is a division of the Core Concepts Group, a leading musculo-skeletal therapy specialist group in Singapore. For more information, visit www.Back2Sports.com.sg.

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Discussion11 Comments

  1. To all of those going through this, it does get better. I had this as a kid and it does hurt. As you get older, it does get better.

  2. I was so scared i Literally thought i had cancer, or some really bad disease the could make me die i mean like i’m only 11 and i thought i was gonna die! now i feel safe because now i know its normal and that everyone is going through the same thing.

  3. Dear reader,
    will this ever go away??? because i’m pretty young and i’m worried…. if i try all those preventions will it at least decrease its pain and slightly ever go back to its original position??? and i’ve also been doing martial arts for about a good year and its been hurting…. also is this something to worry alot about because i dont want to have to tell my parents that something is wrong with my leg… so please anyone awnser my questions…. also if the stretching and ice thing does work thank you for every thing.

  4. I was ice skating once and I am only 12 its hurts when i kind of hit it i dont know what to do unless go to the doctor but my parents think its because of growing.i dont know what to do is there any way i can maybe put ice on it to help?relay back!!THANKS!!

    • im in the exact same position as you… hopefully itll go away… has the treatment actually worked for you???

  5. Here’s something similar to OSD but no one can figure out how to resolve this inflammation…

    I knealt down on my knees in the ocean over 3 years back, and my right patella tendon (at the tibial tubercle) landed squarely with most of my weight on to a sharp, flaky rock. It cut halfway through the tendon, and the ER never irrigated the wound to get the debris out. 2 surgeries later over the years and all of the debris is out, however a large, inflamed knot still exists and is painful in weight bearing situations and running. It never stops hurting.

    The doc’s have even tried doing Platelet Rich Plasma injections which work for a few days, but then the pain starts up and the inflammation never goes away. They are out of ideas…

    Anyone ever seen something like this at all? It’s a form of tendonitis, we think, but physiologically they cannot find any reason for the tendon to still be inflamed: no foreign bodies in the tendon, no infection (3 days of testing), no reason…

    If you can even make a referal on who could possibly help, it would be highly appreciated!

  6. Bernard Nagelvoort

    Thanks very much for your comments. Discussed the situation with a relateive who is an orthopedic surgeon who suggested a visit with a neurologist which I am about to do. We did discuss ice first and then possibly heat, but will find out what neurologist recommends.
    Will let you know outcome.
    Thanks again and best wishes for the season.
    Bernard Nagelvoort

  7. Dear Bernard,
    Thanks so much for your query. In my opinion, you most probably have a sensitization of the area around the tibial tubercle and not OSD. You can try using an ice cube to gently massage that region to see whether it can help decrease your pain. If it still doesn’t recover, it would be good to go and see an orthopedic specialist for some NSAIDs/pain management.

  8. Bernard Nagelvoort

    I am a 78 year old male. A part time job for a year occassions kneeling on a concrete floor. For the past several weeks I have experienced what I initially thought was a floor burn such as suffered in basketball, at the lower edge of my kneecap, but rather than a burn, the pain seems to come from under the skin and is quite an intense pain when the area is rubbed gently. While it first appeared on my right knee, a much milder similar condition is occurring on my left kneecap. I plan to see a dermatologist and perhaps an orthopedics specialist, but wonder if this website can cast any light on the problem?
    I have no other physical ailments and, in fact, run a half mile several times a week without evidence of pain and have been doing so for more than 40 years.
    Thank you for any comments.
    Bernard Nagelvoort

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