Understanding OSD and SLJ : The Impact on Young Athletes
This is the final blog in our series looking at pain and injury in young people and youth athletes! We will be breaking down Osgood–Schlatter and Sinding-Larsen-Johansson Lesions. (For the rest of this blog referred to as OS and SLJ).
Understanding OS and SLJ
Everyone has heard of Osgood-Schlatter, either you, your neighbor, cousin or friend has had it. Up to 10% of all adolescents are affected by OSD (1). But what is it actually? And what is SLJ?
OS is a common osteochondritis (covered in previous blogs) that occurs at the knee joint. Specifically this occurs at the growth plate of the tibial tuberosity. (To touch and palpate this landmark; this is the top bony part of your shin bone before you reach the patella).
SLJ presents very similarly to OS. However, SLJ affects the inferior pole of the patella. Thus, it presents slightly superior (higher) to the knee than OS.
Causes of OS and SLJ
The causes of OS and SLJ are multifaceted.
As mentioned above, OS and SLJ are types of osteochondrosis - self-limiting development of normal bone growth as covered in our previous blog. This can often result from overuse and repetitive bouts of running and jumping. The onset of OS and SLJ are strongly associated with repeated contraction of the quadriceps (repetitive knee extension). Sports involving these movements commonly are basketball, football, athletics and gymnastics (3).
OS and SLJ affects adolescents, most of whom are experiencing or have just experienced a growth spurt. This is due to this condition occurring close to or over the growth plate at the tibial tuberosity.
With the exception of overuse and growth spurt, other risk factors are inconsistent and variable. Some other risk factors involve quadricep muscle tightness, patella tendon alterations, genetics and anatomical differences (2).
Symptoms and Diagnosis
A subjective examination which typically will identify the patient as being adolescent and they will typically present with a growth spurt and a significant spike in physical activity.
Patients with OS and SLJ will also present with localised and specific tenderness on palpation over the tibial tuberosity and inferior pole of patella respectively. Swelling due to the increase in load the athlete may be undertaking may also be present.
The patient may also have increased stiffness over the quadricep and anterior hip region. They may have pain and decreased strength with resisted knee extension.
Additionally, radiographic imaging is typically not required (3).
Treatment and Rehabilitation
It is important to seek professional and collaborative medical treatment by both a Physiotherapist and a Medical Doctor. Injections and surgical intervention for OS and SLJ are typically not indicated as a first line of treatment.
Overall, the prognosis for OS and SLJ is excellent. And should resolve within a few months with the right early management (3).
A consensus recommendation for conservative management of OS and SLJ was developed in 2019 (1). It was indicated that education is vital on the importance of avoiding aggravating activities and undertaking ‘relative rest’ in the early stages. Swimming, cycling and strengthening as indicated by your Physiotherapist are acceptable.
This does not mean that an athlete needs to cease all activity, but rather follow a very closely monitored loading protocol. There is a ‘threshold’ of pain that should be respected with managing OS and SLJ to ensure graded recovery rather than zig zag recovery. The diagram below shows this.
The consensus for conservative management also recommended the use of anti-inflammatory medication and ice in the early protection stage. Rarely indicated was the use of surgical treatment (removal of ossicle fragmentation). Strongly not recommended treatment involves bracing, casting and corticosteroids(1).
Following a period of guided protection and an individualised progressive strengthening program and rehabilitation protocol should be followed and adhered to, guided by your Physiotherapist. Do not delay seeking treatment if you or your young athlete has OS or SLJ – get the management started straight away!
Do you have any questions about OS and SLJ? Do you or your child/young athlete have an injury? We have Sports & Exercise Physiotherapists ready to help ????
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References:
Neuhaus, C., Appenzeller-Herzog, C. and Faude, O. (2021) ‘A systematic review on conservative treatment options for Osgood-Schlatter Disease’, Physical Therapy in Sport, 49, pp. 178–187. doi:10.1016/j.ptsp.2021.03.002.
Lucenti, L. et al. (2022) ‘The etiology and risk factors of Osgood–Schlatter Disease: A systematic review’, Children, 9(6), p. 826. doi:10.3390/children9060826.
Brukner, Peter. & Brukner, Peter. & Khan, Karim. (2017). Brukner & Khan's clinical sports medicine