FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

READER'S PAIN CAUSED BY INJURY, NOT OSGOOD-SCHLATTER'S DISEASE

Question: I was diagnosed with Osgood-Schlatter's disease when I was 15. The doctor told me that it would be "O.K." if I stayed inactive for a while. Of course I went to school, mowed the grass, and did other things I had to do, but I stopped playing sports and doing other vigorous physical activity. I am 18 now, and I have been able to resume playing sports including practicing the martial arts. But the Osgood-Schlatter's Disease left a bump on my leg, and the other day I hit the bump very solidly. It has been unbelievably painful for the last three days. Is there a cure or a surgery for Osgood-Schlatter's disease? Will I be able to play sports after any surgery?

As your personal story illustrates, adolescent athletes are prone to develop Osgood-Schlatter's disease. It affects male and female athletes about equally, and 20 to 30 percent of afflicted individuals develop it in both knees.

Before looking at the specifics of your situation, I think a little background information would enhance your understanding of this disorder. I'm sure that you remember from high school health class that muscles only pull - they do not push. Therefore, the knee is straightened by the powerful pull from muscles on the top of the leg. There are actually four of these that are collectively called the quadriceps femoris muscles, or "quads" for short. The tendons of these muscles join together and attach into the upper surface of the kneecap (patella). Another tendon extends from the lower portion of the kneecap and attaches to the lower leg bone called the tibia. This complex arrangement allows the muscles to repeatedly straighten out the knee joint without wearing out the knee or tendons associated with it.

Osgood-Schlatter's disease is the direct result of repeated small injuries (micro-trauma) to the place where the tendon from the kneecap attaches to the lower leg bone. In an active young person this spot (the tibial tuberosity) is subjected to a great deal of micro-trauma from many forceful extensions of the leg. The growing bone reacts to the trauma by increasing in size. This produces a swollen and tender "bump" at the tibial tuberosity. The area is made more painful by running, going down stairs, or by any direct pressure on it.

Treatment usually only requires reducing the stress on the area-no sports, no bicycles, no running. This sounds like what you did. Occasionally, individuals with a very sore knee (or knees) may need to wear a knee brace for a few weeks to start the healing process. Physical therapy to stretch and tone the leg muscles is started after the acute pain has subsided. Most are back to full activities, including sports, in six months.

Some individuals have persistent pain despite rest and physical therapy. In these situations surgery can be of some benefit, but it can't be done until the individual -- and his or her leg bone -- has stopped growing. Having an enlarged tibial tubercle that forms a conspicuous bump when the knee is bent is not a reason for surgery. This bump is the consequence of the tibia responding to the repeated micro-trauma. By adulthood it becomes solid bone and will be there forever.

Your recent episode of pain may be due to bruising that new "extra bump" of bone caused by the Osgood-Schlatter's disease. You could also have damaged one of the tendons, bursae or even put a crack in the bone. Your current pain is not directly due to Osgood-Schlatter's disease. You need to see your doctor.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.